生活方式模式、遗传易感性与瓣膜性心脏病风险：一项基于英国生物库的前瞻性队列研究。
Lifestyle patterns, genetic susceptibility, and risk of valvular heart disease: a prospective cohort study based on the UK Biobank.
机构信息
Department of Cardiovascular Surgery, West China Biomedical Big Data Center and Med-X Center for Informatics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital/West China School of Medicine, and Key Laboratory of Bio-Resource and Eco-Environment of Ministry of Education, College of Life Sciences, Sichuan University, No. 37 Guoxue Xiang, Chengdu, Sichuan 610041, China.
Department of Cardiovascular Surgery and West China Biomedical Big Data Center, West China Hospital/West China School of Medicine, Sichuan University, No. 37 Guoxue Xiang, Chengdu, Sichuan 610041, China.
出版信息
Eur J Prev Cardiol. 2023 Oct 26;30(15):1665-1673. doi: 10.1093/eurjpc/zwad177.
AIMS
Genetic and lifestyle factors are both major contributors to valvular heart disease (VHD). However, it is still uncertain whether genetic susceptibility alters the association between lifestyle and VHD. We aimed to investigate the association between lifestyle and VHD in different genetic risk backgrounds.
METHODS AND RESULTS
A prospective cohort study was carried out on 499 341 participants without VHD at baseline. The assessment of lifestyle included smoking, alcohol consumption, diet, activity, and sleep. Genetic susceptibility was separately measured by polygenic risk scores (PRSs) and family history of cardiovascular disease (CVD). Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95%CIs) between lifestyle and VHD, as well as aortic stenosis (AS). During a median follow-up of 10.8 years, 12 983 incident VHD cases were diagnosed (incidence rate 2.46 per 1000 person-years), including 3527 AS cases (incidence rate 0.66 per 1000 person-years). The risk of VHD and AS decreased with healthier lifestyles (P value for trend <0.001). Compared to individuals with a unhealthy lifestyle, the HRs of VHD in intermediate and healthy lifestyle groups were 0.81 (0.76-0.86) and 0.81 (0.76-0.87). The negative association between healthy lifestyle and VHD events was independent of genetic risk (P for interaction between healthy lifestyle scores and PRSs/family history of CVD was 0.723/0.763). Similar findings were obtained in analyses of AS, and a stronger negative association was found.
CONCLUSION
Our study reveals that adherence to a healthy lifestyle is significantly associated with a reduced risk of VHD especially AS, irrespective of genetic susceptibility.
SUMMARY
Based on a cohort of around 490 000 participants, the study investigated the association between lifestyle and VHD under different stratifications of genetic risk. The study found that a healthy lifestyle was associated with a lower risk of VHD, particularly AS, independent of genetic risk. Our findings suggest that advance interventions for lifestyle may be an effective way to reduce the global burden of VHD.
目的
遗传和生活方式因素都是导致瓣膜性心脏病（VHD）的主要因素。然而，遗传易感性是否改变生活方式与 VHD 之间的关联仍不确定。我们旨在研究不同遗传风险背景下生活方式与 VHD 之间的关系。
方法和结果
在基线时没有 VHD 的 499341 名参与者中进行了一项前瞻性队列研究。生活方式的评估包括吸烟、饮酒、饮食、活动和睡眠。遗传易感性分别通过多基因风险评分（PRS）和心血管疾病（CVD）家族史进行测量。使用 Cox 回归模型估计生活方式与 VHD 以及主动脉瓣狭窄（AS）之间的危险比（HR）和 95%置信区间（95%CI）。在中位随访 10.8 年期间，诊断出 12983 例新发 VHD 病例（发病率为每 1000 人年 2.46 例），其中 3527 例为 AS 病例（发病率为每 1000 人年 0.66 例）。VHD 和 AS 的风险随着生活方式变得更加健康而降低（趋势 P 值<0.001）。与生活方式不健康的个体相比，中等和健康生活方式组的 VHD HR 分别为 0.81（0.76-0.86）和 0.81（0.76-0.87）。健康生活方式与 VHD 事件之间的负相关独立于遗传风险（健康生活方式评分与 PRS/家族 CVD 史之间的交互作用 P 值为 0.723/0.763）。在对 AS 的分析中也得到了类似的发现，并且发现了更强的负相关关系。
结论
我们的研究表明，坚持健康的生活方式与 VHD 风险降低显著相关，尤其是 AS，与遗传易感性无关。
总结
基于约 490000 名参与者的队列，本研究在不同遗传风险分层的情况下研究了生活方式与 VHD 之间的关系。研究发现，健康的生活方式与 VHD 风险降低相关，尤其是 AS，独立于遗传风险。我们的研究结果表明，针对生活方式的早期干预可能是降低全球 VHD 负担的有效方法。
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