基于生命八要素的心血管健康评分与新发心房颤动的关联研究:大样本长期随访研究

Relationship between Cardiovascular Health Score of Life's Essential 8 and New-onset Atrial Fibrillation:a Large Sample,Long-Term Follow-up Study

背景近年来全球心房颤动(以下简称房颤)的患病率持续升高,房颤增加了卒中、心力衰竭、心肌梗死、慢性肾病等疾病的发病风险。研究证实高血压、糖尿病、吸烟、阻塞性睡眠呼吸暂停、肥胖和久坐等是房颤发生的危险因素。而这些因素多数是美国心脏协会提出的“生命八要素”(LE8)的范畴。目的探讨基于LE8的心血管健康(CVH)评分与房颤的关联。方法选取2006年6月—2007年10月河北省唐山市开滦集团职工健康体检人群91131名为研究对象。LE8评分根据美国心脏协会制订的算法评估,结合开滦研究实际情况形成LE8开滦研究版本,包括4个健康行为(饮食、体育活动、烟草暴露和睡眠)和4个健康因素(BMI、血脂、血糖和血压)。依据LE8评分将研究对象分为3组:LE8评分<50分为低CVH组(8407名),50分≤LE8评分<80分为中CVH组(73493名),LE8评分≥80分为高CVH组(9231名)。以研究对象首次参加开滦体检时间为随访起点,每年随访1次,以发生房颤为终点事件,随访终点时间为发生房颤或随访结束时间(2020-12-31)。采用Kaplan-Meier生存曲线分析不同组新发房颤累积发病率,并进行Log-rank检验比较组间差异;采用Cox比例风险回归分析探讨不同LE8评分分组及单个因素评分对新发房颤发病风险的影响。结果3组研究对象年龄、性别、受教育程度、家庭人均月收入、饮酒史以及LE8评分比较,差异均有统计学意义(P<0.001)。随访中新发房颤1088例,其中低CVH组新发房颤133例(1.58%),中CVH组新发房颤883例(1.20%),高CVH组新发房颤72例(0.78%);中位随访时间15.0(14.7,15.2)年;3组研究对象新发房颤累积发病率比较,差异有统计学意义(P<0.0001)。校正年龄、性别、受教育程度、家庭人均月收入、饮酒史后进行Cox比例风险回归分析结果显示,与低CVH组相比,中CVH组(HR=0.697,95%CI=0.579~0.841,P<0.001)、高CVH组(HR=0.609,95%CI=0.454~0.816,P=0.001)均可降低新发房颤的发病风险;LE8评分升高可降低新发房颤的发病风险(HR=0.859,95%CI=0.804~0.918,P<0.001);LE8单个因素BMI评分(HR=0.762,95%CI=0.717~0.809,P<0.001)、血压评分(HR=0.824,95%CI=0.776~0.876,P<0.001)与新发房颤发病风险呈负相关。结论CVH的LE8评分与新发房颤的发病风险呈负相关,且LE8单个因素BMI评分、血压评分与新发房颤发病风险均呈负相关。

Background The prevalence of atrial fibrillation(AF)has continued to rise globally in recent years,and AF increases the risk of stroke,heart failure,myocardial infarction,chronic kidney disease,and other diseases.Studies have identified hypertension,diabetes,smoking,obstructive sleep apnea,obesity and sedentary lifestyle as risk factors for AF.And most of these factors are within the scope of the"Life's Essential 8"(LE8)proposed by the American Heart Association.Objective To investigate the relationship between cardiovascular health(CVH)score based on the LE8 and AF.Methods A study was conducted in which 91131 employees of Kailuan Group in Tangshan,Hebei Province were selected for physical examination from June 2006 to October 2007,and the LE8 score was evaluated according to the algorithm developed by the American Heart Association,and combined with the actual situation of the Kailuan study to form the Kailuan study version of LE8,including 4 health behaviors(diet,physical activity,tobacco exposure,and sleep)and 4 health factors(BMI,blood lipids,blood glucose,and blood pressure).The study subjects were divided into the three groups of the low CVH group(n=8407)with a LE8 score less than 50,the medium CVH group(n=73493)with a LE8 score of 50 or more but less than 80,and the high CVH group(n=9231)with a LE8 score of 80 or more.The follow-up visit was performed per year with the time of the study subject's first Kailuan physical examination as the starting point,the occurrence of AF as the endpoint event,the end of AF and follow-up(2020-12-31)as the endpoint time.Kaplan Meier survival curve was used to analyze the cumulative incidence of new-onset AF in different groups,and log rank test was used to compare the differences between groups;Cox proportional hazards regression analysis was used to investigate the impact of different LE8 score groups and single factor scores on the risk of new-onset AF.Results There were significant differences in age,gender,education level,monthly per capita household income,history of alcohol consumption,and LE8 scores among the three groups of subjects(P<0.001).During follow-up,1088 cases of new-onset AF were identified,including 133 cases(1.58%)in the low CVH group,883 cases(1.20%)in the medium CVH group,and 72 cases(0.78%)in the high CVH group.The median follow-up time was 15.0(14.7,15.2)years;there was statistically significant difference in the comparison of cumulative incidence rate of new-onset AF in the three groups(P<0.0001).Cox proportional hazards regression analysis after adjusting for age,gender,education level,monthly per capita household income,and history of alcohol consumption showed that,compared with the low CVH group,both the medium CVH group(HR=0.697,95%CI=0.579-0.841,P<0.001)and the high CVH group(HR=0.609,95%CI=0.454-0.816,P=0.001)reduced the risk of new-onset AF.An increase in LE8 score could reduce the risk of new-onset AF(HR=0.859,95%CI=0.804-0.918,P<0.001).The individual factors of LE8,including BMI score(HR=0.762,95%CI=0.717-0.809,P<0.001)and blood pressure score(HR=0.824,95%CI=0.776-0.876,P<0.001),were negatively correlated with the risk of new-onset AF.Conclusion The LE8 score of CVH is negatively correlated with the risk of new-onset AF,and the individual factors of LE8,including BMI score and blood pressure score,are negatively correlated with the risk of new-onset AF.