心血管健康轨迹与随后的心血管疾病及死亡率：动脉粥样硬化多族裔研究（MESA）
Cardiovascular health trajectories and subsequent cardiovascular disease and mortality: The multi-ethnic study of atherosclerosis (MESA).
作者信息
Sheng Qicong, Ding Jie, Gao Yumin, Patel Reshmi Js, Post Wendy S, Martin Seth S
机构信息
Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
出版信息
Am J Prev Cardiol. 2022 Dec 9;13:100448. doi: 10.1016/j.ajpc.2022.100448. eCollection 2023 Mar.
OBJECTIVE
Longitudinal trajectories of cardiovascular health (CVH) may reflect vascular risk burden due to prolonged cumulative exposure to non-ideal CVH levels. Identifying individuals who have a higher risk CVH trajectory may facilitate treatment, screening, and prevention. We aimed to characterize 10-year trajectories of CVH and examine the associations between CVH trajectories and subsequent cardiovascular disease (CVD) and mortality.
METHODS
We analyzed 3674 MESA participants who completed four exams and remained CVD-free from 2000 to 2011. A 12-point CVH score was calculated based on physical activity, smoking status, body mass index, cholesterol, blood pressure, and glucose. Ideal CVH was defined as a score ≥ 9. Group-based trajectory modeling was used to identify trajectories of ideal CVH. Cox models were used to examine the association of CVH trajectories with incident CVD and death from 2011 to 2018, adjusting for age, sex, race/ethnicity, income, education, and marital status.
RESULTS
Three trajectories were identified based on the probability of achieving ideal CVH: high ( = 1251), medium ( = 760), and persistently low ( = 1663). Almost half (45.3%) of the participants had a persistently low trajectory. During a median of 7.7 years follow-up, 392 incident CVD events and 459 deaths occurred. Compared with the high CVH group, participants in the persistently low CVH trajectory group had elevated risks for CVD (adjusted hazard ratios 1.49, 95% confidence interval 1.15-1.93) and mortality (1.34, 1.06-1.70), and participants in the medium group had moderate risks for CVD (1.17, 0.86-1.59) and mortality (1.15, 0.87-1.53) (p-value for trend 0.002 for CVD, 0.014 for mortality).
CONCLUSION
Persistently nonideal CVH is a common trajectory. Targeted prevention programs might benefit individuals with persistently nonideal CVH given their elevated risk of subsequent CVD and mortality.
目的
心血管健康（CVH）的纵向轨迹可能反映出由于长期累积暴露于非理想CVH水平而导致的血管风险负担。识别具有较高风险CVH轨迹的个体可能有助于治疗、筛查和预防。我们旨在描述CVH的10年轨迹，并研究CVH轨迹与随后的心血管疾病（CVD）和死亡率之间的关联。
方法
我们分析了3674名参加多族裔动脉粥样硬化研究（MESA）的参与者，他们完成了四次检查，并且在2000年至2011年期间没有患心血管疾病。基于身体活动、吸烟状况、体重指数、胆固醇、血压和血糖计算了一个12分的CVH评分。理想的CVH定义为评分≥9分。使用基于组的轨迹模型来识别理想CVH的轨迹。使用Cox模型来研究2011年至2018年期间CVH轨迹与新发CVD和死亡之间的关联，并对年龄、性别、种族/族裔、收入、教育程度和婚姻状况进行了调整。
结果
根据达到理想CVH的概率确定了三条轨迹：高轨迹组（n = 1251）、中轨迹组（n = 760）和持续低轨迹组（n = 1663）。几乎一半（45.3%）的参与者处于持续低轨迹组。在中位随访7.7年期间，发生了392例新发CVD事件和459例死亡。与高CVH组相比，持续低CVH轨迹组的参与者患CVD的风险升高（调整后的风险比为1.49，95%置信区间为1.15 - 1.93）以及死亡风险升高（1.34，1.06 - 1.70），而中轨迹组的参与者患CVD的风险中等（1.17，0.86 - 1.59）以及死亡风险中等（1.15，0.87 - 1.53）（CVD的趋势p值为0.002，死亡率的趋势p值为
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