Importance of Healthy Lifestyle Factors and Ideal Cardiovascular Health Metrics for Risk of Heart Failure in Chinese Adults

Abstract

Background: The relative importance of a healthy lifestyle factors and cardiovascular health metrics for risk of heart failure is uncertain.Objectives: To compare the strength of associations of healthy lifestyle factors versus ideal cardiovascular health metrics for risk of heart failure in middle-aged Chinese adults. Methods: A healthy lifestyle score (HLS) was constructed using smoking, drinking, physical activity, diet, body mass index, and waist circumference and compared with the addition of blood pressure, blood glucose and blood lipids to construct ideal cardiovascular health metrics (ICVHMs) in 487 197 participants in the China Kadoorie Biobank. Results: A total of 4 208 incident cases of heart failure were recorded during a median follow-up of 10 years. Both HLS (HR, 0.88; 95% CI, 0.85, 0.91) and ICVHMs (0.87: 0.84, 0.89) were inversely associated with risk of heart failure (P <0.001 for linear trend). Compared with participants with 0 to 1 healthy lifestyle factors, the multivariable-adjusted HR of those with 4 to 5 healthy lifestyle factors was 0.68 (0.59, 0.77). Compared with participants with 0 to 2 ICVHMs, the adjusted HR (95% CIs) of those who had 7 to 8 ICVHMs was 0.47 (0.36, 0.60). Ideal cardiovascular health metrics were more strongly predictive of risk of heart failure (AUC 0.61 vs 0.58; P<0.001) than healthy lifestyle factors alone. Conclusions: Higher levels of healthy lifestyle factors and ideal cardiovascular health metrics were both inversely associated with heart failure, but the associations of ideal cardiovascular health metrics were stronger than those with healthy lifestyle factors alone. Funding Statement: This work was supported by National Natural Science Foundation of China (81941018). The CKB baseline survey and the first re-survey were supported by a grant from the Kadoorie Charitable Foundation in Hong Kong. The long-term follow-up was supported by grants from the UK Wellcome Trust (212946/Z/18/Z, 202922/Z/16/Z, 104085/Z/14/Z, 088158/Z/09/Z), grants (2016YFC0900500, 2016YFC0900501, 2016YFC0900504, 2016YFC1303904) from the National Key R&D Program of China, National Natural Science Foundation of China (81390540, 81390541, 81390544), and Chinese Ministry of Science and Technology (2011BAI09B01). Declaration of Interests: All authors have completed the ICMJE uniform disclosure forms at http://www.icmje.org/coi_disclosure.pdf and declare: no support from any organization for the submitted work; no financial relationships with any organization that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work. Ethics Approval Statement: All participants provided written informed consent to provide information on their medical records. Ethics approval was obtained from the Ethical Committee of the Chinese Center for Disease Control and Prevention (Beijing, China) and the Oxford Tropical Research Ethics Committee, University of Oxford (UK).