Background
Methods
Study population
Assessment of CVH metrics
Subclinical biomarker measurements
Subclinical disease marker measurements
Statistical analysis
Results
General characteristics of the participants
Characteristics | Overall (n = 3009) | Female (n = 1007) | Male (n = 2002) |
P Value |
---|---|---|---|---|
Age, y | 48.6 ± 9.7 | 49.9 ± 9.9 | 48.0 ± 9.6 | <0.001 |
Education, n (%) | ||||
Elementary school | 206 (6.9) | 135(13.4) | 71 (3.6) | <0.001 |
High school | 1353 (45.0) | 538 (53.4) | 815 (40.7) | |
College or above | 1450 (48.2) | 334 (33.2) | 1116 (55.7) | |
Body mass index, kg/m2
| 24.9 ± 3.3 | 23.5 ± 3.1 | 25.5 ± 3.2 | <0.001 |
Systolic blood pressure, mmHg | 128.3 ± 16.6 | 125.5 ± 18.5 | 129.7 ± 15.3 | <0.001 |
Diastolic blood pressure, mmHg | 81.3 ± 11.3 | 76.3 ± 11.0 | 83.6 ± 10.8 | <0.001 |
Hypertension, n (%) | 409 (13.6) | 125 (12.4) | 284 (14.2) | 0.195 |
Antihypertensive medication, n (%) | 373 (12.4) | 109 (10.8) | 264 (13.2) | 0.069 |
Fasting glucose, mmol/L | 5.4 ± 1.4 | 5.2 ± 1.0 | 5.5 ± 1.6 | <0.001 |
Diabetes mellitus, n (%) | 134 (4.5) | 22 (2.2) | 112 (5.6) | <0.001 |
Diabetes medication, n (%) | 111 (3.7) | 21 (2.1) | 90 (4.5) | <0.001 |
Total cholesterol, mmol/L | 5.2 ± 1.0 | 5.2 ± 1.0 | 5.2 ± 1.0 | 0.199 |
HDL-cholesterol, mmol/L | 1.4 ± 0.4 | 1.6 ± 0.4 | 1.3 ± 0.3 | <0.001 |
LDL-cholesterol, mmol/L | 2.9 ± 0.9 | 2.9 ± 0.9 | 2.9 ± 0.9 | 0.95 |
Lipid-lowering medication, n (%) | 47 (1.6) | 10 (1.0) | 37 (1.8) | 0.086 |
Cardiovascular health metrics | ||||
Ideal diet, n (%) | 102 (3.4) | 51 (5.1) | 51 (2.5) | 0.001 |
Ideal smoking status, n (%) | 1944 (64.6) | 978 (97.1) | 966 (48.3) | <0.001 |
Ideal physical activity, n (%) | 339 (11.3) | 112 (11.1) | 227 (11.3) | 0.859 |
Ideal BMI, n (%) | 1591 (52.9) | 726 (72.1) | 865 (43.2) | <0.001 |
Ideal Blood pressure, n (%) | 797 (26.5) | 391 (38.8) | 406 (20.3) | <0.001 |
Ideal Total cholesterol, n (%) | 1472 (48.9) | 517 (51.3) | 955 (47.7) | 0.060 |
Ideal Fasting glucose, n (%) | 2258 (75.0) | 826 (82.0) | 1432 (71.5) | <0.001 |
Ideal CVH score | 2.8 ± 1.3 | 3.6 ± 1.2 | 2.5 ± 1.2 | <0.001 |
Subclinical biomarkers, median (Q1, Q3) | ||||
Homocysteine, μmol/L | 9.4 (7.6, 11.6) | 7.8 (6.3, 9.3) | 10.4(8.6, 12.5) | <0.001 |
C-reactive protein, mg/L | 1.5 (0.8, 2.6) | 1.3 (0.7, 2.4) | 1.6 (0.8, 2.7) | <0.001 |
Microalbuminuria, mg/L | 9.5 (5.3, 16.8) | 7.0 (4.0, 13.0) | 11.0 (6.0, 18.0) | 0.005 |
