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SCIENCE CHINA Life Sciences, Volume 61, Issue 5: 504-514(2018) https://doi.org/10.1007/s11427-018-9281-6

Ideal cardiovascular health and incidence of atherosclerotic cardiovascular disease among Chinese adults: the China-PAR project

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  • ReceivedJan 2, 2018
  • AcceptedFeb 26, 2018
  • PublishedMar 19, 2018

Abstract

Existing evidence on the relationship between cardiovascular health (CVH) metrics and cardiovascular disease (CVD) was primarily derived from western populations. We aimed to evaluate the benefits of ideal CVH metrics on preventing incident atherosclerotic CVD (ASCVD) in Chinese population. This study was conducted among 93,987 adults from the China-PAR project (Prediction for ASCVD Risk in China) who were followed up until 2015. Cox proportional hazard regression models were used to estimate the hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs) of CVH metrics for the risk of ASCVD, including coronary heart disease (CHD), stroke and ASCVD death. We further estimated the population-attributable risk percentage (PAR%) of these metrics in relation to each outcome. We observed gradient inverse associations between the number of ideal CVH metrics and ASCVD incidence. Compared with participants having ≤2 ideal CVH metrics, the multivariable-adjusted HRs (95% CIs) of ASCVD for those with 3, 4, 5, 6 and 7 ideal CVH metrics were 0.83 (0.74–0.93), 0.66 (0.59–0.74), 0.55 (0.48–0.61), 0.44 (0.38–0.50) and 0.24 (0.18–0.31), respectively (P for trend <0.0001). Approximately 62.1% of total ASCVD, 38.7% of CHD, 66.4% of stroke, and 60.5% of ASCVD death were attributable to not achieving all the seven ideal CVH metrics. After adjusting effects of ideal health factors, having four ideal health behaviors could independently bring adults health benefits in preventing 17.4% of ASCVD, 18.0% of CHD, 16.7% of stroke, and 10.1% of ASCVD death. Among all the seven CVH metrics, to keep with ideal blood pressure (BP) implied the largest public health gains against various ASCVD events (PAR% between 33.0% and 47.2%), while ideal diet was the metric most difficult to be achieved in the long term. Our study indicates that the more ideal CVH metrics adults have, the less ASCVD burden there is in China. Special efforts of health education and behavior modification should be made on keeping ideal BP and dietary habits in general Chinese population to prevent the epidemic of ASCVD.


Funded by

grants from the CAMS Innovation Fund for Medical Sciences(2017-12M-1-004)

and National Natural Science Foundation of China(91643208)

Ministry of Science and Technology of China(2017YFC0211700)


Acknowledgment

The authors thank the staffs and participants of the China-PAR project for their important participation and contribution. This work was supported by grants from the CAMS Innovation Fund for Medical Sciences (2017-12M-1-004), Ministry of Science and Technology of China (2017YFC0211700), and National Natural Science Foundation of China (91643208).


Interest statement

The author(s) declare that they have no conflict of interest.


Supplement

SUPPORTING INFORMATION

Table S1 Adjusted hazard ratios for the risk of ASCVD events according to the number of ideal cardiovascular health metrics, stratified by cohorts of the China-PAR project

Table S2 Adjusted hazard ratios for the risk of ASCVD events according to the number of ideal cardiovascular health metrics when cases occurring in the first year after follow-up were removed

Table S3 Comparison of baseline characteristics between included individuals and those lost to follow up

Table S4 Definition of ideal cardiovascular health metrics (>20 years of age) in this study

Figure S1 Adjusted hazard ratios for total ASCVD events by the number of ideal cardiovascular health metrics and subgroups of sex, age group, living region, and urbanization.

Figure S2 Adjusted hazard ratios for CHD by the number of ideal cardiovascular health metrics and subgroups of sex, age group, living region, and urbanization.

Figure S3 Adjusted hazard ratios for stroke by the number of ideal cardiovascular health metrics and subgroups of sex, age group, living region, and urbanization.

Figure S4 Adjusted hazard ratios for ASCVD death by the number of ideal cardiovascular health metrics and subgroups of sex, age group, living region, and urbanization.

Figure S5 Age- and sex-adjusted incidence rates of ASCVD events according to the number of ideal health behaviors and ideal health factors.

