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Updated: Sep 30, 2025
Author Spotlight: Assessing the Cardiovascular Profile of Patients with Metabolic Syndrome
Published on: September 27, 2024
Cardiovascular health and healthy longevity in people with and without cardiometabolic disease: A prospective cohort
Chenjie Xu1, Pengjie Zhang2, Zhi Cao3
1School of Public Health, Hangzhou Normal University, Hangzhou, China.
Insights
Maintaining ideal cardiovascular health (CVH) significantly increases life expectancy and reduces mortality risk in both general populations and patients with cardiometabolic disease (CMD). This highlights the importance of comprehensive strategies for preserving CVH.
Area of Science:
- Cardiovascular Health Research
- Public Health
- Epidemiology
Background:
- Cardiovascular health (CVH) is linked to cardiometabolic disease (CMD) and mortality, but its impact on life expectancy, especially in CMD patients, requires further investigation.
- The American Heart Association (AHA) 7-item tool defines CVH using behavioral and biological metrics.
Purpose of the Study:
- To investigate the association between CVH levels and life expectancy in individuals with and without CMD.
- To quantify the impact of ideal CVH on survival years among CMD patients.
Main Methods:
- Utilized UK Biobank data from 341,331 participants (ages 37-73) followed from 2006-2010 to 2020.
- Assessed CVH using 7 metrics (4 behavioral, 3 biological) to categorize participants into poor, intermediate, or ideal CVH.
- Employed flexible parametric survival models to estimate life expectancy.
Main Results:
- Ideal CVH significantly attenuated CMD-related mortality risk (62% for males, 53% for females).
- In CMD patients, ideal CVH at age 45 was associated with an additional 5.5 years for males and 4.2 years for females compared to poor CVH.
- Ideal CVH also increased life expectancy in those without CMD.
Conclusions:
- An ideal CVH is strongly associated with reduced premature mortality and extended life expectancy across populations, including those with CMD.
- Promoting healthy lifestyles and managing biological factors are crucial for preserving and improving CVH.
- Comprehensive strategies are needed to maintain higher CVH levels throughout life.
Background:
Existing evidence suggest an association of cardiovascular health (CVH) level with cardiometabolic disease (CMD) and mortality, but the effect of CVH on life expectancy, particularly survival years in CMD patients, has not been well-established. This study aimed to investigate the association of CVH defined using the 7-item tool from the American Heart Association (AHA) with life expectancy in people with and without CMD.
Methods:
Between 2006 and 2010, a total of 341,331 participants (age 37-73 years) in the UK Biobank were examined and thereafter followed up to 2020. The CVH raised by the AHA included 4 behavioral (smoking, diet, physical activity, body mass index) and 3 biological (fasting glucose, blood cholesterol, blood pressure) metrics, coded on a three-point scale (0, 1, 2). The CVH score was the sum of 7 metrics (score range 0-14) and was then categorized into poor (scores 0-6), intermediate (7-11), and ideal (12-14) CVH. The flexible parametric survival models were applied to estimate life expectancy.
Findings:
During a median follow-up of 11.4 years, 18,420 (5.4%) deaths occurred. The multivariable-adjusted hazard ratio (HRs) of all-cause mortality were 2.21 (95% CI: 1.77 to 2.75) for male and 2.63 (95% CI: 2.22 to 3.12) for female with prevalent CMD and a poor CVH compared with CMD-free and ideal CVH group, an ideal CVH attenuated the CMD-related risk of mortality by approximately 62% for male and 53% for female. In CMD patients, an ideal CVH compared to poor CVH was associated with additional life years gain of 5.50 (95% CI: 3.94-7.05) for male 4.20 (95% CI: 2.77-5.62) for female at the age of 45 years. Corresponding estimates in those without CMD were 4.55 (95% CI: 3.62-5.48) and 4.89 (95% CI: 3.99-5.79), respectively. Ideal smoking status, fasting glucose and physical activity for male and ideal smoking status, cholesterol level and physical activity for female contributed to the greatest survival benefit.
Interpretation:
An ideal CVH is associated with a lower risk of premature mortality and longer life expectancy whether in general population or CMD patients. Our study highlights the benefits of maintaining better CVH across the life course and calls attention to the need for comprehensive strategies (healthy behavioral lifestyle and biological phenotypes) to preserve and restore a higher CVH level.
Funding:
Scientific Research Foundation for Scholars of HZNU (Grant No. 4265C50221204119).
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