美国成年人的心血管健康与预期寿命。
Cardiovascular Health and Life Expectancy Among Adults in the United States.
机构信息
Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (H.M., X.W., Q.X., X.L., Y.H., L.Q.).
Obstetrical Department, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China (Z.L.).
出版信息
Circulation. 2023 Apr 11;147(15):1137-1146. doi: 10.1161/CIRCULATIONAHA.122.062457. Epub 2023 Apr 10.
BACKGROUND
Cardiovascular disease may be the main reason for stagnant growth in life expectancy in the United States since 2010. The American Heart Association recently released an updated algorithm for evaluating cardiovascular health (CVH)-Life's Essential 8 (LE8) score. We aimed to quantify the associations of CVH levels, estimated by the LE8 score, with life expectancy in a nationally representative sample of US adults.
METHODS
We included 23 003 nonpregnant, noninstitutionalized participants aged 20 to 79 years who participated in the National Health and Nutrition Examination Survey from 2005 to 2018 and whose mortality was identified through linkage to the National Death Index through December 31, 2019. The overall CVH was evaluated by the LE8 score (range, 0-100), as well as the score for each component of diet, physical activity, tobacco/nicotine exposure, sleep duration, body mass index, non-high-density lipoprotein cholesterol, blood glucose, and blood pressure. Life table method was used to estimate life expectancy by levels of the CVH.
RESULTS
During a median of 7.8 years of follow-up, 1359 total deaths occurred. The estimated life expectancy at age 50 years was 27.3 years (95% CI, 26.1-28.4), 32.9 years (95% CI, 32.3-33.4), and 36.2 years (95% CI, 34.2-38.2) in participants with low (LE8 score <50), moderate (50≤ LE8 score <80), and high (LE8 score ≥80) CVH, respectively. Equivalently, participants with high CVH had an average 8.9 (95% CI, 6.2-11.5) more years of life expectancy at age 50 years compared with those with low CVH. On average, 42.6% of the gained life expectancy at age 50 years from adhering to high CVH was attributable to reduced cardiovascular disease death. Similarly significant associations of CVH with life expectancy were observed in men and women, respectively. Similarly significant associations of CVH with life expectancy were observed in White participants and Black participants but not in Mexican participants.
CONCLUSIONS
Adhering to a high CVH, defined as the LE8 score, is related to a considerably increased life expectancy in US adults, but more research needs to be done in other races and ethnicities (eg, Hispanic and Asian).
背景
自 2010 年以来，心血管疾病可能是美国预期寿命增长停滞的主要原因。美国心脏协会最近发布了一种更新的心血管健康评估算法（CVH）-Life's essential 8（LE8）评分。我们旨在量化 LE8 评分评估的 CVH 水平与美国成年人全国代表性样本中预期寿命之间的关联。
方法
我们纳入了 23003 名年龄在 20 至 79 岁之间、无妊娠、非住院的非裔美国成年人，他们参加了 2005 年至 2018 年的国家健康和营养调查，并通过与国家死亡指数的链接确定了他们的死亡率，截止到 2019 年 12 月 31 日。通过 LE8 评分（范围为 0-100）评估整体 CVH，以及饮食、身体活动、烟草/尼古丁暴露、睡眠时间、体重指数、非高密度脂蛋白胆固醇、血糖和血压等各个组成部分的评分。使用寿命表法根据 CVH 水平估计预期寿命。
结果
在中位数为 7.8 年的随访期间，共发生 1359 例全因死亡。50 岁时的预期寿命估计值分别为低 CVH 组（LE8 评分<50）为 27.3 年（95%CI，26.1-28.4），中 CVH 组（50≤LE8 评分<80）为 32.9 年（95%CI，32.3-33.4）和高 CVH 组（LE8 评分≥80）为 36.2 年（95%CI，34.2-38.2）。同样，50 岁时具有高 CVH 的参与者比具有低 CVH 的参与者平均多 8.9 年（95%CI，6.2-11.5）的预期寿命。平均而言，50 岁时由于坚持高 CVH 而获得的预期寿命的 42.6%归因于心血管疾病死亡的减少。在男性和女性中，CVH 与预期寿命之间也存在类似的显著关联。在白人和黑人群体中观察到 CVH 与预期寿命之间存在类似的显著关联，但在墨西哥裔参与者中没有观察到这种关联。
结论
坚持高 CVH（定义为 LE8 评分）与美国成年人的预期寿命显著增加有关，但需要在其他种族和族裔（如西班牙裔和亚裔）中进行更多研究。
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