Ministry of Education Key Laboratory of Environment and Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China.
Department of Epidemiology and Biostatistics, School of Public Health, Peking University Center for Public Health and Epidemic Preparedness & Response, Peking University Health Science Center, Beijing 100191, China.
Chin Med J (Engl). 2023 Jan 20;136(2):141-149. doi: 10.1097/CM9.0000000000002379.
Evidence on the relations of the American Heart Association's ideal cardiovascular health (ICH) with mortality in Asians is sparse, and the interaction between behavioral and medical metrics remained unclear. We aimed to fill the gaps.
A total of 198,164 participants without cancer and cardiovascular disease (CVD) were included from the China Kadoorie Biobank study (2004-2018), Dongfeng-Tongji cohort (2008-2018), and Kailuan study (2006-2019). Four behaviors (i.e., smoking, physical activity, diet, body mass index) and three medical factors (i.e., blood pressure, blood glucose, and blood lipid) were classified into poor, intermediate, and ideal levels (0, 1, and 2 points), which constituted 8-point behavioral, 6-point medical, and 14-point ICH scores. Results of Cox regression from three cohorts were pooled using random-effects models of meta-analysis.
During about 2 million person-years, 20,176 deaths were recorded. After controlling for demographic characteristics and alcohol drinking, hazard ratios (95% confidence intervals) comparing ICH scores of 10-14 vs. 0-6 were 0.52 (0.41-0.67), 0.44 (0.37-0.53), 0.54 (0.45-0.66), and 0.86 (0.64-1.14) for all-cause, CVD, respiratory, and cancer mortality. A higher behavioral or medical score was independently associated with lower all-cause and CVD mortality among the total population and populations with different levels of behavioral or medical health equally, and no interaction was observed.
ICH was associated with lower all-cause, CVD, and respiratory mortality among Chinese adults. Both behavioral and medical health should be improved to prevent premature deaths.
关于美国心脏协会的理想心血管健康（ICH）与亚洲人群死亡率之间关系的证据很少，行为和医疗指标之间的相互作用仍不清楚。我们旨在填补这一空白。
共纳入来自中国慢性病前瞻性研究（2004-2018 年）、东风-同济队列（2008-2018 年）和开滦研究（2006-2019 年）的 198164 名无癌症和心血管疾病（CVD）的参与者。将四种行为（即吸烟、身体活动、饮食、体重指数）和三种医学因素（即血压、血糖和血脂）分为较差、中等和理想水平（0、1 和 2 分），构成 8 分行为、6 分医学和 14 分 ICH 评分。采用随机效应模型荟萃分析，对来自三个队列的 Cox 回归结果进行汇总。
在大约 200 万人年期间，记录了 20176 例死亡。在控制了人口统计学特征和饮酒因素后，ICH 评分为 10-14 分与 0-6 分相比，全因、CVD、呼吸和癌症死亡率的风险比（95%置信区间）分别为 0.52（0.41-0.67）、0.44（0.37-0.53）、0.54（0.45-0.66）和 0.86（0.64-1.14）。在全人群和不同行为或健康水平的人群中，较高的行为或医学评分与全因和 CVD 死亡率降低独立相关，且未观察到交互作用。
ICH 与中国成年人的全因、CVD 和呼吸死亡率降低相关。改善行为和医疗健康都有助于预防过早死亡。
