Shenzhen Key Laboratory of Cardiovascular Health and Precision Medicine, Southern University of Science and Technology, Shenzhen, China; Department of Cardiology, Kailuan General Hospital, Tangshan, China; School of Medicine, Southern University of Science and Technology, Shenzhen, China.
Department of Epidemiology, Fu wai Hospital, National Center for Atherosclerotic cardiovascular diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Am J Prev Med. 2023 Jun;64(6):927-935. doi: 10.1016/j.amepre.2023.01.009. Epub 2023 Feb 20.
Cardiovascular health level according to the American Heart Association's Life's Essential 8 (LE8) in China and its effectiveness on the 10-year and lifetime risk of atherosclerotic cardiovascular diseases is unclear.
This prospective study included 88,665 participants in the China-PAR cohort (data from 1998 to 2020) and 88,995 in the Kailuan cohort (data from 2006 to 2019). Analyses were conducted by November 2022. LE8 was measured according to the American Heart Association's LE8 algorithm, and a high cardiovascular health status was defined as a LE8 score ≥80 points. Participants were followed for the primary composite outcomes, including fatal and nonfatal acute myocardial infarction, ischemic stroke, and hemorrhagic stroke. The lifetime risk was estimated from the cumulative risk of atherosclerotic cardiovascular diseases through ages 20-85 years, the association of LE8 and LE8 change with atherosclerotic cardiovascular diseases was assessed with the Cox proportional-hazards model, and partial population-attributable risks evaluated the proportion of atherosclerotic cardiovascular diseases that could be averted.
The mean LE8 score was 70.0 in the China-PAR cohort and 64.6 in the Kailuan cohort, with 23.3% and 8.0% of participants having a high cardiovascular health status, respectively. Participants in the highest quintile had about 60% lower 10-year and lifetime risk of atherosclerotic cardiovascular diseases in the China-PAR and Kailuan cohorts than participants with the lowest quintile LE8 score. If everyone maintained the highest quintile of LE8 score, approximately half of the atherosclerotic cardiovascular diseases could be prevented. The participant with LE8 score that increased from the lowest to the highest tertile during 2006-2012 had a 44% (hazard ratio=0.56; 95% CI=0.45, 0.69) lower observed risk and a 43% (hazard ratio=0.57; 95% CI=0.46, 0.70) lower lifetime risk of atherosclerotic cardiovascular diseases than those remaining in the lowest tertile in the Kailuan cohort.
The LE8 score was below optimal levels in Chinese adults. A high baseline LE8 score and an improving LE8 score were associated with decreased 10-year and lifetime risk of atherosclerotic cardiovascular diseases.
根据美国心脏协会的生命必备 8 项（LE8）标准评估的心血管健康水平及其对中国人群 10 年和终生动脉粥样硬化性心血管疾病风险的影响尚不清楚。
本前瞻性研究纳入了中国 PAR 队列（1998 年至 2020 年的数据）中的 88665 名参与者和开滦队列（2006 年至 2019 年的数据）中的 88995 名参与者。分析于 2022 年 11 月完成。LE8 按照美国心脏协会的 LE8 算法进行测量，心血管健康状况高定义为 LE8 评分≥80 分。主要复合结局为致命性和非致命性急性心肌梗死、缺血性卒中和出血性卒中等。通过 20 岁至 85 岁的动脉粥样硬化性心血管疾病累积风险估计终生风险，采用 Cox 比例风险模型评估 LE8 与 LE8 变化与动脉粥样硬化性心血管疾病的关系，通过部分人群归因风险评估可预防的动脉粥样硬化性心血管疾病比例。
在中国 PAR 队列中，LE8 评分的平均值为 70.0，在开滦队列中为 64.6，分别有 23.3%和 8.0%的参与者心血管健康状况良好。在最高五分位组中，参与者 10 年和终生动脉粥样硬化性心血管疾病的风险比最低五分位 LE8 评分组参与者低约 60%。如果每个人都保持 LE8 评分的最高五分位，大约一半的动脉粥样硬化性心血管疾病可以预防。在开滦队列中，2006-2012 年间 LE8 评分从最低到最高三分位增加的参与者，其观察到的风险降低了 44%（风险比=0.56；95%CI=0.45，0.69），终生动脉粥样硬化性心血管疾病风险降低了 43%（风险比=0.57；95%CI=0.46，0.70）。
中国成年人的 LE8 评分低于理想水平。较高的基线 LE8 评分和改善的 LE8 评分与降低 10 年和终生动脉粥样硬化性心血管疾病风险相关。
