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Joint association of modifiable lifestyle and metabolic health status with incidence of cardiovascular disease and all-cause mortality: a prospective cohort study

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Abstract

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.

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Data availability

Data are available to researchers on request for purposes of reproducing the results or replicating the procedure by directly contacting the corresponding author.

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Acknowledgements

The authors thank all study participants, their relatives, the members of the survey teams at the 11 regional hospitals of the Kailuan Medical Group, and the project development and management teams at the Beijing Tiantan Hospital and the Kailuan Group.

Funding

This study was funded by Beijing Municipal Administration of Hospitals Incubating Program (PX2020021), Beijing Excellent Talents Training Program (2018000021469G234), Young Elite Scientists Sponsorship Program by CAST (2018QNRC001), and National Key R&D Program of China (2018YFC1312400 and 2018YFC1312402).

Author information

Author notes

  1. These authors contributed equally: Yingting Zuo, Haibin Li

Authors and Affiliations

  1. China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

    Yingting Zuo, Xue Tian, Dapeng Mo & Anxin Wang

  2. Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

    Yingting Zuo, Xue Tian, Dapeng Mo & Anxin Wang

  3. Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China

    Yingting Zuo & Xue Tian

  4. Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China

    Yingting Zuo & Xue Tian

  5. Department of Cardiac Surgery, Heart Center, and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China

    Haibin Li

  6. Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China

    Shuohua Chen & Shouling Wu

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  1. Yingting Zuo
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Contributions

Y.Z. and H.L. wrote the manuscript. Y.Z., A.W., S.C., X.T., and H.L. collected the data. S.C. and X.T. researched data and contributed to discussion. S.W. and D.M. reviewed and edited the manuscript. A.W. contributed to the discussion and reviewed/edited the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Shouling Wu or Anxin Wang.

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Conflict of interest

The authors declare no competing interests.

Ethical approval

The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was performed according to the guidelines of the Helsinki Declaration and was approved by the Ethics Committee of Kailuan General Hospital (approval number: 2006-05) and Beijing Tiantan Hospital (approval number: 2010-014-01). Written consents were obtained from all participants or their legal representatives.

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Zuo, Y., Li, H., Chen, S. et al. Joint association of modifiable lifestyle and metabolic health status with incidence of cardiovascular disease and all-cause mortality: a prospective cohort study. Endocrine 75, 82–91 (2022). https://doi.org/10.1007/s12020-021-02832-9

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  • DOI: https://doi.org/10.1007/s12020-021-02832-9

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