Xu Chenjie, Zhang Pengjie, Cao Zhi
School of Public Health, Hangzhou Normal University, Hangzhou, China.
School of Public Health, Fudan University, Shanghai, China.
EClinicalMedicine. 2022 Mar 6;45:101329. doi: 10.1016/j.eclinm.2022.101329. eCollection 2022 Mar.
Existing evidence suggest an association of cardiovascular health (CVH) level with cardiometabolic disease (CMD) and mortality, but the effect of CVH on life expectancy, particularly survival years in CMD patients, has not been well-established. This study aimed to investigate the association of CVH defined using the 7-item tool from the American Heart Association (AHA) with life expectancy in people with and without CMD.
Between 2006 and 2010, a total of 341,331 participants (age 37-73 years) in the UK Biobank were examined and thereafter followed up to 2020. The CVH raised by the AHA included 4 behavioral (smoking, diet, physical activity, body mass index) and 3 biological (fasting glucose, blood cholesterol, blood pressure) metrics, coded on a three-point scale (0, 1, 2). The CVH score was the sum of 7 metrics (score range 0-14) and was then categorized into poor (scores 0-6), intermediate (7-11), and ideal (12-14) CVH. The flexible parametric survival models were applied to estimate life expectancy.
During a median follow-up of 11.4 years, 18,420 (5.4%) deaths occurred. The multivariable-adjusted hazard ratio (HRs) of all-cause mortality were 2.21 (95% CI: 1.77 to 2.75) for male and 2.63 (95% CI: 2.22 to 3.12) for female with prevalent CMD and a poor CVH compared with CMD-free and ideal CVH group, an ideal CVH attenuated the CMD-related risk of mortality by approximately 62% for male and 53% for female. In CMD patients, an ideal CVH compared to poor CVH was associated with additional life years gain of 5.50 (95% CI: 3.94-7.05) for male 4.20 (95% CI: 2.77-5.62) for female at the age of 45 years. Corresponding estimates in those without CMD were 4.55 (95% CI: 3.62-5.48) and 4.89 (95% CI: 3.99-5.79), respectively. Ideal smoking status, fasting glucose and physical activity for male and ideal smoking status, cholesterol level and physical activity for female contributed to the greatest survival benefit.
An ideal CVH is associated with a lower risk of premature mortality and longer life expectancy whether in general population or CMD patients. Our study highlights the benefits of maintaining better CVH across the life course and calls attention to the need for comprehensive strategies (healthy behavioral lifestyle and biological phenotypes) to preserve and restore a higher CVH level.
Scientific Research Foundation for Scholars of HZNU (Grant No. 4265C50221204119).
现有证据表明心血管健康（CVH）水平与心脏代谢疾病（CMD）及死亡率相关，但CVH对预期寿命的影响，尤其是对CMD患者生存年限的影响，尚未得到充分证实。本研究旨在探讨使用美国心脏协会（AHA）的7项工具定义的CVH与有无CMD人群预期寿命之间的关联。
2006年至2010年期间，对英国生物银行中的341331名参与者（年龄37 - 73岁）进行了检查，并随访至2020年。AHA提出的CVH包括4项行为指标（吸烟、饮食、身体活动、体重指数）和3项生物学指标（空腹血糖、血胆固醇、血压），按三分制编码（0、1、2）。CVH得分是7项指标的总和（得分范围0 - 14），然后分为差（得分0 - 6）、中等（7 - 11）和理想（12 - 14）的CVH。应用灵活的参数生存模型来估计预期寿命。
在中位随访11.4年期间，发生了18420例（5.4%）死亡。与无CMD且CVH理想的组相比，患有CMD且CVH差的男性全因死亡率的多变量调整风险比（HR）为2.21（95%CI：1.77至2.75），女性为2.63（95%CI：2.22至3.12），理想的CVH使男性与CMD相关的死亡风险降低约62%，女性降低约53%。在CMD患者中，45岁时，与CVH差相比，理想的CVH使男性额外获得5.50年（95%CI：3.94 - 7.05）的生存年限，女性额外获得4.20年（95%CI：2.77 - 5.62）的生存年限。在无CMD的人群中，相应的估计值分别为4.55年（95%CI：3.62 - 5.48）和4.89年（95%CI：3.99 - 5.79）。男性理想的吸烟状况、空腹血糖和身体活动，以及女性理想的吸烟状况、胆固醇水平和身体活动对生存益处贡献最大。
无论是在一般人群还是CMD患者中，理想的CVH都与较低的过早死亡风险和更长的预期寿命相关。我们的研究强调了在生命历程中保持更好的CVH的益处，并呼吁关注采取综合策略（健康的行为生活方式和生物学表型）来维持和恢复更高的CVH水平。
杭州师范大学学者科研基金（批准号4265C50221204119）。
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