Life’s Essential 8 and risk of non-communicable chronic diseases:Outcome-wide analyses

Background:Life’s Simple 7,the former construct of cardiovascular health(CVH)has been used to evaluate adverse non-communicable chronic diseases(NCDs).However,some flaws have been recognized in recent years and Life’s Essential 8 has been established.In this study,we aimed to analyze the association between CVH defined by Life’s Essential 8 and risk of 44 common NCDs and further estimate the population attributable fractions(PAFs)of low-moderate CVH scores in the 44 NCDs.Methods:In the UK Biobank,170,726 participants free of 44 common NCDs at baseline were included.The Life’s Essential 8 composite measure consists of four health behaviours(diet,physical activity,nicotine exposure,and sleep)and four health factors(body mass index,non-high density lipoprotein cholesterol,blood glucose,and blood pressure),and the maximum CVH score was 100 points.CVH score was categorized into low,moderate,and high groups.Participants were followed up for 44 NCDs diagnosis across 10 human system disorders according to the International Classification of Diseases 10th edition(ICD-10)code using linkage to national health records until 2022.Cox proportional hazard models were used in this study.The hazard ratios(HRs)and PAFs of 44 NCDs associated with CVH score were examined.Results:During the median follow-up of 10.85 years,58,889 incident NCD cases were documented.Significant linear dose-response associations were found between higher CVH score and lower risk of 25(56.8%)of 44 NCDs.Low-moderate CVH(<80 points)score accounted for the largest proportion of incident cases in diabetes(PAF:80.3%),followed by gout(59.6%),sleep disorder(55.6%),chronic liver disease(45.9%),chronic kidney disease(40.9%),ischemic heart disease(40.8%),chronic obstructive pulmonary disease(40.0%),endometrium cancer(35.8%),lung cancer(34.0%),and heart failure(34.0%)as the top 10.Among the eight modifiable factors,overweight/obesity explained the largest number of cases of incident NCDs in endocrine,nutritional,and metabolic diseases(35.4%),digestive system disorders(21.4%),mental and behavioral disorders(12.6%),and cancer(10.3%);however,the PAF of ideal sleep duration ranked first in nervous system(27.5%)and neuropsychiatric disorders(9.9%).Conclusions:Improving CVH score based on Life’s Essential 8 may lower risk of 25 common NCDs.Among CVH metrics,avoiding overweight/obesity may be especially important to prevent new cases of metabolic diseases,NCDs in digestive system,mental and behavioral disorders,and cancer.

Sex Hormone-binding Globulin,Cardiometabolic Biomarkers,and Gestational Diabetes:A Longitudinal Study and Meta-analysis

Objective::This study investigated the prospective associations of circulating levels of sex hormone-binding globulin(SHBG)levels with cardiometabolic biomarkers and risk of gestational diabetes(GDM)during pregnancy.It also examines the longitudinal trajectory of SHBG in women with and without GDM.Methods::We conducted a nested case-control study of 107 incident GDM cases and 214 matched controls within the Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Studies-Singleton Cohort.The cohort enrolled non-obese and obese women aged 18-40 years with a singleton pregnancy between 8 and 13 weeks of gestation from 2009 to 2013.GDM was ascertained via medical records review.Blood samples were drawn four times at gestational weeks 10-14,15-26,23-31,and 33-39.The prospective associations between SHBG levels and cardiometabolic biomarkers were examined using the Spearman partial correlation among the controls.The longitudinal trajectories of SHBG levels were examined among the cases and the controls.Meta-analysis of prospective studies were performed to examine the association between SHBG levels and GDM risk.Results::SHBG levels at gestational weeks 10-14 were significantly inversely associated with fasting insulin(r=-0.17,P=0.01)and insulin resistance as measured by HOMA-IR(r=-0.17,P=0.01)at gestational week 15-26.SHBG at gestational weeks 10-14 and 15-26 was lower in cases than controls(mean±standard deviation:(204.0±97.6)vs.(220.9±102.5)nmol/L,P=0.16 and(305.6±124.3)vs.(322.7±105.1)nmol/L,P=0.14,respectively),yet the differences were not significant.In the meta-analysis,SHBG was 41.5 nmol/L(95%confidence interval:23.9,59.1,P<0.01)significantly lower among women with GDM than without,and each 50 nmol/L increase in SHBG was significantly associated with an odds ratio of 0.85(95%confidence interval:0.76-0.95,P=0.01)for GDM.Conclusion::Lower SHBG levels in early pregnancy were prospectively associated with higher high insulin levels and insulin resistance in mid-pregnancy and subsequent risk of GDM,independent of adiposity.SHBG may serve as a marker for the identification of high-risk pregnancies during early pregnancy.