Spring Bonnie, Moller Arlen C, Colangelo Laura A, Siddique Juned, Roehrig Megan, Daviglus Martha L, Polak Joseph F, Reis Jared P, Sidney Stephen, Liu Kiang
From the Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL (B.S., A.C.M., L.A.C., J.S., M.R., M.L.D., K.L.); Department of Radiology, Tufts University School of Medicine, Boston, MA (J.F.P.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.P.R.); and Division of Research, Kaiser Permanente Northern California, Oakland, CA (S.S.).
Circulation. 2014 Jul 1;130(1):10-7. doi: 10.1161/CIRCULATIONAHA.113.005445. Epub 2014 Apr 28.
The benefits of healthy habits are well established, but it is unclear whether making health behavior changes as an adult can still alter coronary artery disease risk.
The Coronary Artery Risk Development in Young Adults (CARDIA) prospective cohort study (n=3538) assessed 5 healthy lifestyle factors (HLFs) among young adults aged 18 to 30 years (year 0 baseline) and 20 years later (year 20): not overweight/obese, low alcohol intake, healthy diet, physically active, nonsmoker. We tested whether change from year 0 to 20 in a continuous composite HLF score (HLF change; range, -5 to +5) is associated with subclinical atherosclerosis (coronary artery calcification and carotid intima-media thickness) at year 20, after adjustment for demographics, medications, and baseline HLFs. By year 20, 25.3% of the sample improved (HLF change ≥+1); 40.4% deteriorated (had fewer HLFs); 34.4% stayed the same; and 19.2% had coronary artery calcification (>0). Each increase in HLFs was associated with reduced odds of detectable coronary artery calcification (odds ratio=0.85; 95% confidence interval, 0.74-0.98) and lower intima-media thickness (carotid bulb β=-0.024, P=0.001), and each decrease in HLFs was predictive to a similar degree of greater odds of coronary artery calcification (odds ratio=1.17; 95% confidence interval, 1.02-1.33) and greater intima-media thickness (β=+0.020, P<0.01).
Healthy lifestyle changes during young adulthood are associated with decreased risk and unhealthy lifestyle changes are associated with increased risk for subclinical atherosclerosis in middle age.
健康习惯的益处已得到充分证实，但尚不清楚成年后改变健康行为是否仍能改变冠状动脉疾病风险。
青年成人冠状动脉风险发展（CARDIA）前瞻性队列研究（n = 3538）在18至30岁的青年成人（第0年基线）及20年后（第20年）评估了5种健康生活方式因素（HLF）：体重正常/非肥胖、低酒精摄入量、健康饮食、身体活跃、不吸烟。我们测试了从第0年到第20年连续综合HLF评分的变化（HLF变化；范围为-5至+5）在调整人口统计学、药物治疗和基线HLF后，是否与第20年的亚临床动脉粥样硬化（冠状动脉钙化和颈动脉内膜中层厚度）相关。到第20年时，25.3%的样本情况有所改善（HLF变化≥ +1）；40.4%的样本情况恶化（HLF减少）；34.4%的样本保持不变；19.2%的样本有冠状动脉钙化（>0）。HLF每增加一项，可检测到的冠状动脉钙化几率降低（优势比 = 0.85；95%置信区间，0.74 - 0.98），内膜中层厚度降低（颈动脉窦β = -0.024，P = 0.001），HLF每减少一项，冠状动脉钙化几率增加的程度相似（优势比 = 1.17；95%置信区间，1.02 - 1.33），内膜中层厚度增加（β = +0.020，P < 0.01）。
青年期健康生活方式的改变与中年亚临床动脉粥样硬化风险降低相关，不健康生活方式的改变与风险增加相关。
