INSERM, U970, Paris Cardiovascular Research Center, University Paris Descartes, Sorbonne Paris Cité, Paris, France
INSERM, U970, Paris Cardiovascular Research Center, University Paris Descartes, Sorbonne Paris Cité, Paris, France.
J Am Heart Assoc. 2017 Oct 17;6(10):e006389. doi: 10.1161/JAHA.117.006389.
The aim of this study was to investigate whether the association between baseline cardiovascular health (CVH) and incident cardiovascular disease differs according to coronary heart disease (CHD) and stroke subtypes, and to assess the mediating effect of inflammatory and hemostatic blood biomarkers.
The association of ideal CVH with outcomes was derived in 9312 middle-aged men from Northern Ireland and France (whole cohort) in multivariable Cox proportional hazards regression analysis. The mediating effect of baseline inflammatory and hemostatic blood biomarkers was evaluated in a case-control study nested within the cohort after 10 years of follow-up. After a median follow-up of 10 years, 614 first CHD events and 117 first stroke events were adjudicated. Compared with those with poor CVH, those with an ideal CVH profile at baseline had a 72% lower risk of CHD (hazard ratio=0.28; 95% confidence interval, 0.17; 0.46) and a 76% lower risk of stroke (hazard ratio =0.24; 95% confidence interval, 0.06; 0.98). The magnitude of the risk reductions was similar for incident angina and myocardial infarction, but was lower for ischemic stroke. In the controls, the mean concentrations of high-sensitivity C-reactive protein, IL-6, and fibrinogen decreased with higher CVH status. Furthermore, the association of behavioral CVH with incident CHD was partly mediated by high-sensitivity C-reactive protein (16.69%), IL-6 (8.52%), and fibrinogen (7.30%) CONCLUSIONS: Our study shows no clear heterogeneity in the association of baseline CVH with the main subtypes of cardiovascular disease. This supports a universal promotion of ideal CVH for all cardiovascular disease subtypes. Furthermore, our mediation analysis suggests that the lower risk of CHD associated with ideal CVH is partly mediated by lower inflammatory and hemostatic blood biomarkers.
本研究旨在探讨基线心血管健康（CVH）与心血管疾病事件的相关性是否因冠心病（CHD）和中风亚型而异，并评估炎症和止血血液生物标志物的中介作用。
在北爱尔兰和法国的 9312 名中年男性中，通过多变量 Cox 比例风险回归分析得出理想 CVH 与结局的相关性。在 10 年随访后，在队列中嵌套的病例对照研究中评估了基线炎症和止血血液生物标志物的中介作用。中位随访 10 年后，确定了 614 例首次 CHD 事件和 117 例首次中风事件。与 CVH 较差者相比，基线时具有理想 CVH 特征者 CHD 的风险降低 72%（风险比=0.28；95%置信区间，0.17；0.46），中风风险降低 76%（风险比=0.24；95%置信区间，0.06；0.98）。心绞痛和心肌梗死的风险降低幅度相似，但缺血性中风的风险降低幅度较低。在对照组中，高敏 C 反应蛋白、IL-6 和纤维蛋白原的平均浓度随 CVH 状态的升高而降低。此外，行为 CVH 与 CHD 事件的关联部分通过高敏 C 反应蛋白（16.69%）、IL-6（8.52%）和纤维蛋白原（7.30%）介导。
本研究表明，基线 CVH 与主要心血管疾病亚型之间的相关性没有明显异质性。这支持普遍促进所有心血管疾病亚型的理想 CVH。此外，我们的中介分析表明，理想 CVH 与 CHD 风险降低相关的部分原因是炎症和止血血液生物标志物降低。
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