背景:目前的心血管预防策略是基于很少包括瓣膜性心脏病(VHD)的研究。在具有不同社会经济状况(SES)的老年人中,可改变的生活方式因素对VHD进展和预期寿命的作用仍然未知。
方法:该队列研究包括164,775名60岁及以上的UKBiobank参与者。生活方式是使用涵盖吸烟状况的五因素评分系统确定的,肥胖,身体活动,饮食,和睡眠模式。根据这个分数,然后参与者被归类为“穷人,“”适度,\"或\"理想\"生活方式组。根据汤森剥夺指数,SES被分类为高或低。使用多态模式评估生活方式与主要VHD进展的关联。使用寿命表方法来确定具有VHD和不具有VHD的预期寿命。
结果:英国生物银行记录了5132例VHD事件,平均随访12.3年,VHD后1418例死亡,平均随访6.0年。与那些生活方式不好的人相比,遵循理想生活方式的女性和男性发生VHD的风险比较低(95%CI为0.66,女性为0.59-0.73,男性为0.77,95%CI为0.71-0.83)和VHD后死亡率(女性为0.58,男性95%CI0.46-0.74和0.62,95%CI0.54-0.73)。当生活方式和SES结合在一起时,与生活方式不健康且SES较低的参与者相比,生活方式理想且SES较高的参与者发生VHD的风险和死亡率较低.生活方式和SES与VHD的发病率和随后的死亡率之间没有显著的相互作用。在低SES人群中,遵循理想生活方式的60岁VHD女性和男性寿命更长4.2年(95%CI,3.8-4.7)和5.1年(95%CI,4.5-5.6),分别,与那些生活方式差的人相比。相比之下,在坚持理想生活方式与不良生活方式相比,无VHD患者的预期寿命增加女性为4.4岁(95%CI,4.0~4.8),男性为5.3岁(95%CI,4.8~5.7).
结论:采用更健康的生活方式可以显着减缓从无VHD到易发VHD以及进一步死亡的进展,并增加不同社会经济老年人群中有和没有VHD的个体的预期寿命。
BACKGROUND: Current cardiovascular prevention strategies are based on studies that seldom include valvular heart disease (VHD). The role of modifiable lifestyle factors on VHD progression and life expectancy among the elderly with different socioeconomic statuses (SES) remains unknown.
METHODS: This cohort study included 164,775 UK Biobank participants aged 60 years and older. Lifestyle was determined using a five-factor scoring system covering smoking status, obesity, physical activity, diet, and sleep patterns. Based on this score, participants were then classified into \"poor,\" \"moderate,\" or \"ideal\" lifestyle groups. SES was classified as high or low based on the Townsend Deprivation Index. The association of lifestyle with major VHD progression was evaluated using a multistate mode. The life table method was employed to determine life expectancy with VHD and without VHD.
RESULTS: The UK Biobank documented 5132 incident VHD cases with a mean follow-up of 12.3 years and 1418 deaths following VHD with a mean follow-up of 6.0 years. Compared to those with a poor lifestyle, women and men followed an ideal lifestyle had lower hazard ratios for incident VHD (0.66 with 95% CI, 0.59-0.73 for women and 0.77 with 95% CI, 0.71-0.83 for men) and for post-VHD mortality (0.58 for women, 95% CI 0.46-0.74 and 0.62 for men, 95% CI 0.54-0.73). When lifestyle and SES were combined, the lower risk of incident VHD and mortality were observed among participants with an ideal lifestyle and high SES compared to participants with an unhealthy lifestyle and low SES. There was no significant interaction between lifestyle and SES in their correlation with the incidence and subsequent mortality of VHD. Among low SES populations, 60-year-old women and men with VHD who followed ideal lifestyles lived 4.2 years (95% CI, 3.8-4.7) and 5.1 years (95% CI, 4.5-5.6) longer, respectively, compared to those with poor lifestyles. In contrast, the life expectancy gain for those without VHD was 4.4 years (95% CI, 4.0-4.8) for women and 5.3 years (95% CI, 4.8-5.7) for men when adhering to an ideal lifestyle versus a poor one.
CONCLUSIONS: Adopting a healthier lifestyle can significantly slow down the progression from free of VHD to incident VHD and further to death and increase life expectancy for both individuals with and without VHD within diverse socioeconomic elderly populations.