Neves, Vinicius Vieira

ABSTRACT Aims Religiosity and spirituality (R/S) are generally associated with a more favourable cardiovascular risk profile, but longitudinal evidence is limited. We examined whether multidimensional R/S predicts its future behavioural and biological components. Methods This prospective cohort study analysed 6,844 adults aged ≥50 (56% women; mean R/S score 2.1; 20% weekly attenders; 81% Christian) from waves 4–7 of the English Longitudinal Study of Ageing (ELSA). Behavioural outcomes included smoking, exercise, alcohol intake, and fruit and vegetable consumption; biological outcomes included blood pressure (BP), haemoglobin A1c (HbA1c), and the inflammatory risk markers C-reactive protein (CRP) and fibrinogen. R/S was assessed with four items from the Santa Clara Strength of Religious Faith Questionnaire. Hierarchical linear and logistic regressions adjusted for age, sex, wealth, education and ethnicity; biomarker models also adjusted for health behaviours and body mass index. Results Greater spirituality ( B =−0.019; 95%CI[−0.036,−0.003]), daily prayer/meditation ( B =−0.017; 95%CI[−0.032,−0.002]), participation in organized religion ( B =−0.017; 95%CI[−0.032,−0.002]), and importance of religious faith ( B =−0.017; 95%CI[−0.033,−0.002]) were independently associated with lower fibrinogen levels. Daily prayer/meditation also independently predicted higher fruit and vegetable intake ( B =0.004; 95%CI[0.000,0.008]). However, frequent attendance (OR=0.846; 95%CI[0.730,0.982]), the significance of faith (OR=0.935; 95%CI[0.879,0.994]), and religious purpose (OR=0.939; 95%CI[0.884,0.997]) independently reduced the odds of meeting exercise recommendations. Similarly, frequent attendance was associated with higher HbA1c ( B =0.002; 95%CI[0.000,0.005]). There were no independent associations with CRP or blood pressure. Conclusion R/S showed mixed prospective associations with the cardiovascular risk profile: favourable for fibrinogen and fruit and vegetable intake, unfavourable for physical activity and HbA1c. LAY SUMMARY We examined whether religious and spiritual involvement was related to later heart-related health behaviours and blood measurements in more than 6,800 English adults aged 50 and over. The associations ran in both directions, and the study cannot show that religion or spirituality causes these changes. Stronger religious and spiritual involvement was associated with lower fibrinogen, a blood protein linked to clotting. Daily prayer or meditation was associated with eating more fruit and vegetables. Regular attendance at religious services was associated with less physical activity and higher blood sugar. GRAPHICAL ABSTRACT

Background: Mindfulness-based interventions may improve cardiovascular health (CVH) by supporting behavioral change across multiple risk factors. This study evaluated the impact of Mindfulness-Based Blood Pressure Reduction (MB-BP), a mindfulness program targeting hypertension-related behaviors ( Image 1 ), on CVH using the American Heart Association’s Life’s Essential 8 framework. Methods: This secondary analysis of parallel-group, phase 2 randomized clinical trial evaluated the effects of MB-BP on CVH in 201 participants with elevated office BP (≥120/80 mmHg). The MB-BP group (n=101) received an 8-week program focused on mindfulness training and education targeting diet, physical activity, medication adherence, alcohol use, and stress, whereas the control group (n=100) received enhanced usual care ( Image 2 ). CVH was assessed using available Life’s Essential 8 components: systolic blood pressure, body mass index (BMI), diet (DASH adherence), physical activity, smoking, and sleep duration. Generalized estimating equations evaluated intervention effects through six months. Results: At six months follow-up, MB-BP participants significantly improved composite CVH scores compared to controls (standardized mean difference: 0.144; 95% CI: 0.023, 0.266) ( Image 3 ). MB-BP influenced most CVH components in healthier directions at trend levels, with the strongest responses for physical activity (47.9 MET min/week; 95% CI: -16.5, 112.3), sleep (0.34 hours/night; 95% CI: -0.10, 0.78), systolic blood pressure (-4.95 mmHg; 95% CI: -10.34, 0.44) and DASH diet score (0.27, 95% CI: -0.15, 0.69). Conclusions: MB-BP led to modest but clinically significant improvements in CVH, driven by multiple Life’s Essential 8 components. These findings suggest that MB-BP may be an effective behavioral intervention to support CVH and reduce risk for cardiovascular disease. ClinicalTrials.gov Preregistration Identifiers: NCT03256890, NCT03859076