Ideal cardiovascular health and incidence of atherosclerotic cardiovascular disease among Chinese adults: the China-PAR project
- 54 Downloads
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.
Keywordscardiovascular health ASCVD cohort China
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).
- Dong, C., Rundek, T., Wright, C.B., Anwar, Z., Elkind, M.S.V., and Sacco, R.L. (2012). Ideal cardiovascular health predicts lower risks of myocardial infarction, stroke, and vascular death across whites, blacks, and hispanics: The Northern Manhattan Study. Circulation 125, 2975–2984.CrossRefPubMedPubMedCentralGoogle Scholar
- Folsom, A.R., Yatsuya, H., Nettleton, J.A., Lutsey, P.L., Cushman, M., Rosamond, W.D., and Rosamond, W.D. (2011). Community prevalence of ideal cardiovascular health, by the American Heart Association definition, and relationship with cardiovascular disease incidence. J Am Coll Cardiol 57, 1690–1696.CrossRefPubMedPubMedCentralGoogle Scholar
- 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
- 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. (2017). 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 390, 1345–1422.CrossRefGoogle Scholar
- 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. (2015). The costeffectiveness of low-cost essential antihypertensive medicines for hypertension control in China: a modelling study. PLoS Med 12, e1001–860.CrossRefGoogle Scholar
- 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., and Ahn, Y.O. (2013). 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 46, 319–328.CrossRefPubMedPubMedCentralGoogle Scholar
- 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. (2010). 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 121, 586–613.CrossRefPubMedGoogle Scholar
- Shay, C.M., Ning, H., Allen, N.B., Carnethon, M.R., Chiuve, S.E., Greenlund, K.J., Daviglus, M.L., and Lloyd-Jones, D.M. (2012). Status of cardiovascular health in US adults: prevalence estimates from the National Health and Nutrition Examination Surveys (NHANES) 2003-2008. Circulation 125, 45–56.CrossRefPubMedGoogle Scholar
- 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