Abstract：
OBJECTIVE: Our study examined the trends of cardiovascular health metrics in individuals with coronary heart disease (CHD) and their associations with all-cause and cardiovascular disease mortality in the US.
RESULTS: The cohort study was conducted based on the National Health and Nutrition Examination Survey 1999-2018 and their linked mortality files (through 2019). Baseline CHD was defined as a composite of self-reported doctor-diagnosed coronary heart disease, myocardial infarction, and angina pectoris. Cardiovascular health metrics were assessed according to the American Heart Association recommendations. Long-term all-cause and cardiovascular disease mortality were the primary outcomes. Survey-adjusted Cox regression models were used to estimate hazard ratios and corresponding 95% confidence intervals for the associations between cardiovascular health metrics and all-cause and cardiovascular disease mortality. The prevalence of one or fewer ideal cardiovascular health metrics increased from 14.15% to 22.79% (P < 0.001) in CHD, while the prevalence of more than four ideal cardiovascular health metrics decreased from 21.65% to 15.70 % (P < 0.001) from 1999 to 2018, respectively. Compared with CHD participants with one or fewer ideal cardiovascular health metrics, those with four or more ideal cardiovascular health metrics had a 35% lower risk (hazard ratio, 0.65; 95% confidence interval: 0.51, 0.82) and a 44% lower risk (0.56; 0.38, 0.84) in all-cause and cardiovascular disease mortality, respectively.
CONCLUSIONS: Substantial declines were noted in ideal cardiovascular health metrics in US adults with CHD. A higher number of cardiovascular health metrics was associated with lower all-cause and cardiovascular disease mortality in them.
RESULTS: The cohort study was conducted based on the National Health and Nutrition Examination Survey 1999-2018 and their linked mortality files (through 2019). Baseline CHD was defined as a composite of self-reported doctor-diagnosed coronary heart disease, myocardial infarction, and angina pectoris. Cardiovascular health metrics were assessed according to the American Heart Association recommendations. Long-term all-cause and cardiovascular disease mortality were the primary outcomes. Survey-adjusted Cox regression models were used to estimate hazard ratios and corresponding 95% confidence intervals for the associations between cardiovascular health metrics and all-cause and cardiovascular disease mortality. The prevalence of one or fewer ideal cardiovascular health metrics increased from 14.15% to 22.79% (P < 0.001) in CHD, while the prevalence of more than four ideal cardiovascular health metrics decreased from 21.65% to 15.70 % (P < 0.001) from 1999 to 2018, respectively. Compared with CHD participants with one or fewer ideal cardiovascular health metrics, those with four or more ideal cardiovascular health metrics had a 35% lower risk (hazard ratio, 0.65; 95% confidence interval: 0.51, 0.82) and a 44% lower risk (0.56; 0.38, 0.84) in all-cause and cardiovascular disease mortality, respectively.
CONCLUSIONS: Substantial declines were noted in ideal cardiovascular health metrics in US adults with CHD. A higher number of cardiovascular health metrics was associated with lower all-cause and cardiovascular disease mortality in them.
摘要：
目的：我们的研究调查了美国冠心病（CHD）患者心血管健康指标的变化趋势及其与全因死亡率和心血管疾病死亡率的关系。
结果：该队列研究是根据1999-2018年国家健康和营养检查调查及其相关死亡率文件（至2019年）进行的。基线冠心病被定义为自我报告的医生诊断的冠心病的复合，心肌梗塞,还有心绞痛.根据美国心脏协会的建议评估心血管健康指标。长期全因死亡率和心血管疾病死亡率是主要结果。使用调查调整的Cox回归模型来估计心血管健康指标与全因死亡率和心血管疾病死亡率之间关联的风险比和相应的95%置信区间。一个或更少的理想心血管健康指标的患病率在冠心病中从14.15%增加到22.79%(P<0.001)。从1999年到2018年，超过4个理想心血管健康指标的患病率分别从21.65%降至15.70%(P<0.001)。与具有一个或更少的理想心血管健康指标的冠心病参与者相比，那些具有四个或更多理想心血管健康指标的人的风险降低了35%(风险比，0.65；95％置信区间：0.51，0.82）和全因和心血管疾病死亡率的风险降低44％（0.56；0.38，0.84），分别。
结论：在美国成人冠心病患者中，理想的心血管健康指标显著下降。较高数量的心血管健康指标与较低的全因死亡率和心血管疾病死亡率相关。
结果：该队列研究是根据1999-2018年国家健康和营养检查调查及其相关死亡率文件（至2019年）进行的。基线冠心病被定义为自我报告的医生诊断的冠心病的复合，心肌梗塞,还有心绞痛.根据美国心脏协会的建议评估心血管健康指标。长期全因死亡率和心血管疾病死亡率是主要结果。使用调查调整的Cox回归模型来估计心血管健康指标与全因死亡率和心血管疾病死亡率之间关联的风险比和相应的95%置信区间。一个或更少的理想心血管健康指标的患病率在冠心病中从14.15%增加到22.79%(P<0.001)。从1999年到2018年，超过4个理想心血管健康指标的患病率分别从21.65%降至15.70%(P<0.001)。与具有一个或更少的理想心血管健康指标的冠心病参与者相比，那些具有四个或更多理想心血管健康指标的人的风险降低了35%(风险比，0.65；95％置信区间：0.51，0.82）和全因和心血管疾病死亡率的风险降低44％（0.56；0.38，0.84），分别。
结论：在美国成人冠心病患者中，理想的心血管健康指标显著下降。较高数量的心血管健康指标与较低的全因死亡率和心血管疾病死亡率相关。
