Is adherence to the 24-hour movement guidelines related to a lower risk of cardiovascular events? A prospective cohort study including 13 897 participants from the SUN project

Cardiovascular disease (CVD) remains the leading global cause of death, and preventive interventions are likely to be the most effective strategies. The 24-hour movement guidelines emphasize an integrated score, including physical activity (PA), sedentary time, and sleep. The combined effect of adhering to all three 24-hour movement guidelines on CVD events remains unclear. In a prospective assessment of 13 897 Spanish university graduates from the Seguimiento Universidad de Navarra cohort, the relationship between a comprehensive exposure (adherence to all three 24-hour movement guidelines) and CVD incidence was investigated. Participants completed baseline questionnaires from 1999, with biennial follow-up. Exposure was assessed using the Canadian 24-Hour Movement Guidelines: ≥ 150 minutes/week of moderate-to-vigorous PA, ≤ 8 hours/day sitting, and 7-9 hours/night sleep (or 7-8 hours for ≥ 65 years). A composite score (0-3 points) was calculated for the exposure. The primary endpoint was incident CVD (nonfatal myocardial infarction, stroke, cardiovascular death). Nearly half (46.68%) of participants met all three guidelines, while only 0.96% met none. Over a mean follow-up of 14.48 years, 148 cardiovascular event (CVE) occurred. Fully adjusted models revealed a significantly reduced CVE risk for participants meeting two [hazard ratio (HR) = 0.37; 95% confidence interval (CI): 0.14-0.99], or three (HR = 0.36; 95% CI: 0.14-0.95) guidelines compared to meeting none. Adherence to at least two of the 24-hour movement guidelines appears to be associated with a lower risk of CVEs. These findings suggest that a comprehensive approach to daily movement behaviors may play a beneficial role in CVD prevention. Public health strategies could consider promoting these integrated guidelines as part of broader efforts to improve cardiovascular health.