PURPOSE We aimed to identify the joint associations of modifiable lifestyle and metabolic factors with the incidences of cardiovascular disease and all-cause mortality. METHODS We recruited 94,831 participants (men, 79.76%; median age, 51.60 [43.47-58.87]) without a history of cardiovascular disease from the Kailuan study during 2006 and 2007 and followed them until a cardiovascular disease event, or death occurred, or until December 31, 2017. Baseline metabolic health status was assessed using Adult Treatment Panel III criteria, and details of the lifestyles of the participants were recorded using a self-reported questionnaire. We used Cox proportional hazards models to evaluate the joint associations. RESULTS During a median follow-up of 11.03 years, we recorded 6590 cardiovascular disease events and 9218 all-cause mortality. Participants with the most metabolic risk components and the least healthy lifestyle had higher risk of cardiovascular disease (hazard ratio 2.06 [95% confidence interval (CI) 1.77-2.39]) and mortality (HR 1.53 [95% CI 1.31-1.78]), than participants with fewer metabolic risk components and the healthiest lifestyle. Compared with those in participants with the healthiest lifestyle, the HRs for cardiovascular disease in participants with the least healthy lifestyle were 1.26 (95% CI 1.17-1.37), 1.16 (95% CI 1.03-1.31), and 1.07 (95% CI 0.90-1.27) for those with low, medium, and high metabolic risk, respectively. CONCLUSION Healthy lifestyle is associated with a lower risk of cardiovascular disease and there is no significant interaction between metabolic risk and a healthy lifestyle. Therefore, a healthy lifestyle should be promoted, even for people with high metabolic risk.

中文翻译：

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可改变的生活方式和代谢健康状况与心血管疾病发病率和全因死亡率的联合关联：一项前瞻性队列研究。

目的 我们旨在确定可改变的生活方式和代谢因素与心血管疾病发病率和全因死亡率的联合关联。方法 我们在 2006 年和 2007 年期间从开滦研究中招募了 94,831 名参与者（男性，79.76%；中位年龄，51.60 [43.47-58.87]），并跟踪他们直到心血管疾病事件或死亡发生，或直到2017 年 12 月 31 日。使用成人治疗小组 III 标准评估基线代谢健康状况，并使用自我报告的问卷记录参与者的生活方式细节。我们使用 Cox 比例风险模型来评估联合关联。结果 在 11.03 年的中位随访期间，我们记录了 6590 例心血管疾病事件和 9218 例全因死亡率。具有最多代谢风险成分和最不健康生活方式的参与者患心血管疾病的风险较高（风险比 2.06 [95% 置信区间 (CI) 1.77-2.39]）和死亡率（HR 1.53 [95% CI 1.31-1.78]），与代谢风险成分较少且生活方式最健康的参与者相比。与生活方式最健康的参与者相比，生活方式最不健康的参与者心血管疾病的 HR 分别为 1.26（95% CI 1.17-1.37）、1.16（95% CI 1.03-1.31）和 1.07（95% CI 0.90） -1.27) 分别适用于代谢风险低、中、高的人。结论 健康的生活方式与心血管疾病的风险降低相关，代谢风险与健康的生活方式之间没有显着的相互作用。因此，应该提倡健康的生活方式，