Ideal Cardiovascular Health and Incident Cardiovascular Disease: Heterogeneity Across Event Subtypes and Mediating Effect of Blood Biomarkers: The PRIME Study.
Ideal Cardiovascular Health and Incident Cardiovascular Disease: Heterogeneity Across Event Subtypes and Mediating Effect of Blood Biomarkers: The PRIME Study.
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DOI：
10.1161/jaha.117.006389
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发表时间：
2017-10-17
影响因子：
5.4
通讯作者：
Empana JP
中科院分区：
文献类型：
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作者：
Gaye B;Tafflet M;Arveiler D;Montaye M;Wagner A;Ruidavets JB;Kee F;Evans A;Amouyel P;Ferrieres J;Empana JP
本研究的目的是探讨基线心血管健康（CVH）与心血管疾病发病率之间的相关性是否因冠心病（CHD）和卒中亚型而异，并评估炎症和止血血液生物标志物的介导作用。通过多变量Cox比例风险回归分析，得出了北爱尔兰和法国9312名中年男性（全队列）理想CVH与预后的关系。基线炎症和止血血液生物标志物的介导作用在10年随访后的病例对照研究中进行了评估。中位随访10年后，614例首次冠心病事件和117例首次中风事件被判定。与CVH较差的患者相比，基线CVH较理想的患者患冠心病的风险降低72%（风险比=0.28；95%可信区间为0.17;0.46），卒中风险降低76%（风险比=0.24；95%可信区间为0.06;0.98）。发生心绞痛和心肌梗死的风险降低幅度相似，但缺血性中风的风险降低幅度较低。在对照组中，高敏感C反应蛋白、IL - 6和纤维蛋白原的平均浓度随着CVH水平的升高而降低。此外，行为性CVH与冠心病的关联部分是由高敏感性C反应蛋白（16.69%）、IL - 6（8.52%）和纤维蛋白原（7.30%）介导的。我们的研究显示基线CVH与主要心血管疾病亚型的关联没有明显的异质性。这支持在所有心血管疾病亚型中普遍推广理想的CVH。此外，我们的中介分析表明，与理想CVH相关的冠心病风险较低部分是由较低的炎症和止血血液生物标志物介导的。
The aim of this study was to investigate whether the association between baseline cardiovascular health (CVH) and incident cardiovascular disease differs according to coronary heart disease (CHD) and stroke subtypes, and to assess the mediating effect of inflammatory and hemostatic blood biomarkers. The association of ideal CVH with outcomes was derived in 9312 middle‐aged men from Northern Ireland and France (whole cohort) in multivariable Cox proportional hazards regression analysis. The mediating effect of baseline inflammatory and hemostatic blood biomarkers was evaluated in a case–control study nested within the cohort after 10 years of follow‐up. After a median follow‐up of 10 years, 614 first CHD events and 117 first stroke events were adjudicated. Compared with those with poor CVH, those with an ideal CVH profile at baseline had a 72% lower risk of CHD (hazard ratio=0.28; 95% confidence interval, 0.17; 0.46) and a 76% lower risk of stroke (hazard ratio =0.24; 95% confidence interval, 0.06; 0.98). The magnitude of the risk reductions was similar for incident angina and myocardial infarction, but was lower for ischemic stroke. In the controls, the mean concentrations of high‐sensitivity C‐reactive protein, IL‐6, and fibrinogen decreased with higher CVH status. Furthermore, the association of behavioral CVH with incident CHD was partly mediated by high‐sensitivity C‐reactive protein (16.69%), IL‐6 (8.52%), and fibrinogen (7.30%) Our study shows no clear heterogeneity in the association of baseline CVH with the main subtypes of cardiovascular disease. This supports a universal promotion of ideal CVH for all cardiovascular disease subtypes. Furthermore, our mediation analysis suggests that the lower risk of CHD associated with ideal CVH is partly mediated by lower inflammatory and hemostatic blood biomarkers.