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Association Between Comprehensive Health Assessment and Cardiac Mortality and All-Cause Mortality in Patients With
Yanqiong Li1, Lixia Yang1, Jiaoyang Lu1
1Internal Medicine Nursing Teaching and Research Section, School of Nursing, Changsha Medical University, Changsha, Hunan, China.
Insights
Improving multidimensional health significantly lowers mortality risk in coronary heart disease (CHD) patients. A higher Comprehensive Health Assessment Score (CHAS) strongly correlates with reduced all-cause and cardiac mortality, emphasizing lifestyle and medication adherence for secondary prevention.
Area of Science:
- Cardiovascular Disease Epidemiology
- Preventive Cardiology
- Public Health
Background:
- Coronary heart disease (CHD) presents a major global health challenge, necessitating effective secondary prevention strategies.
- Understanding the impact of multidimensional health on long-term outcomes in CHD patients is crucial but not well-established in population studies.
Purpose of the Study:
- To investigate the independent and joint associations of multidimensional health with all-cause and cardiac mortality in U.S. adults with CHD.
- To evaluate the role of a Comprehensive Health Assessment Score (CHAS) in predicting long-term mortality risk.
Main Methods:
- Prospective cohort study utilizing linked data from the National Health and Nutrition Examination Survey (NHANES) and National Center for Health Statistics (NCHS) mortality files.
- Analysis included 4823 U.S. adults with self-reported CHD, employing Cox proportional hazards and Fine-Gray competing risk models.
- Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated to assess mortality risks.
Main Results:
- Higher Comprehensive Health Assessment Scores (CHAS) were significantly associated with reduced all-cause and cardiac mortality.
- Moderate CHAS showed HRs of 0.68 (all-cause) and 0.62 (cardiac), while high CHAS showed further reductions (HRs 0.45 and 0.39, respectively).
- Physical activity and statin use emerged as key independent predictors, with observed dose-response relationships and consistent findings across subgroups.
Conclusions:
- A favorable multidimensional health profile, encompassing lifestyle, physical function, metabolic health, and comorbidity control, is strongly linked to lower mortality in CHD patients.
- These findings support the integration of comprehensive health management strategies for effective secondary prevention of CHD.
- Optimizing lifestyle factors and adherence to medical treatments are vital for improving long-term survival in individuals with coronary heart disease.
Background:
Coronary heart disease (CHD) confers a substantial global burden, and comprehensive health assessment is critical for secondary prevention. However, the independent and joint associations of multidimensional health with long-term mortality in CHD patients remain unclear in population-based studies.
Methods:
This prospective cohort study included 4823 U.S. adults with self-reported CHD using linked data from the National Health and Nutrition Examination Survey 1999-2018 and National Center for Health Statistics mortality files (through 2019). Associations were evaluated using Cox proportional hazards and Fine-Gray competing risk models, with hazard ratios (HRs) and 95% confidence intervals (CIs) estimated.
Results:
Over a median follow-up of 6.2 years (IQR: 3.5-9.1), 1542 deaths occurred, including 587 cardiac deaths. After full adjustment, compared with low Comprehensive Health Assessment Score (CHAS [reference]), moderate CHAS was associated with lower all-cause mortality (HR = 0.68; 95% CI: 0.59-0.78) and cardiac mortality (HR = 0.62; 95% CI: 0.51-0.76); High CHAS showed further risk reductions (all-cause mortality: HR = 0.45; 95% CI: 0.38-0.53; cardiac mortality: HR = 0.39; 95% CI: 0.30-0.51). Dose-response relationships were observed (P for trend < 0.001). Physical activity (≥ 150 MET-min/week) (all-cause mortality: HR = 0.71; 95% CI: 0.63-0.80) and statin use (cardiac mortality: HR = 0.58; 95% CI: 0.49-0.69) were the strongest independent predictors. Subgroup analyses showed consistent associations across age, sex, and obesity.
Conclusions:
A favorable lifestyle, physical function, metabolic health, and comorbidity control, was strongly associated with lower cardiac and all-cause mortality in patients with CHD, supporting multidimensional health management for secondary prevention of CHD.
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