不良童年经历、成年后采取健康生活方式与心血管疾病风险。

Adverse childhood experience, adopting a healthy lifestyle in adulthood, and risk of cardiovascular diseases.

机构信息

Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.

Department of Nutrition and Food Hygiene, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.

出版信息

J Affect Disord. 2024 Oct 1;362:450-458. doi: 10.1016/j.jad.2024.07.023. Epub 2024 Jul 14.

DOI:10.1016/j.jad.2024.07.023

PMID:39009308

Abstract

BACKGROUND

Both adverse childhood experiences (ACEs) and lifestyle factors have been associated with risk of cardiovascular diseases (CVDs) in later life, but whether and to what extent adherence to a healthy lifestyle in adulthood can offset the increased cardiovascular risk associated with ACEs is unclear. We aimed to determine whether and to what extent adopting to a healthy lifestyle in adulthood can offset the risk of CVDs in individuals according to their ACEs.

METHODS

A prospective cohort study included 143,869 participants aged 38-72 years, free of CVDs at baseline from the UK Biobank. The history of ACEs was assessed using the Childhood Trauma Screener. Participants were divided into three risk groups based on ACEs: low (no ACEs), intermediate (one or two ACEs), and high (three or more ACEs). A healthy lifestyle score in adulthood was constructed as the sum of four modifiable lifestyle factors (no smoking, adequate physical activity, healthy diet, no obesity), and participants were then categorized into three groups based on this score (unfavorable [0-1 point], intermediate [2-3 points], favorable [4 points]). Cox proportional hazard models were conducted to investigate the association between ACEs, healthy lifestyle, and incident CVDs.

RESULTS

During a median follow-up of 12.49 years, 13,373 incident cases of overall CVDs were identified. This included 7521 cases of coronary heart disease (CHD), 6175 cases of atrial fibrillation (AF) and 1813 cases of stroke. Individuals with high ACEs had a greater risk of incident overall CVDs (hazard ratio [HR] = 1.39, [95%CI = 1.29 to 1.50]), CHD (1.50 [1.36 to 1.65]) and AF (1.18 [1.05 to 1.33]) compared to those with low ACEs. The risk of CVDs decreased moving from unfavorable to favorable lifestyle categories (P for trend<0.001), with the lowest risk observed among individuals with a favorable lifestyle (0.70 [0.66 to 0.74] for overall CVDs, 0.69 [0.64 to 0.75] for CHD, and 0.71 [0.65 to 0.78] for AF). Participants with high ACEs and a favorable lifestyle had a 39 %, 40 % and 47 % lower risk of developing overall CVDs (0.61 [0.48 to 0.76]), CHD (0.60 [0.44 to 0.81], and AF (0.53 [0.36 to 0.77]) than those with high ACEs and an unfavorable lifestyle.

CONCLUSIONS

Having a healthy lifestyle in adulthood could substantially attenuate the increased risk of overall CVDs, CHD, and AF conferred by ACEs.

摘要

背景

不良童年经历（ACEs）和生活方式因素都与晚年患心血管疾病（CVDs）的风险相关，但在成年后是否以及在何种程度上坚持健康的生活方式可以抵消 ACEs 相关的心血管风险增加仍不清楚。我们旨在确定根据 ACEs，成年后是否以及在何种程度上采取健康的生活方式可以降低个体患 CVDs 的风险。

方法

一项前瞻性队列研究纳入了来自英国生物库的 143869 名年龄在 38-72 岁、基线时无 CVDs 的参与者。使用儿童创伤筛查器评估 ACEs 病史。根据 ACEs 将参与者分为三组：低风险（无 ACEs）、中风险（一或两个 ACEs）和高风险（三个或更多 ACEs）。成年后健康生活方式评分构建为四个可改变生活方式因素（不吸烟、适度体力活动、健康饮食、不肥胖）的总和，然后根据该评分将参与者分为三组（不利[0-1 分]、中等[2-3 分]、有利[4 分]）。采用 Cox 比例风险模型探讨 ACEs、健康生活方式和新发 CVDs 之间的关系。

结果

在中位数为 12.49 年的随访期间，共确定了 13373 例总体 CVDs 事件。其中包括 7521 例冠心病（CHD）、6175 例心房颤动（AF）和 1813 例中风。与低 ACEs 相比，高 ACEs 个体发生总体 CVDs（风险比[HR] = 1.39，[95%CI = 1.29 至 1.50]）、CHD（1.50 [1.36 至 1.65]）和 AF（1.18 [1.05 至 1.33]）的风险更高。从不利生活方式类别转变为有利生活方式类别，CVDs 的风险降低（趋势 P<0.001），在具有有利生活方式的个体中观察到的风险最低（总体 CVDs 为 0.70 [0.66 至 0.74]，CHD 为 0.69 [0.64 至 0.75]，AF 为 0.71 [0.65 至 0.78]）。高 ACEs 且生活方式有利的个体患总体 CVDs（0.61 [0.48 至 0.76]）、CHD（0.60 [0.44 至 0.81]）和 AF（0.53 [0.36 至 0.77]）的风险比高 ACEs 且生活方式不利的个体分别低 39%、40%和 47%。