Subclinical disease markers | ||||
1. Increased CIMT, n (%) | 422 (14.0) | 118 (11.7) | 30 (15.2) | 0.010 |
2. Presence of carotid plaque, n (%) | 805 (26.8) | 250 (24.8) | 555 (27.7) | 0.097 |
3. LV hypertrophy by ECG/Echocardiography | ||||
LV hypertrophy by ECG (Sokolow-Lyon criteria), n (%) | 132 (4.4) | 18(1.8) | 114(5.7) | <0.001 |
LV mass-to-BSA ratio, g/m2 | 92.4 ± 18.2 | 77.8 ± 14.2 | 99.7 ± 15.3 | <0.001 |
LV hypertrophy by Echocardiography, n (%) | 341 (11.3) | 84 (8.3) | 257 (12.8) | <0.001 |
LV hypertrophy by ECG or Echocardiography,
n (%) | 453 (15.1) | 100 (1.0) | 353(17.6) | <0.001 |
4. LV systolic dysfunction by echocardiography | ||||
Fractional shortening | 0.37 ± 0.04 | 0.38 ± 0.04 | 0.37 ± 0.04 | <0.001 |
LV systolic dysfunction, n (%) | 63 (2.1) | 11 (1.1) | 52 (2.6) | <0.001 |
5. Peripheral arterial disease by ABI | ||||
ABI ≤ 0.9, n (%) | 35 (1.2) | 19 (1.9) | 16 (0.8) | 0.011 |
Composite of subclinical disease markers | ||||
At least 1, n (%) | 1339 (44.5) | 377 (37.4) | 962 (48.1) | <0.001 |
At least 2, n (%) | 383 (12.7) | 105 (10.4) | 278 (13.9) | |
≥ 3, n (%) | 56 (1.9) | 16 (1.6) | 40 (2.0) | |
Mean score | 0.59 ± 0.76 | 0.49 ± 0.72 | 0.64 ± 0.77 | <0.001 |
Distribution of the subclinical biomarkers/subclinical disease markers by CVH category
Characteristics | Poor CVH (0–2) | Intermediate CVH (3–4) | Ideal CVH (5–7) |
P Value |
---|---|---|---|---|
Number, n | 1238 | 1423 | 348 | |
Subclinical biomarkers, median (Q1, Q3) | ||||
Homocysteine, μmol/L | 10.2 (8.3,12.3) | 9.0 (7.3, 11.0) | 7.5 (6.2, 9.2) | <0.001 |
C-reactive protein, mg/L | 1.9 (1.1, 3.2) | 1.3 (0.7, 2.3) | 0.9 (0.58, 1.6) | <0.001 |
Microalbuminuria, mg/L | 11.6 (6.1, 21.6) | 8.6 (4.9, 14.3) | 5.2 (2.0, 9.8) | <0.001 |
Subclinical disease markers, n (%) | ||||
1. Increased CIMT | 214 (17.3) | 184 (12.9) | 24 (6.9) | <0.001 |
2. Presence of carotid plaque | 396 (32.0) | 364 (25.6) | 45 (12.9) | <0.001 |
3. LV hypertrophy by ECG/echocardiography | 215 (17.4) | 211 (14.8) | 27 (7.8) | <0.001 |
4. LV systolic dysfunction by echocardiography | 39 (3.2) | 23 (1.6) | 1 (0.3) | 0.001 |
5. Peripheral arterial disease by ABI ≤ 0.9 | 22 (1.8) | 13 (0.9) | 0 | 0.012 |
Composite of subclinical disease markers | ||||
At least 1, n (%) | 643 (51.9) | 605 (42.5) | 91 (26.3) | <0.001 |
At least 2, n (%) | 201 (16.27) | 167 (11.7) | 15 (4.3) | <0.001 |
≥3, n (%) | 31 (2.5) | 24 (1.7) | 1 (0.3) | 0.021 |
