背景心血管健康(CVH)状态的变化与心血管疾病的风险有关。然而,没有研究探讨CVH与心源性猝死(SCD)风险的变化规律.我们旨在研究基线CVH和CVH随时间变化与SCD风险之间的联系。方法和结果在前瞻性队列ARIC(社区动脉粥样硬化风险)研究中进行了分析,始于1987年至1989年。ARIC从美国4个社区招募了15792名45至64岁的人(福赛斯县,北卡罗来纳州;杰克逊,密西西比州;明尼阿波利斯的郊区,明尼苏达州;和华盛顿县,马里兰)。具有0至2、3至4和5至7个理想CVH指标的受试者被归类为不良,中间,或理想的CVH,分别。考虑了在1987年至1989年和1993年至1995年之间的6年内CVH的变化。主要研究结果是医生裁定的SCD。研究人群由15026名受试者组成,其中12207人有CVH变化的数据。在平均23.0年的随访中,记录583例SCD。基线CVH指标和随时间变化的CVH指标与SCD风险之间存在很强的负相关。与CVH持续较差的受试者相比,从不良到中等/理想的人群的SCD风险较低(风险比[HR],0.67[95%CI,0.48-0.94]),中级到穷人(HR,0.73[95%CI,0.54-0.99]),从中级到理想(HR,0.49[95%CI,0.24-0.99]),理想到差/中等CVH(HR,0.23[95%CI,0.10-0.52]),或那些具有一致中级(HR,0.49[95%CI,0.36-0.66])或一致理想的CVH(HR,0.31[95%CI,0.13-0.76])。对于非SCD也观察到类似的结果。结论与持续较差的CVH相比,CVH的其他变化模式与SCD风险较低相关.这些发现强调了在SCD的原始预防中促进理想CVH的重要性。
Background The change of cardiovascular health (CVH) status has been associated with risk of cardiovascular disease. However, no studies have explored the change patterns of CVH in relation to risk of sudden cardiac death (SCD). We aim to examine the link between baseline CVH and change of CVH over time with the risk of SCD. Methods and Results Analyses were conducted in the prospective cohort ARIC (Atherosclerosis Risk in Communities) study, started in 1987 to 1989. ARIC enrolled 15 792 individuals 45 to 64 years of age from 4 US communities (Forsyth County, North Carolina; Jackson,
Mississippi; suburbs of Minneapolis, Minnesota; and Washington County, Maryland). Subjects with 0 to 2, 3 to 4, and 5 to 7 ideal metrics of CVH were categorized as having poor, intermediate, or ideal CVH, respectively. Change in CVH over 6 years between 1987 to 1989 and 1993 to 1995 was considered. The primary study outcome was physician adjudicated SCD. The study population consisted of 15 026 subjects, of whom 12 207 had data about CVH change. Over a median follow-up of 23.0 years, 583 cases of SCD were recorded. There was a strong inverse association between baseline CVH metrics and time varying CVH metrics with risk of SCD. Compared with subjects with consistently poor CVH, risk of SCD was lower in those changed from poor to intermediate/ideal (hazard ratio [HR], 0.67 [95% CI, 0.48-0.94]), intermediate to poor (HR, 0.73 [95% CI, 0.54-0.99]), intermediate to ideal (HR, 0.49 [95% CI, 0.24-0.99]), ideal to poor/intermediate CVH (HR, 0.23 [95% CI, 0.10-0.52]), or those with consistently intermediate (HR, 0.49 [95% CI, 0.36-0.66]) or consistently ideal CVH (HR, 0.31 [95% CI, 0.13-0.76]). Similar results were also observed for non-SCD. Conclusions Compared with consistently poor CVH, other patterns of change in CVH were associated with lower risk of SCD. These findings highlight the importance of promotion of ideal CVH in the primordial prevention of SCD.