Figure S6 Flowchart of the study.

The supporting information is available online at http://life.scichina.com and https://link.springer.com. The supporting materials are published as submitted, without typesetting or editing. The responsibility for scientific accuracy and content remains entirely with the authors.


References

[1] Bambs C., Reis S.E.. Embracing primordial prevention for ideal cardiovascular health. Fut Cardiol, 2011, 7: 447-450 CrossRef PubMed Google Scholar

[2] Bellavia, A., Stilling, F., and Wolk, A. (2016). High red meat intake and all-cause cardiovascular and cancer mortality: is the risk modified by fruit and vegetable intake? Am J Clin Nutr 104, 1137–1143. Google Scholar

[3] Bi Y., Jiang Y., He J., Xu Y., Wang L., Xu M., Zhang M., Li Y., Wang T., Dai M., et al. Status of cardiovascular health in Chinese adults. J Am Coll Cardiol, 2015, 65: 1013-1025 CrossRef PubMed Google Scholar

[4] Claas S.A., Arnett D.K.. The role of healthy lifestyle in the primordial prevention of cardiovascular disease. Curr Cardiol Rep, 2016, 18: 56 CrossRef PubMed Google Scholar

[5] Dong C., Rundek T., Wright C.B., Anwar Z., Elkind M.S.V., Sacco R.L.. Ideal cardiovascular health predicts lower risks of myocardial infarction, stroke, and vascular death across whites, blacks, and hispanics: The Northern Manhattan Study. Circulation, 2012, 125: 2975-2984 CrossRef PubMed Google Scholar

[6] Folsom A.R., Yatsuya H., Nettleton J.A., Lutsey P.L., Cushman M., Rosamond W.D., Rosamond W.D.. Community prevalence of ideal cardiovascular health, by the American Heart Association definition, and relationship with cardiovascular disease incidence. J Am Coll Cardiol, 2011, 57: 1690-1696 CrossRef PubMed Google Scholar

[7] GBD 2013 Mortality and Causes of Death Collaborators. (2015). Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 385, 117–171. Google Scholar

[8] Gakidou E., Afshin A., Abajobir A.A., Abate K.H., Abbafati C., Abbas K.M., Abd-Allah F., Abdulle A.M., Abera S.F., Aboyans V., et al. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet, 2017, 390: 1345-1422 CrossRef Google Scholar

[9] Gu D., He J., Coxson P.G., Rasmussen P.W., Huang C., Thanataveerat A., Tzong K.Y., Xiong J., Wang M., Zhao D., et al. The cost-effectiveness of low-cost essential antihypertensive medicines for hypertension control in China: a modelling study. PLoS Med, 2015, 12: e1001860 CrossRef PubMed Google Scholar

[10] Gu D., He J., Duan X., Reynolds K., Wu X., Chen J., Huang G., Chen C.S., Whelton P.K.. Body weight and mortality among men and women in China. JAMA, 2006, 295: 776-783 CrossRef PubMed Google Scholar

[11] He J., Gu D., Chen J., Wu X., Kelly T.N., Huang J., Chen J., Chen C.S., Bazzano L.A., Reynolds K., et al. Premature deaths attributable to blood pressure in China: a prospective cohort study. Lancet, 2009, 374: 1765-1772 CrossRef Google Scholar

[12] He J., Gu D., Wu X., Reynolds K., Duan X., Yao C., Wang J., Chen C.S., Chen J., Wildman R.P., et al. Major causes of death among men and women in China. N Engl J Med, 2005, 353: 1124-1134 CrossRef PubMed Google Scholar

[13] Kim J.Y., Ko Y.J., Rhee C.W., Park B.J., Kim D.H., Bae J.M., Shin M.H., Lee M.S., Li Z.M., Ahn Y.O.. Cardiovascular health metrics and all-cause and cardiovascular disease mortality among middle-aged men in Korea: the Seoul Male Cohort Study. J Prev Med Public Health, 2013, 46: 319-328 CrossRef Google Scholar

[14] Lloyd-Jones D.M., Hong Y., Labarthe D., Mozaffarian D., Appel L.J., Van Horn L., Greenlund K., Daniels S., Nichol G., Tomaselli G.F., et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic impact goal through 2020 and beyond. Circulation, 2010, 121: 586-613 CrossRef PubMed Google Scholar

