Association of Changes in Cardiovascular Health Metrics and Risk of Subsequent Cardiovascular Disease and Mortality.
Association of Changes in Cardiovascular Health Metrics and Risk of Subsequent Cardiovascular Disease and Mortality.
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DOI：
10.1161/jaha.120.017458
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发表时间：
2020-10-20
影响因子：
5.4
通讯作者：
Jouven X
中科院分区：
文献类型：
--
作者：
Gaye B;Tajeu GS;Vasan RS;Lassale C;Allen NB;Singh-Manoux A;Jouven X
中年心血管健康（CVH）的变化在多大程度上降低了随后心血管疾病和死亡率的风险尚不清楚。CVH是在1987年至1989年和1993年至1995年的2次ARIC（社区动脉粥样硬化风险）研究访视中计算的，使用7个指标（吸烟、体重指数、总胆固醇、血糖、血压、体力活动和饮食），每个指标被分类为差、中等和理想。总体CVH被分类为差、中等和理想，对应于理想水平的0至2、3至4和5至7个指标。有10 038名参与者，年龄在44至66岁之间，符合条件。从第一次到第二次研究访视，17%的参与者的总体CVH有所改善，21%的参与者的CVH有所下降。在两次研究访视中，分别有28%、27%和6%的患者总体CVH较差、中等和理想。与两次访视时CVH较差的患者相比，两次访视时CVH理想的患者的心血管疾病风险（风险比[HR]，0.26; 95% CI，0.20-0.34）和死亡率（HR，0.35; 95% CI，0.29-0.44）最低。CVH从较差改善至中等/理想也与心血管疾病风险（HR，0.67; 95% CI，0.59-0.75）和死亡率（HR，0.80; 95% CI，0.72-0.89）降低相关。与随时间推移CVH较差的患者相比，CVH改善或稳定的理想CVH与心血管疾病和全因死亡率的风险降低相关。吸烟状况和胆固醇的变化可能占了观察到的关联的很大一部分。
The extent to which change in cardiovascular health (CVH) in midlife reduces risk of subsequent cardiovascular disease and mortality is unclear. CVH was computed at 2 ARIC (Atherosclerosis Risk in Communities) study visits in 1987 to 1989 and 1993 to 1995, using 7 metrics (smoking, body mass index, total cholesterol, blood glucose, blood pressure, physical activity, and diet), each classified as poor, intermediate, and ideal. Overall CVH was classified as poor, intermediate, and ideal to correspond to 0 to 2, 3 to 4, and 5 to 7 metrics at ideal levels. There 10 038 participants, aged 44 to 66 years that were eligible. From the first to the second study visit, there was an improvement in overall CVH for 17% of participants and a decrease in CVH for 21% of participants. At both study visits, 28%, 27%, and 6% had poor, intermediate, and ideal overall CVH, respectively. Compared with those with poor CVH at both visits, the risk of cardiovascular disease (hazard ratio [HR], 0.26; 95% CI, 0.20–0.34) and mortality (HR, 0.35; 95% CI, 0.29–0.44) was lowest in those with ideal CVH at both measures. Improvement from poor to intermediate/ideal CVH was also associated with a lower risk of cardiovascular disease (HR, 0.67; 95% CI, 0.59–0.75) and mortality (HR, 0.80; 95% CI, 0.72–0.89). Improvement in CVH or stable ideal CVH, compared with those with poor CVH over time, is associated with a lower risk of incident cardiovascular disease and all‐cause mortality. The change in smoking status and cholesterol may have accounted for a large part of the observed association.