生活方式因素及其对心血管-肾脏-代谢性多病症纵向进展的相对贡献：一项前瞻性队列研究。
Lifestyle factors and their relative contributions to longitudinal progression of cardio-renal-metabolic multimorbidity: a prospective cohort study.
机构信息
West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, China.
State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Chinese Academy of Medical Sciences , Sichuan University, Chengdu, 610041, China.
出版信息
Cardiovasc Diabetol. 2024 Jul 18;23(1):265. doi: 10.1186/s12933-024-02347-3.
BACKGROUND
The role of lifestyle factors and their relative contributions to the development and mortality of cardio-renal-metabolic multimorbidity (CRMM) remains unclear.
METHODS
A study was conducted with 357,554 UK Biobank participants. CRMM was defined as the coexistence of two or three cardio-renal-metabolic diseases (CRMDs), including cardiovascular disease (CVD), type 2 diabetes (T2D) and chronic kidney disease (CKD). The prospective study examined the associations of individual and combined lifestyle scores (diet, alcohol consumption, smoking, physical activity, sedentary behavior, sleep duration and social connection) with longitudinal progression from healthy to first cardio-renal-metabolic disease (FCRMD), then to CRMM, and ultimately to death, using a multistate model. Subsequently, quantile G-computation was employed to assess the relative contribution of each lifestyle factor.
RESULTS
During a median follow-up of 13.62 years, lifestyle played crucial role in all transitions from healthy to FCRMD, then to CRMM, and ultimately to death. The hazard ratios (95% CIs) per score increase were 0.91 (0.90, 0.91) and 0.90 (0.89, 0.91) for healthy to FCRMD, and for FCRMD to CRMM, and 0.84 (0.83, 0.86), 0.87 (0.86, 0.89), and 0.90 (0.88, 0.93) for mortality risk from healthy, FCRMD, and CRMM, respectively. Among the seven factors, smoking status contributed to high proportions for the whole disease progression, accounting for 19.88-38.10%. High-risk diet contributed the largest proportion to the risk of transition from FCRMD to CRMM, with 22.53%. Less-frequent social connection contributed the largest proportion to the risk of transition from FCRMD to death, with 28.81%. When we further consider the disease-specific transitions, we find that lifestyle scores had slightly stronger associations with development to T2D than to CVD or CKD.
CONCLUSIONS
Our study indicates that a healthy lifestyle may have a protective effect throughout the longitudinal progression of CRMM, informing more effective management and treatment. Smoking status, diet, and social connection played pivotal roles in specific disease transitions.
背景
生活方式因素的作用及其对心肾代谢合并症（CRMM）的发生和死亡的相对贡献尚不清楚。
方法
本研究纳入了 357554 名英国生物库参与者。CRMM 定义为两种或三种心肾代谢疾病（CRMDs）的共存，包括心血管疾病（CVD）、2 型糖尿病（T2D）和慢性肾脏病（CKD）。这项前瞻性研究使用多状态模型，通过个体和综合生活方式评分（饮食、饮酒、吸烟、体力活动、久坐行为、睡眠时间和社会联系），来检测其与从健康到首次心肾代谢疾病（FCRMD）、再到 CRMM、最终到死亡的纵向进展之间的关联。随后，采用分位数 G 计算来评估每个生活方式因素的相对贡献。
结果
在中位随访 13.62 年期间，生活方式在从健康到 FCRMD，再到 CRMM，最后到死亡的所有转变中都起着至关重要的作用。每个评分增加的危险比（95%CI）分别为 0.91（0.90，0.91）和 0.90（0.89，0.91），从健康到 FCRMD，以及从 FCRMD 到 CRMM，死亡率风险分别为 0.84（0.83，0.86）、0.87（0.86，0.89）和 0.90（0.88，0.93）。在这七个因素中，吸烟状况对整个疾病进展的贡献比例较高，占 19.88%-38.10%。高风险饮食对从 FCRMD 到 CRMM 的转变风险贡献最大，占 22.53%。较少的社会联系对从 FCRMD 到死亡的转变风险贡献最大，占 28.81%。当我们进一步考虑特定疾病的转变时，我们发现生活方式评分与 T2D 的发展比与 CVD 或 CKD 的发展有更强的关联。
结论
我们的研究表明，健康的生活方式可能对 CRMM 的纵向进展具有保护作用，为更有效的管理和治疗提供了依据。吸烟状况、饮食和社会联系在特定疾病的转变中起着关键作用。
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