Lin Chunying, Zhang Xingyi, Fang Xin, He Wenyan, Zhang Xiaoyan, Wu Chaoqun, Bai Xueke, Yang Yang, Cui Jianlan, Xu Wei, Song Lijuan, Yang Hao, Zhang Yan, Gao Yan, Zhang Haibo, Li Xi
National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
Laboratory of Non-communicable Chronic Disease Control, Fujian Provincial Center for Disease Control and Prevention, Fuzhou, People's Republic of China.
BMC Public Health. 2025 Jul 15;25(1):2462. doi: 10.1186/s12889-025-23694-0.
The association between lifestyles and carotid plaque showed heterogeneity in results across studies, which may be limited by sample size or population characteristics. In addition, there is a lack of evidence on how long healthy lifestyles delay plaque development and on the metabolic factors which are likely to mediate these associations. This study aims to investigate the impact of multiple healthy lifestyles on the risk and time of carotid plaque incidence in the early stages of atherosclerotic cardiovascular disease (CVD), and to identify the metabolic factors mediating this association.
We analyzed data from 43,651 participants with moderate or high risk for CVD from the ChinaHEART cohort (2014-2021), excluding those with prior carotid plaque or CVD, or incomplete data. We examined the association between non-smoking, moderate alcohol intake, sufficient leisure time physical activity (LTPA), and a healthy diet and incident carotid plaque using odds ratios (ORs) and time ratios (TRs) from repeated carotid ultrasounds, and calculated the mediation effects of metabolic factors.
During a mean follow-up period of 1.74 ± 0.43 years, the study included 43,651 participants with a mean age of 57.76 years; 62.5% were female. Incident carotid plaque was documented in 14,698 participants (33.7%). Non-smoking (OR: 0.86 [0.80, 0.91]), moderate alcohol use (0.90 [0.84, 0.97]), sufficient LTPA (0.94 [0.90, 0.99]), and a healthy diet (0.90 [0.84, 0.97]) each independently lowered the risk of carotid plaque, with TRs indicating delays in plaque onset (1.01 to 1.06). Compliance with all four healthy lifestyles significantly reduced plaque risk (OR: 0.64) and delayed onset (TR: 1.16), with stronger effects in the high-risk group (P < 0.05). Metabolic factors varied in their mediation of lifestyle effects on plaque incidence.
Healthy lifestyles are associated with a lower risk and later onset of carotid plaque, suggesting that a primary prevention strategy focusing on multiple healthy behaviors, especially in high-risk individuals, may provide significant benefits.
生活方式与颈动脉斑块之间的关联在各项研究中的结果存在异质性，这可能受到样本量或人群特征的限制。此外，关于健康生活方式能延缓斑块发展多长时间以及哪些代谢因素可能介导这些关联，目前缺乏证据。本研究旨在调查多种健康生活方式对动脉粥样硬化性心血管疾病（CVD）早期阶段颈动脉斑块发生风险和时间的影响，并确定介导这种关联的代谢因素。
我们分析了来自中国心脏队列研究（2014 - 2021年）中43651名CVD中高危参与者的数据，排除了既往有颈动脉斑块或CVD、或数据不完整的参与者。我们使用重复颈动脉超声检查得到的优势比（OR）和时间比（TR），研究了不吸烟、适度饮酒、充足的休闲时间体力活动（LTPA）和健康饮食与颈动脉斑块发生之间的关联，并计算了代谢因素的中介效应。
在平均随访1.74±0.43年期间，该研究纳入了43651名平均年龄为57.76岁的参与者；62.5%为女性。14698名参与者（33.7%）有颈动脉斑块发生记录。不吸烟（OR：0.86 [0.80, 0.91]）、适度饮酒（0.90 [0.84, 0.97]）、充足的LTPA（0.94 [0.90, 0.99]）和健康饮食（0.90 [0.84, 0.97]）各自独立降低了颈动脉斑块的风险，TR表明斑块发病延迟（1.01至1.06）。符合所有四种健康生活方式显著降低了斑块风险（OR：0.64）并延迟了发病（TR：1.16），在高危组中效果更强（P < 0.05）。代谢因素在生活方式对斑块发生率的影响中介导作用各不相同。
健康生活方式与较低的颈动脉斑块风险和较晚的发病相关，这表明聚焦多种健康行为的一级预防策略，尤其是在高危个体中，可能会带来显著益处。
