背景:美国心脏协会最近推出了一种新的心血管健康(CVH)指标,生命的本质8(LE8),促进健康。然而,LE8与癌症死亡风险之间的关系仍不确定.
方法:我们调查了来自美国国家健康与营养调查(USNHANES)的17,076名参与者和来自英国生物银行的272,727名参与者,基线时全部无癌。CVH分数,基于LE8指标,包含四种健康行为(饮食,身体活动,吸烟,和睡眠)和四个健康因素(体重指数,脂质,血糖,和血压)。自我报告问卷评估健康行为。主要结果是总癌症及其亚型的死亡率。使用带调整的Cox模型检查CVH评分(连续和分类变量)与结果之间的关联。构建与癌症亚型相关的多基因风险评分(PRS),以评估其与CVH对癌症死亡风险的相互作用。
结果:美国NHANES超过141,526人年,发生了424例癌症相关死亡,在英国生物银行,在3,690,893人年期间记录了8,872例癌症死亡。与低CVH相比,高CVH与总体癌症死亡率降低相关(美国NHANES中HR0.58,95%CI0.37-0.91;英国生物银行中HR0.51,0.46-0.57)。在美国NHANES中,CVH评分的每一个标准差增加与癌症死亡率降低19%(HR:0.81;95%CI:0.73-0.91)和英国生物银行降低19%(HR:0.81;95%CI:0.79-0.83)相关。坚持理想的CVH与降低肺部死亡风险呈线性关系,膀胱,肝脏,肾,食道,乳房,结直肠,胰腺,和英国生物银行的胃癌。此外,整合遗传数据显示,与PRS和CVH较高的患者相比,PRS较低和CVH较高的患者在8种癌症中死亡率最低(HRs为0.36~0.57).未观察到因遗传易感性导致的CVH与八种癌症的死亡风险之间的关联的显着改变。亚组分析显示,在年轻参与者和社会经济地位较低的参与者中,总体癌症死亡率具有更明显的保护性关联。
结论:维持最佳CVH与总体癌症死亡率风险的显著降低相关。对理想CVH的坚持与多种癌症亚型的死亡风险降低呈线性关系。具有理想CVH和高遗传易感性的个体表现出显著的健康益处。这些发现支持采用理想的CVH作为干预策略,以减轻癌症死亡风险并促进健康衰老。
BACKGROUND: The American Heart Association recently introduced a novel cardiovascular health (CVH) metric, Life\'s Essential 8 (LE8), for health promotion. However, the relationship between LE8 and cancer mortality risk remains uncertain.
METHODS: We investigated 17,076 participants from US National Health and Nutrition Examination Survey (US NHANES) and 272,727 participants from UK Biobank, all free of cancer at baseline. The CVH score, based on LE8 metrics, incorporates four health behaviors (diet, physical activity, smoking, and sleep) and four health factors (body mass index, lipid, blood glucose, and blood pressure). Self-reported questionnaires assessed health behaviors. Primary outcomes were mortality rates for total cancer and its subtypes. The association between CVH score (continuous and categorical variable) and outcomes was examined using Cox model with adjustments. Cancer subtypes-related polygenic risk score (PRS) was constructed to evaluate its interactions with CVH on cancer death risk.
RESULTS: Over 141,526 person-years in US NHANES, 424 cancer-related deaths occurred, and in UK Biobank, 8,872 cancer deaths were documented during 3,690,893 person-years. High CVH was associated with reduced overall cancer mortality compared to low CVH (HR 0.58, 95% CI 0.37-0.91 in US NHANES; 0.51, 0.46-0.57 in UK Biobank). Each one-standard deviation increase in CVH score was linked to a 19% decrease in cancer mortality (HR: 0.81; 95% CI: 0.73-0.91) in US NHANES and a 19% decrease (HR: 0.81; 95% CI: 0.79-0.83) in UK Biobank. Adhering to ideal CVH was linearly associated with decreased risks of death from lung, bladder, liver, kidney, esophageal, breast, colorectal, pancreatic, and gastric cancers in UK Biobank. Furthermore, integrating genetic data revealed individuals with low PRS and high CVH exhibited the lowest mortality from eight cancers (HRs ranged from 0.36 to 0.57) compared to those with high PRS and low CVH. No significant modification of the association between CVH and mortality risk for eight cancers by genetic predisposition was observed. Subgroup analyses showed a more pronounced protective association for overall cancer mortality among younger participants and those with lower socio-economic status.
CONCLUSIONS: Maintaining optimal CVH is associated with a substantial reduction in the risk of overall cancer mortality. Adherence to ideal CVH correlates linearly with decreased mortality risk across multiple cancer subtypes. Individuals with both ideal CVH and high genetic predisposition demonstrated significant health benefits. These findings support adopting ideal CVH as an intervention strategy to mitigate cancer mortality risk and promote healthy aging.