Mean score | 0.71 ± 0.80 | 0.56 ± 0.74 | 0.31 ± 0.56 | <0.001 |
Association between the subclinical biomarkers and the CVH score
Overall | Female | Male | ||||
---|---|---|---|---|---|---|
β Coefficient (95% CI) |
P Value | β Coefficient (95% CI) |
P Value | β Coefficient (95% CI) |
P Value | |
Homocysteine | ||||||
Model 1 | −0.228 (−1.926 to −1.415) | <0.001 | −0.188 (−1.827 to −0.935) | <0.001 | −0.087 (−0.909 to −0.299) | <0.001 |
Model 2 | −0.097 (−0.960 to −0.456) | <0.001 | −0.115 (−1.271 to −0.412) | <0.001 | −0.084 (−0.890 to −0.277) | <0.001 |
Model 3 | −0.092 (−0.930 to −0.426) | <0.001 | −0.111 (−1.242 to −0.388) | <0.001 | −0.081 (−0.873 to −0.259) | <0.001 |
C-reactive protein | ||||||
Model 1 | −0.233 (−0.815 to −0.603) | <0.001 | −0.316 (−1.032 to −0.709) | <0.001 | −0.177 (−0.621 to −0.378) | <0.001 |
Model 2 | −0.190 (−0.674 to −0.479) | <0.001 | −0.231 (−0.795 to −0.474) | <0.001 | −0.175 (−0.617 to −0.373) | <0.001 |
Model 3 | −0.182 (−0.652 to −0.457) | <0.001 | −0.219 (−0.764 to −0.441) | <0.001 | −0.172 (−0.605 to −0.363) | <0.001 |
Microalbuminuria | ||||||
Model 1 | −0.296 (−0.929 to −0.729) | <0.001 | −0.192 (−0.587 to −0.305) | <0.001 | −0.244 (−0.677 to −0.476) | <0.001 |
Model 2 | −0.228 (−0.734 to −0.546) | <0.001 | −0.167 (−0.521 to −0.257) | <0.001 | −0.245 (−0.676 to −0.475) | <0.001 |
Model 3 | −0.224 (−0.720 to −0.534) | <0.001 | −0.163 (−0.511 to −0.247) | <0.001 | −0.238 (−0.662 to −0.463) | <0.001 |
Association between the subclinical disease markers and the CVH score
Overall | Female | Male | ||||
---|---|---|---|---|---|---|
β Coefficient (95% CI) |
P Value | β Coefficient (95% CI) |
P Value | β Coefficient (95% CI) |
P Value | |
Increased CIMT | ||||||
Model 1 | −0.115 (−0.580 to −0.305) | <0.001 | −0.170 (−0.873 to −0.412) | <0.001 | −0.076 (−0.412 to −0.110) | 0.001 |
Model 2 | −0.060 (−0.363 to −0.100) | <0.001 | −0.087 (−0.551 to −0.104) | 0.004 | −0.071 (−0.407 to −0.085) | 0.003 |
Model 3 | −0.060 (−0.362 to −0.099) | <0.001 | −0.081 (−0.527 to −0.082) | 0.007 | −0.072 (−0.527 to −0.082) | 0.002 |
Presence of carotid plaque | ||||||
Model 1 | −0.127 (−0.494 to −0.279) | <0.001 | −0.261 (−0.902 to −0.566) | <0.001 | −0.061 (−0.291 to −0.048) | 0.006 |
Model 2 | −0.071 (−0.324 to −0.108) | <0.001 | −0.114 (−0.504 to −0.139) | 0.001 | −0.055 (−0.284 to −0.021) | 0.023 |
