中国人群“生活八要素” 与十年和终身动脉粥样硬化性心血管疾病风险

背景与目的: 动脉粥样硬化性心血管疾病（Atherosclerotic Cardiovascular Diseases，ASCVD）是全球最主要的死亡原因。随着人口老龄化和不健康生活方式的普遍流行，ASCVD的负担正在不断增加。为了有效应对这一趋势，急需加强心血管疾病的初级预防工作。最近，美国心脏协会发布“生活八要素（Life's Essential 8，LE8）”，旨在评估和促进心血管健康。LE8包括戒烟、适度运动、健康饮食、良好睡眠以及控制体重、血压、血脂和血糖等八个健康行为和因素。然而，在我国成年人中，LE8的分布情况及其与心血管疾病短期和长期风险的关系尚不明确。本研究旨在利用LE8来评估我国成年人的心血管健康水平，并探讨LE8及其变化与十年和终身ASCVD风险之间的关系。我们希望通过提供简便有效的心血管健康评估工具，促进我国人群改善心血管健康水平，从而降低心血管疾病的负担。方法与结果: 研究的第一部分纳入了中国ASCVD风险预测（China-PAR）研究的三个子队列。我们利用LE8对符合纳入标准的88,665名研究对象进行了心血管健康水平评估。结果显示，他们的基线LE8得分为70.0分，其中约有23.3%的研究对象达到LE8高分水平（≧80分）。随后，我们根据基线LE8得分的五分位数界点将研究对象分为五组，并随访其ASCVD和死亡风险至2018-2020年。在校正了年龄、性别、婚姻状况、教育水平、家庭收入和ASCVD家族史后，发现LE8得分从第一组到第五组，ASCVD的十年发病风险分别为5.14%、4.29%、3.50%、2.58%和1.96%。与第一组相比，第二到第五组的ASCVD十年发病风险分别下降了17%、32%、50%和62%。如果整个研究人群的LE8得分都达到第五组的水平，将可预防47.4%的ASCVD事件。此外，从第一组到第五组，ASCVD的终身发病风险分别为33.8%、29.2%、24.7%、19.2%和15.1%，其中第二到第五组的ASCVD终身发病风险相较于第一组分别下降了16%、31%、48%和60%。趋势检验显示，随着LE8得分的增加，ASCVD的十年和终身风险呈现下降趋势（P <0.001）。研究的第二部分包括了开滦研究队列中88,995名参与了2006调查且符合纳入标准的个体。我们首先验证了LE8得分与ASCVD发病风险之间的负向相关关系。随后，我们观察了46,629名研究对象在2006和2012调查期间LE8得分的变化情况。结果显示，在两次调查期间，LE8得分保持在较低、中等和较高水平的人群比例分别为17.5%、13.2%和17.3%，26.3%的研究对象LE8水平下降，25.8%的研究对象LE8水平改善。我们随访各LE8变化组的ASCVD和死亡风险至2019年12月。在校正了混杂因素后，与LE8保持在较低水平组相比，LE8保持在中等和较高水平组的ASCVD终身发病风险分别降低了43%和71%。LE8从较低改善到中等水平组的终身发病风险降低了32%，LE8从较低改善到较高水平组的终身发病风险降低了43%，LE8从中等改善到较高水平组的终身发病风险降低了61%。结论与意义: LE8作为评估心血管健康的简便易行工具可有效评估未来发生ASCVD的风险。我国人群的心血管健康水平亟待提高，建议采用LE8作为评估和监测我国心血管健康的可选择指标，促进人群达到理想心血管健康水平，从而减轻我国心血管疾病负担。该研究为这些生活要素影响健康政策的制定提供了科学依据。

Background and Objectives: Atherosclerotic Cardiovascular Diseases (ASCVD) are the leading cause of death globally. With the acceleration of population aging and the widespread prevalence of unhealthy lifestyles, the burden of ASCVD is expected to continue to rise. To effectively curb this trend, there is an urgent need to strengthen the primordial prevention of cardiovascular diseases. The American Heart Association recently released "Life's Essential 8 (LE8)" to assess and promote cardiovascular health. "Life's Essential 8" includes eight healthy behaviors and factors: smoking cessation, physical activity, healthy diet, healthy sleep, weight control, blood pressure control, lipid control, and blood sugar control. The distribution of LE8 among Chinese adults and its association with short-term and long-term ASCVD risk remains unclear. This study aims to use LE8 to assess the cardiovascular health status of Chinese adults and explore the relationship between LE8 and both 10-year and lifetime ASCVD risk. We strive to promote improvement in cardiovascular health among the Chinese population by providing a simple and effective tool for cardiovascular health assessment, thereby reducing the burden of cardiovascular diseases in China. Methods and Results: The first part of this study included three sub-cohorts of the China ASCVD Risk Assessment (China-PAR) study. We assessed the cardiovascular health levels of 88,665 eligible participants using the LE8. The results showed that their baseline LE8 score was 70.0 points, with 23.3% of participants reaching a high LE8 score (≧80 points). Subsequently, we divided the study participants into five groups based on the quintile cut-off points of the baseline LE8 scores and followed their ASCVD and mortality risks until 2018-2020. After adjusting for age, gender, marital status, education level, household income, and ASCVD family history, we found that the 10-year risk of ASCVD from the first to the fifth group of LE8 was 5.14%, 4.29%, 3.50%, 2.58%, and 1.96%, respectively. Compared to the first group, the 10-year risk of ASCVD decreased by 17%, 32%, 50%, and 62% from the second to fifth groups. If the entire study population achieved the LE8 level of the fifth group, 47.4% of ASCVD events could be prevented. Moreover, the lifetime risk of ASCVD from the first to the fifth group was 33.8%, 29.2%, 24.7%, 19.2%, and 15.1%, respectively, with reductions of 16%, 31%, 48%, and 60% in ASCVD lifetime risk from the second to fifth groups compared to the first group. Trend tests showed a decreasing trend in ASCVD 10-year and lifetime risks with increasing LE8 scores (P <0.001). The second part of this study included 88,995 adults from the Kailuan study cohort who participated in the 2006 survey and met the inclusion criteria. We first verified the inverse association between LE8 levels and ASCVD risk. Subsequently, we observed changes in LE8 scores among 46,629 study participants during the 2006 and 2012 surveys. The results showed that during the two survey periods, the proportions of individuals who maintained low, moderate, and high LE8 levels were 17.5%, 13.2%, and 17.3%, respectively, with 26.3% of participants experiencing a decrease and 25.8% experiencing an improvement in LE8 levels. We followed the ASCVD and mortality risks of the LE8 change groups until December 2019. After adjusting for confounding factors, compared to the group that maintained low LE8 levels, the groups that maintained moderate and high LE8 levels had a 43% and 71% reduction in lifetime risk of ASCVD, respectively. The lifetime risk of ASCVD decreased by 32% when LE8 improved from low to moderate levels, 43% when LE8 improved from low to high levels, and 61% when LE8 improved from mild to high levels. Conclusion and Significance: LE8, as a simple and feasible tool for assessing cardiovascular health, can effectively evaluate the risk of future ASCVD events. The cardiovascular health status of the Chinese population urgently needs improvement. It is recommended that LE8 be used as a selectable indicator for assessing and monitoring cardiovascular health in China, promoting the population to achieve ideal cardiovascular health levels, thereby reducing the burden of cardiovascular diseases in China. This study provides scientific evidence for formulating health policies related to these essential lifestyle factors.

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