Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing 100191, China.
Department of Statistics and Actuarial Science, The University of Hong Kong, Hong Kong 999077, China.
Nutrients. 2022 May 28;14(11):2273. doi: 10.3390/nu14112273.
Background: Observational studies have shown that modifiable risk factors are associated with aortic valve stenosis (AVS). However, the causality behind these associations remains largely unknown. Objectives: To explore the associations of modifiable risk factors, including metabolic factors, biochemical measures, education, and lifestyles with AVS and their potential causal associations. Methods: We enrolled 361,930 British white people with genetic data in the UK biobank. Cox proportional risk regression models were used to estimate the hazard ratios between 28 modifiable risk factors and AVS. We used genetic instruments for modifiable risk factors to determine the potential causal relationships using a one-sample Mendelian randomization (MR) approach. Results: A total of 1602 participants developed AVS during an 8.4-year follow-up. Observational analyses showed higher adiposity, blood pressure, heart rate, low-density lipoprotein, urate, C-reactive protein, creatinine, albumin, and glycated hemoglobin, but lower serum vitamin D, and education, unhealthy lifestyle, and poor sleep quality were related to a higher risk of AVS after adjusting for the Bonferroni correction (p < 0.0013). Genetically predicted 1-SD higher levels of body mass index [HR: 1.09, 95% CI: 1.03 to 1.16], body fat percentage (1.17, 1.03 to 1.33), triglyceride (TG) [1.08, 1.00 to 1.16], low-density lipoprotein (LDL) (1.15, 1.08 to 1.21) and serum total cholesterol (TC) (1.13, 1.02 to 1.25) were associated with a higher risk of AVS, respectively. Genetically determined per category higher insomnia (1.32, 1.13 to 1.55) was also associated with AVS. The abovementioned genetic associations with the incident AVS showed an increasing relationship pattern. Conclusions: This study provides strong evidence for the potential causal roles of cardiometabolic factors in developing AVS, highlighting that an idea of metabolic status through a healthy lifestyle may help prevent AVS.
背景:观察性研究表明,可改变的风险因素与主动脉瓣狭窄(AVS)有关。然而,这些关联背后的因果关系在很大程度上仍然未知。目的:探讨可改变的风险因素,包括代谢因素、生化指标、教育程度和生活方式与 AVS 的关联及其潜在的因果关联。方法:我们纳入了英国生物库中具有遗传数据的 361930 名英国白人。使用 Cox 比例风险回归模型估计 28 种可改变的风险因素与 AVS 之间的风险比。我们使用可改变的风险因素的遗传工具,通过单样本 Mendelian 随机化(MR)方法来确定潜在的因果关系。结果:在 8.4 年的随访中,共有 1602 名参与者发生了 AVS。观察性分析表明,较高的肥胖、血压、心率、低密度脂蛋白、尿酸、C 反应蛋白、肌酐、白蛋白和糖化血红蛋白水平,以及较低的血清维生素 D 水平、教育程度、不健康的生活方式和较差的睡眠质量与 AVS 的风险增加相关,调整 Bonferroni 校正后(p<0.0013)。遗传预测的 1-SD 更高水平的体重指数 [HR:1.09,95%CI:1.03 至 1.16]、体脂肪百分比(1.17,1.03 至 1.33)、甘油三酯(TG)[1.08,1.00 至 1.16]、低密度脂蛋白(LDL)(1.15,1.08 至 1.21)和血清总胆固醇(TC)(1.13,1.02 至 1.25)分别与 AVS 风险增加相关。遗传上确定的每类更高的失眠症(1.32,1.13 至 1.55)也与 AVS 相关。上述与新发 AVS 的遗传关联呈现出递增关系模式。结论:本研究提供了强有力的证据,证明代谢因素在发展 AVS 中的潜在因果作用,强调通过健康的生活方式来改善代谢状态的理念可能有助于预防 AVS。
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