Amani-Beni Reza, Darouei Bahar, Mohammadifard Noushin, Feizi Awat, Bateni Motahare, Haghighatdoost Fahimeh, Boshtam Maryam, Grau Narges, Sarrafzadegan Nizal
Interventional Cardiology Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Lipids Health Dis. 2025 Jun 7;24(1):206. doi: 10.1186/s12944-025-02631-5.
Atherogenic indices outperform traditional lipid markers; however, the combined association of lifestyle habits with these indices remains unclear. This study, which is based on population data, explored the link between the Healthy Lifestyle Score (HLS) and various atherogenic indices.
In this cross-sectional analysis of the 2013 Isfahan Cohort Study 2 (participants aged ≥ 35 years), HLS was derived from four factors: smoking status, body mass index (18.5-24.9 kg/m²), physical activity (≥ 1350 MET minutes/week), and diet quality (top two quintiles of the Alternate Healthy Eating Index-2010). Each factor was scored as 1 for adherence and zero otherwise, yielding a score of 0-4. The atherogenic indices included the Atherogenic Coefficient (AC), Atherogenic Index of Plasma (AIP), Atherogenic Combined Index (ACI), Castelli Risk Indices I and II (CRI-I/II), non-high-density Lipoprotein Cholesterol (NHC), Lipoprotein Combined Index (LCI), Remnant Lipoprotein Cholesterol (RLPC), and triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio. Logistic and linear regression analyses were conducted to examine these associations after adjusting for confounders.
Among 2,256 participants (49.7% men), the overall mean age was 58.15 ± 9.89 years. Across the population, a higher HLS was strongly linked to a decreased likelihood of elevated levels of individual atherogenic indices. Compared to individuals with HLS 0-1, those with HLS 3-4 had notably reduced odds of high AIP (odds ratio (OR): 0.42; 95% CI: 0.30-0.59), ACI (OR: 0.60; 95% CI: 0.47-0.77), and other indices (all P for trend < 0.05). Sex-stratified analyses revealed distinct patterns: in men, HLS was strongly associated with lower TG/HDL-C, AIP, and ACI, whereas in women, stronger associations were observed with cholesterol-driven markers (AC, NHC, RLPC, CRI-I, and CRI-II). Linear regression analysis confirmed that each unit increase in HLS corresponded to lower continuous values of these indices in the total population. AIP emerged as the most sensitive marker in both sexes.
Adherence to a healthier lifestyle, as measured by the HLS, was significantly associated with lower atherogenic indices, highlighting its role in reducing cardiovascular risk. These results support integrating lifestyle interventions with cardiovascular prevention. Future studies should assess the causal impact of lifestyle modifications on atherogenic profiles.
致动脉粥样硬化指数优于传统脂质标志物；然而，生活习惯与这些指数之间的联合关联仍不明确。本基于人群数据的研究探讨了健康生活方式评分（HLS）与各种致动脉粥样硬化指数之间的联系。
在对2013年伊斯法罕队列研究2（年龄≥35岁的参与者）进行的这项横断面分析中，HLS源自四个因素：吸烟状况、体重指数（18.5 - 24.9kg/m²）、身体活动（≥1350代谢当量分钟/周）和饮食质量（2010年替代健康饮食指数的前两个五分位数）。每个因素若符合则评分为1，否则为0，得出0 - 4分。致动脉粥样硬化指数包括致动脉粥样硬化系数（AC）、血浆致动脉粥样硬化指数（AIP）、致动脉粥样硬化综合指数（ACI）、卡斯泰利风险指数I和II（CRI - I/II）、非高密度脂蛋白胆固醇（NHC）、脂蛋白综合指数（LCI）、残余脂蛋白胆固醇（RLPC）以及甘油三酯/高密度脂蛋白胆固醇（TG/HDL - C）比值。在对混杂因素进行调整后，进行逻辑回归和线性回归分析以检验这些关联。
在2256名参与者（49.7%为男性）中，总体平均年龄为58.15±9.89岁。在整个人口中，较高的HLS与个体致动脉粥样硬化指数升高可能性降低密切相关。与HLS为0 - 1的个体相比，HLS为3 - 4的个体患高AIP（优势比（OR）：0.42；95%置信区间：0.30 - 0.59）、ACI（OR：0.60；95%置信区间：0.47 - 0.77）及其他指数的几率显著降低（所有趋势P值<0.05）。按性别分层分析显示出不同模式：在男性中，HLS与较低的TG/HDL - C、AIP和ACI密切相关，而在女性中，与胆固醇驱动的标志物（AC、NHC、RLPC、CRI - I和CRI - II）的关联更强。线性回归分析证实，在总体人群中，HLS每增加一个单位，这些指数的连续值就越低。AIP在两性中均是最敏感的标志物。
以HLS衡量，坚持更健康的生活方式与较低的致动脉粥样硬化指数显著相关，突出了其在降低心血管风险中的作用。这些结果支持将生活方式干预与心血管预防相结合。未来研究应评估生活方式改变对致动脉粥样硬化谱的因果影响。
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