A large-scale observational study from China has demonstrated the link between ideal behavioural and medical cardiovascular factors and lower mortality rates.
Cardiovascular disease (CVD) is one of the greatest contributors to global deaths.
According to the American Heart Association (AHA), ideal cardiovascular health (ICH) is determined by a combination of seven behavioural and medical factors; no smoking, a body mass index (BMI) below 23 kg/m2, adequate physical activity, a balanced diet, total cholesterol of less than 200 mg/dL, blood pressure below 120/80 mm Hg and fasting glucose under 100 mg/dL.
Although these factors have been linked to reduced rates of mortality, studies in Asian populations have been limited.
How the behavioural and medical factors interact with each other is also poorly understood and as a result intervention programmes for CVD in Asian countries like China have been hampered.
A study, published in the Chinese Medical Journal, sought answers to these challenges.
To ensure adequate representation of the Chinese population, the researchers pooled data from three study cohorts encompassing almost 200,000 individuals and examined the association between ICH and death due to different causes.
In total, the study included 198,164 Chinese adults from the China Kadoorie Biobank study (2004–2018), Dongfeng-Tongji cohort (2008–2018), and Kailuan study (2006–2019).
To remove possible bias, only participants without CVD and cancer at the start of the study were included. Each participant was scored based on their performance on the seven behavioral and medical parameters (poor performance being scores as 0; intermediate performance as one; and ideal performance as two).
Accordingly, the highest possible behavioural score was eight, while the highest possible medical score was six. By adding these scores, a 14-point ICH score was computed. This ICH score was then weighed against death due to any cause (all-cause mortality), CVD, respiratory dysfunction, and cancer.
Through its large sample size and follow-up durations, the study achieved an overall follow-up period of around 2 million person-years.
During this period, compared to those with an ICH score of 0–6, individuals with ICH scores of 10–14 had an approximately 50 per cent lower risk of all-cause, CVD, and respiratory mortality.
This suggested that ICH is associated with lower all-cause, CVD, and respiratory mortality among Chinese adults.
Interestingly, although there was no interaction between medical and behavioural factors, higher behavioural and medical scores were both independently associated with lower rates of all-cause and CVD mortality. However, only higher behavioural health scores were associated with lower rates of death due to cancer and respiratory dysfunction.
Corresponding author Dr An Pan, a Professor of Epidemiology at the School of Public Health, Tongji Medical College, explained: “To prevent premature death, it is imperative to identify population-specific determinants of health. The goal was to examine these factors in a Chinese population and provide an impetus for improving healthcare management in China.”
Shedding light on the importance of these findings, Dr Shouling Wu of Kailuan Hospital, also a corresponding author on this study, added: “The results of this study are powered by a large sample size, the use of multiple patient cohorts, and the long-term follow-up. They are consistent with the results of previous studies from western populations and provide a much clearer roadmap for premature death prevention in the Chinese population.”
Indeed, the findings show that both behavioural and medical health parameters need to be targeted in order to prevent premature deaths in China. Individuals should try to maintain healthy lifestyles and cardiometabolic conditions, and policies that aid this goal should be developed.
While additional studies are needed to validate the association of ICH with non-CVD mortality or mortality due to different subtypes of CVD and to explore unseen interactions between behavioural and medical parameters, this study attests to the power of individual lifestyle behaviours in prolonging one’s lifespan and potentially one’s quality of life
