亚临床动脉粥样硬化成年人的死亡和心血管疾病预防中的健康因素。
Factors of health in the protection against death and cardiovascular disease among adults with subclinical atherosclerosis.
机构信息
Department of Medicine, University of Kansas School of Medicine, Wichita, KS; Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD.
Departments of Preventive Medicine and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
出版信息
Am Heart J. 2018 Apr;198:180-188. doi: 10.1016/j.ahj.2017.10.026. Epub 2017 Nov 11.
BACKGROUND
Although cardiovascular disease (CVD) prevention traditionally emphasizes risk factor control, recent evidence also supports the promotion of "health factors" associated with cardiovascular wellness. However, whether such health factors exist among adults with advanced subclinical atherosclerosis is unknown. We aimed to study the association between health factors and events among persons with elevated coronary artery calcium (CAC).
METHODS
Self-reported health-factors studied included nonsmoking, physical activity, Mediterranean-style diet, sleep quality, emotional support, low stress burden, and absence of depression. Measured health-factors included optimal weight, blood pressure, lipids, and glucose. Multivariable-adjusted Cox models examined the association between health factors and incident CVD or mortality, independent of risk factor treatment. Accelerated failure time models assessed whether health factors were associated with relative time delays in disease onset.
RESULTS
Among 1,601 Multi-Ethnic Study of Atherosclerosis participants with CAC >100 without baseline clinical atherosclerotic CVD, mean age was 69 (±9) years, 64% were male, and median CAC score was 332 Agatston units. Over 12 years of follow-up, nonsmoking, high-density lipoprotein cholesterol levels >40 mg/dL for men and >50 mg/dL for women, and low stress burden were inversely associated with ASCVD (hazard ratios ranging from 0.58 to 0.71, all P<.05). Nonsmoking, glucose levels <100 mg/dL, regular physical activity, and low stress burden were inversely associated with mortality (hazard ratios ranging from 0.40 to 0.77, all P<.05). Each of these factors was also associated with delays in onset of clinical disease, as was absence of depression.
CONCLUSIONS
Adults with elevated CAC appear to have healthy lifestyle options to lower risk and delay onset of CVD, over and above standard preventive therapies.
背景
尽管心血管疾病（CVD）预防传统上强调危险因素控制，但最近的证据也支持促进与心血管健康相关的“健康因素”。然而，在患有进展性亚临床动脉粥样硬化的成年人中是否存在这些健康因素尚不清楚。我们旨在研究健康因素与冠状动脉钙（CAC）升高者的事件之间的关联。
方法
研究中包括的自我报告的健康因素包括不吸烟、身体活动、地中海式饮食、睡眠质量、情感支持、低压力负担和没有抑郁。测量的健康因素包括理想体重、血压、血脂和血糖。多变量调整的 Cox 模型检查了健康因素与 CVD 或死亡率事件之间的关联，独立于危险因素治疗。加速失效时间模型评估了健康因素是否与疾病发病的相对时间延迟有关。
结果
在 1601 名 CAC >100 且无基线临床动脉粥样硬化性 CVD 的多民族动脉粥样硬化研究参与者中，平均年龄为 69（±9）岁，64%为男性，中位 CAC 评分 332 个 Agatston 单位。在 12 年的随访中，不吸烟、男性高密度脂蛋白胆固醇水平>40mg/dL 和女性>50mg/dL 以及低压力负担与 ASCVD 呈负相关（危险比范围为 0.58 至 0.71，均 P<.05）。不吸烟、血糖水平<100mg/dL、有规律的身体活动和低压力负担与死亡率呈负相关（危险比范围为 0.40 至 0.77，均 P<.05）。这些因素中的每一个都与临床疾病发病的延迟有关，而没有抑郁也是如此。
结论
在 CAC 升高的成年人中，似乎有健康的生活方式选择可以降低 CVD 的风险并延迟发病，超过了标准的预防治疗。
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