Model 3 | −0.069 (−0.315 to −0.100) | <0.001 | −0.114 (−0.503 to −0.140) | 0.001 | −0.053 (−0.278 to −0.015) | 0.029 |
LV hypertrophy by ECG/echocardiography | ||||||
Model 1 | −0.118 (−0.648 to −0.348) | <0.001 | −0.193 (−1.116 to −0.582) | <0.001 | −0.062 (−0.391 to −0.067) | 0.006 |
Model 2 | −0.073 (−0.448 to −0.171) | <0.001 | −0.141 (−0.872 to −0.366) | <0.001 | −0.058 (−0.377 to −0.049) | 0.011 |
Model 3 | −0.066 (−0.419 to −0.141) | <0.001 | −0.130 (−0.825 to −0.318) | <0.001 | −0.053 (−0.363 to −0.033) | 0.018 |
LV systolic dysfunction by echocardiography | ||||||
Model 1 | −0.083 (−1.113 to −0.445) | <0.001 | −0.105 (−1.945 to −0.506) | 0.001 | −0.059 (−0.802 to −0.119) | 0.008 |
Model 2 | −0.056 (−0.826 to −0.217) | 0.001 | −0.060 (−1.381 to −0.027) | 0.042 | −0.058 (−0.791 to −0.108) | 0.010 |
Model 3 | −0.053 (−0.803 to −0.195) | 0.001 | −0.059 (−1.358 to −0.012) | 0.046 | −0.056 (−0.778 to −0.096) | 0.012 |
Peripheral arterial disease by ABI ≤ 0.9 | ||||||
Model 1 | −0.053 (−1.109 to −0.215) | 0.004 | −0.108 (−1.512 to −0.413) | 0.001 | −0.060 (−1.440 to −0.221) | 0.008 |
Model 2 | −0.065 (−1.218 to −0.406) | <0.001 | −0.087 (−1.291 to −0.265) | 0.003 | −0.058 (−1.415 to −0.195) | 0.010 |
Model 3 | −0.062 (−1.182 to −0.317) | <0.001 | −0.081 (−1.236 to −0.214) | 0.005 | −0.057 (−1.401 to −0.181) | 0.011 |
Overall | Female | Male | ||||
---|---|---|---|---|---|---|
OR (95% CI) |
P Value | OR (95% CI) |
P Value | OR (95% CI) |
P Value | |
≥1 vs. 0 | ||||||
Model 1 | 0.745 (0.704–0.788) | <0.001 | 0.533 (0.471–0.602) | <0.001 | 0.856 (0.797–0.902) | <0.001 |
Model 2 | 0.802 (0.749–0.858) | <0.001 | 0.676 (0.591–0.774) | <0.001 | 0.857 (0.791–0.928) | <0.001 |
Model 3 | 0.808 (0.755–0.865) | <0.001 | 0.682 (0.596–0.781) | <0.001 | 0.862 (0.796–0.933) | <0.001 |
≥2 vs. 0 or 1 | ||||||
Model 1 | 0.703 (0.644–0.767) | <0.001 | 0.509 (0.423–0.613) | <0.001 | 0.742 (0.657–0.838) | <0.001 |
Model 2 | 0.724 (0.654–0.802) | <0.001 | 0.627 (0.513–0.766) | <0.001 | 0.744 (0.658–0.840) | <0.001 |
Model 3 | 0.729 (0.658–0.807) | <0.001 | 0.640 (0.523–0.782) | 0.001 | 0.781 (0.700–0.872) | <0.001 |
≥3 vs. 0, 1, or 2 | ||||||
Model 1 | 0.594 (0.463–0.761) | <0.001 | 0.465 (0.298–0.698) | <0.001 | 0.573 (0.422–0.778) | <0.001 |
Model 2 | 0.595 (0.464–0.763) | <0.001 | 0.568 (0.358–0.901) | 0.016 | 0.579 (0.274–0.784) | <0.001 |
Model 3 | 0.603 (0.484–0.752) | <0.001 | 0.583 (0.368–0.925) | 0.022 | 0.623 (0.468–0.830) | 0.001 |