Hadaegh Farzad, Hosseinpour-Niazi Somayeh, Deravi Niloofar, Hasheminia Mitra, Moslehi Nazanin, Toreyhi Hossein, Azizi Fereidoun
Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Front Cardiovasc Med. 2022 Aug 4;9:898681. doi: 10.3389/fcvm.2022.898681. eCollection 2022.
To quantify the association between ideal cardiovascular health (CVH) metrics and incident cardiovascular disease (CVD) including different subtypes [coronary heart disease (CHD), stroke, and sudden death], and all-cause mortality in an Iranian population.
The study population included 6,388 participants (2,726 men) aged 48.0 ± 12.4 years free of CVD at baseline. We utilized the American Heart Association's 2020 impact target criteria of ideal, intermediate, and poor CVH. The multivariate Cox proportional Hazard model, adjusted for age, sex, educational level, marital status, and family history of CVD, was applied to estimate the hazard ratio (HR) of outcomes per one additional metric of ideal CVH metrics. Furthermore, the risk was also calculated for ideal and intermediate categories considering poor category as a reference.
During the median follow-up of 11.26 years, 692 CVD, 589 CHD, 130 stroke, 111 sudden death, and 519 all-cause mortality events were reported. All of the individual ideal CVH metrics were independent predictors except intermediate physical activity level for CVD, BMI < 25 kg/m, and intermediate physical activity for all-cause mortality. Each additional metrics of ideal CVH decreased the risk by 31 (0.69, 0.65-0.73) for CVD, 32 (0.68, 0.64-0.73) for CHD, 31 (0.69, 0.60-0.80) for stroke, 25 (0.75, 0.64-0.88) for sudden death, and 13% (0.87, 0.81-0.93) for all-cause mortality events. Moreover, intermediate and ideal categories of CVH metrics were associated with lower risk for different CVD outcomes, i.e., 44 (0.56, 0.48-0.65) and 76% (0.24, 0.17-0.35) for CVD; 43 (0.57, 0.47-0.67) and 75% (0.25, 0.16-0.37) for CHD, 58 (0.42, 0.29-0.61) and 86% (0.14, 0.04-0.44) for stroke; 56 (0.44, 0.29-0.66) and 55% (0.45, 0.21-0.99) for sudden death; and 25 (0.75, 0.62-0.90) and 46% (0.54, 0.37-0.80) for all-cause mortality events, respectively. We also assessed the impact of changes in ideal CVH status from phase III to phase IV (2008-2011) on CVD events among 5,666 participants. Accordingly, compared to those remaining in the poor category, all of the changes in ideal CVH categories showed a lower risk for CVD events.
Among the Iranian population, meeting higher ideal CVH metrics is associated with a lower risk of different CVD events and mortality outcomes.
量化理想心血管健康（CVH）指标与心血管疾病（CVD）发病之间的关联，包括不同亚型[冠心病（CHD）、中风和猝死]，以及伊朗人群的全因死亡率。
研究人群包括6388名参与者（2726名男性），基线时年龄为48.0±12.4岁，无CVD。我们采用了美国心脏协会2020年理想、中等和不良CVH的影响目标标准。应用多变量Cox比例风险模型，对年龄、性别、教育水平、婚姻状况和CVD家族史进行调整，以估计每增加一项理想CVH指标时结局的风险比（HR）。此外，以不良类别为参照，还计算了理想和中等类别的风险。
在11.26年的中位随访期间，报告了692例CVD、589例CHD、130例中风、111例猝死和519例全因死亡事件。除了中等身体活动水平对CVD、BMI<25kg/m以及中等身体活动对全因死亡率外，所有个体理想CVH指标均为独立预测因素。理想CVH每增加一项指标，CVD风险降低31%（0.69，0.65 - 0.73），CHD风险降低32%（0.68，0.64 - 0.73），中风风险降低31%（0.69，0.60 - 0.80），猝死风险降低25%（0.75，0.64 - 0.88），全因死亡事件风险降低13%（0.87，0.81 - 0.93）。此外，CVH指标的中等和理想类别与不同CVD结局的较低风险相关，即CVD分别为44%（0.56，0.48 - 0.65）和76%（0.24，0.17 - 0.35）；CHD分别为43%（0.57，0.47 - 0.67）和75%（0.25，0.16 - 0.37）；中风分别为58%（0.42，0.29 - 0.61）和86%（0.14，0.04 - 0.44）；猝死分别为56%（0.44，0.29 - 0.66）和55%（0.45，0.21 - 0.99）；全因死亡事件分别为25%（0.75，0.62 - 0.90）和46%（0.54，0.37 - 0.80）。我们还评估了5666名参与者中从第三阶段到第四阶段（2008 - 2011年）理想CVH状态变化对CVD事件的影响。因此，与仍处于不良类别的参与者相比，理想CVH类别中的所有变化均显示CVD事件风险较低。
在伊朗人群中，达到更高的理想CVH指标与不同CVD事件和死亡结局的较低风险相关。