[15] Montero D., Walther G., Perez-Martin A., Roche E., Vinet A.. Endothelial dysfunction, inflammation, and oxidative stress in obese children and adolescents: markers and effect of lifestyle intervention. Obes Rev, 2012, 13: 441-455 CrossRef PubMed Google Scholar

[16] Nahrendorf M., Swirski F.K.. Lifestyle effects on hematopoiesis and atherosclerosis. Circ Res, 2015, 116: 884-894 CrossRef PubMed Google Scholar

[17] Nayor M., Enserro D.M., Vasan R.S., Xanthakis V.. Cardiovascular health status and incidence of heart failure in the Framingham Offspring Study. Circ Heart Fail, 2016, 9: e002416 CrossRef PubMed Google Scholar

[18] Rebholz C.M., Reynolds K., Wofford M.R., Chen J., Kelly T.N., Mei H., Whelton P.K., He J.. Effect of soybean protein on novel cardiovascular disease risk factors: a randomized controlled trial. Eur J Clin Nutr, 2013, 67: 58-63 CrossRef PubMed Google Scholar

[19] Schoenfeld D.. Partial residuals for the proportional hazards regression model. Biometrika, 1982, 69: 239-241 CrossRef Google Scholar

[20] Shay C.M., Ning H., Allen N.B., Carnethon M.R., Chiuve S.E., Greenlund K.J., Daviglus M.L., Lloyd-Jones D.M.. Status of cardiovascular health in US adults: prevalence estimates from the National Health and Nutrition Examination Surveys (NHANES) 2003-2008. Circulation, 2012, 125: 45-56 CrossRef PubMed Google Scholar

[21] Spiegelman D., Hertzmark E., Wand H.C.. Point and interval estimates of partial population attributable risks in cohort studies: examples and software. Cancer Causes Control, 2007, 18: 571-579 CrossRef PubMed Google Scholar

[22] Wang S.S., Lay S., Yu H.N., Shen S.R.. Dietary Guidelines for Chinese Residents (2016): comments and comparisons. J Zhejiang Univ Sci B, 2016, 17: 649-656 CrossRef PubMed Google Scholar

[23] Wu H.Y., Sun Z.H., Cao D.P., Wu L.X., Zeng Q.. Cardiovascular health status in Chinese adults in urban areas: analysis of the Chinese Health Examination Database 2010. Int J Cardiol, 2013, 168: 760-764 CrossRef PubMed Google Scholar

[24] Yang G., Wang Y., Zeng Y., Gao G.F., Liang X., Zhou M., Wan X., Yu S., Jiang Y., Naghavi M., et al. Rapid health transition in China, 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet, 2013, 381: 1987-2015 CrossRef Google Scholar

[25] Yang Q., Cogswell M.E., Flanders W.D., Hong Y., Zhang Z., Loustalot F., Gillespie C., Merritt R., Hu F.B.. Trends in cardiovascular health metrics and associations with all-cause and CVD mortality among US adults. JAMA, 2012, 307: 1273-1283 CrossRef PubMed Google Scholar

[26] Yang X., Li J., Hu D., Chen J., Li Y., Huang J., Liu X., Liu F., Cao J., Shen C., et al. Predicting the 10-year risks of atherosclerotic cardiovascular disease in Chinese population. Circulation, 2016, 134: 1430-1440 CrossRef PubMed Google Scholar

[27] Zhang C., Qin Y.Y., Wei X., Yu F.F., Zhou Y.H., He J.. Tea consumption and risk of cardiovascular outcomes and total mortality: a systematic review and meta-analysis of prospective observational studies. Eur J Epidemiol, 2015, 30: 103-113 CrossRef PubMed Google Scholar

[28] Zhang Q., Zhou Y., Gao X., Wang C., Zhang S., Wang A., Li N., Bian L., Wu J., Jia Q., et al. Ideal cardiovascular health metrics and the risks of ischemic and intracerebral hemorrhagic stroke. Stroke, 2013, 44: 2451-2456 CrossRef PubMed Google Scholar

[29] Zhao, D. (1999). Poisson regression adjustment of event rates and its macro procedure ADJ_POIS. SAS Users Group 24th International Annual Conference. (Florida, USA). Google Scholar

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