Cardiovascular health and healthy longevity in people with and without cardiometabolic disease: A prospective cohort study

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)