Dr. Shahar Madjar, Journal columnist

Can small changes in daily habits prevent cardiovascular events such as heart attacks, heart failure, and strokes?

A recent study by Nicholas A. Koemel and colleagues, published in European Journal of Preventive Cardiology in March 2026, attempts to answer the question. The researchers examined how three everyday behaviors–sleep, physical activity, and nutrition (SPAN)–affect cardiovascular health. Rather than studying each one separately, the investigators asked a simple question: what happens when we look at these behaviors together?

The study followed 53,242 adults from the UK Biobank, with a median age of 63 years and about 57% men. Participants were observed over a median of eight years, during which researchers recorded major cardiovascular events. These included heart attacks, strokes, and heart failure–collectively referred to as major adverse cardiovascular events (MACE). Over the follow-up period, 2,034 such events occurred, including 932 heart attacks, 584 strokes, and 518 cases of heart failure.

To measure lifestyle behaviors, the study used a mix of objective and self-reported tools. Sleep duration (in hours per day) and physical activity (minutes per day of moderate to vigorous activity) were measured using wrist-worn accelerometers (similar in concept to Fitbit or Apple Watch). Diet, by contrast, was assessed using a 10-item diet quality score (DQS) based on questionnaire responses.

Participants were grouped into different categories based on their levels of sleep, activity, and diet. The researchers created 27 combinations by dividing each behavior into three levels (low, medium, high). They also developed a composite SPAN score ranging from 0 to 100 to reflect overall lifestyle patterns.

The main finding is that better combined lifestyle behaviors were associated with lower cardiovascular risk. Individuals in the most favorable category–those sleeping 8.0 to 9.4 hours per day, engaging in 42 to 104 minutes of moderate-to-vigorous physical activity daily, and having higher diet quality scores–had a 57% lower risk of major cardiovascular events compared to those in the lowest category. This result is expressed as a hazard ratio of 0.43, meaning the risk was less than half that of the reference group.

Even moderate improvements were associated with substantial differences. A median SPAN score (52.8)–representing a middle level of combined behaviors–was linked to a 41% lower risk of MACE. When looking at specific outcomes, this same score corresponded to a 47% lower risk of heart failure, a 35% lower risk of heart attack, and a 48% lower risk of stroke.

Do these goals seem unachievable to you? Fear not. The study also examined smaller, more incremental differences. A combined change consisting of 11 additional minutes of sleep per day, 4.5 additional minutes of physical activity, and a modest improvement in diet (about 3 points on the diet score, roughly equivalent to a quarter cup of vegetables per day) was associated with a 10% lower risk of cardiovascular events. This finding highlights that even relatively small differences in behavior, when considered together, are associated with measurable differences in risk.

The researchers found that each behavior–sleep, exercise, and diet–helps on its own, and when combined, their benefits simply add together rather than amplify each other. In other words, the effect wasn’t synergistic, only additive.

While the study reports clear associations between behaviors and health outcomes, it is important to remember that this is an observational study, not an experiment. Participants were not assigned to different lifestyle patterns; instead, their natural behaviors were recorded and analyzed. As a result, the study can identify associations but cannot prove that these behaviors directly cause the observed differences in cardiovascular risk.

There are additional limitations to consider. Sleep and physical activity were measured objectively using wearable devices, whereas diet was assessed through self-reported questionnaires, which tend to be less precise. People may misreport or inaccurately recall what they eat, introducing measurement error.

The study population consisted of volunteers from the UK Biobank, who tend to be healthier and more health-conscious than the general population. This may limit how broadly the findings apply to other groups.

Taken together, the study shows that combinations of sleep, physical activity, and diet are associated with cardiovascular outcomes in a graded and measurable way. Higher combined levels of these behaviors are linked to lower rates of heart attack, stroke, and heart failure over time. Smaller differences across all three behaviors are also associated with meaningful differences in risk.

Should you eat better, exercise more, and try to get a better night’s sleep? While the study does not prove that such changes would lead to better health, it definitely points to the association between good habits and better health outcomes.

EDITOR’S NOTE: Shahar Madjar, MD, MBA, is a urologist and an author. He practices at Schoolcraft Memorial Hospital in Manistique, and in Baraga County Memorial Hospital in L’Anse. Find his books on Amazon or contact him at smadjar@yahoo.com.