生命八要素评分与臂间收缩压差的相关性

Correlation between life's essential 8 score and inter-arm systolic blood pressure difference

    摘要
  • 摘要:
    目的  探讨生命八要素（LE8）评分与臂间收缩压差（IASBPD）之间的相关性。
    方法  采用横断面研究方法。选取参加2010—2020年开滦集团健康体检且至少参加过一次四肢动脉硬化检测者作为研究对象，排除单侧或双侧血压值缺失者和LE8资料任意一项缺失者，共纳入研究对象47 671名。基于美国心脏协会的算法，并结合开滦研究的实际情况，形成了LE8开滦研究版本，包括4种心血管健康行为（尼古丁暴露、体育锻炼、饮食状况、睡眠健康）和4种心血管健康因素（体重指数、血压水平、血糖水平和血脂水平）。采用广义线性模型分析LE8评分与IASBPD的关联；采用logistic回归模型分析LE8评分对IASBPD的影响；采用限制性立方样条图探讨LE8评分与IASBPD之间的剂量-反应关系；对不同年龄和性别以及对肿瘤、非肿瘤和冠心病、非冠心病患者分别进行分层分析。
    结果  检出IASBPD≥10 mmHg者5 411名，检出率为11.35%。校正混杂因素后，广义线性回归模型结果显示，LE8评分每增加10分，总人群IASBPD降低0.31 mmHg，男性IASBPD降低0.27 mmHg，女性IASBPD降低0.30 mmHg，中青年组IASBPD降低0.27 mmHg，老年组IASBPD降低0.26 mmHg（均P＜0.01）。多因素logistic回归分析结果显示，以低心血管健康（CVH）组（LE8评分0～49分）为参照，中CVH组（LE8评分50～79分）和高CVH组（LE8评分80～100分）IASBPD异常的风险分别降低24%（OR=0.76, 95%CI 0.71～0.81, P＜0.01）和65%（OR=0.35, 95%CI 0.29～0.43, P＜0.01）。LE8评分每增加1个标准差，IASBPD异常风险降低21%（OR=0.79, 95%CI 0.76～0.81, P＜0.01）。限制性立方样条图显示，LE8评分和IASBPD之间呈非线性负相关（P总体＜0.01, P非线性＜0.01）。分层分析显示，LE8评分分组与性别和年龄间存在交互作用（均P＜0.01）。性别分层分析显示，女性人群中高CVH组IASBPD异常的风险降低72%（OR=0.28, 95%CI 0.20～0.38），男性人群中高CVH组IASBPD异常的风险降低43%（OR=0.57, 95%CI 0.44～0.74）。年龄分层分析显示，在中青年组，高CVH组IASBPD异常风险降低63%（OR=0.37, 95%CI 0.30～0.46），在老年组，高CVH组IASBPD异常风险降低53%（OR=0.47, 95%CI 0.29～0.76）。
    结论 高水平的LE8评分与IASBPD异常风险较低相关，在女性和中青年人群中二者关联更明显。

     

    Abstract:
    Objective To explore the correlation between the life's essential 8 (LE8) score and the inter-arm systolic blood pressure difference (IASBPD).
    Methods A cross-sectional study was conducted. Participants who underwent health check-ups at the Kailuan Group between 2010 and 2020 and had at least one peripheral arterial stiffness test were selected. After excluding the subjects with missing unilateral or bilateral blood pressure values and any missing LE8 data, a total of 47 671 subjects were included. According to the LE8 algorithm developed by the American Heart Association, and combined with the actual situation of Kailuan Study, the Kailuan Study version of LE8 was developed, including 4 cardiovascular health behaviors (nicotine exposure, physical exercise, dietary status, and sleeping health) and 4 cardiovascular health factors (body mass index, blood pressure, blood glucose, and blood lipid). The association between LE8 score and IASBPD was analyzed using generalized linear models. The impact of LE8 score on IASBPD was analyzed using logistic regression models. The dose-effect relationship between LE8 score and IASBPD was assessed by a restricted cubic spline regression model. Stratified analysis was conducted for patients of different ages and genders, as well as for patients with and without tumors, and with and without coronary heart disease.
    Results IASBPD≥10 mmHg was detected in 5 411 subjects, with a detection rate of 11.35%. After adjusting for confounding factors, the results of the generalized linear regression model showed that for every ten-point increase in LE8 score, the IASBPD in the total population decreased by 0.31 mmHg, in males decreased by 0.27 mmHg, in females decreased by 0.30 mmHg, in the middle-aged and young group decreased by 0.27 mmHg, and in the elderly group decreased by 0.26 mmHg (P＜0.01 for all). The results of multivariate logistic regression analysis showed that compared to the low cardiovascular health (CVH) group (LE8 score was 0–49), the risk of abnormal IASBPD was reduced by 24% (OR=0.76, 95%CI:0.71–0.81, P＜0.01) in the medium CVH group (LE8 score was 50–79) and reduced by 65% (OR=0.35, 95%CI:0.29–0.43, P＜0.01) in the high CVH group (LE8 score was 80–100). For every one standard deviation increase in LE8 score, the risk of abnormal IASBPD was reduced by 21% (OR=0.79, 95%CI: 0.76–0.81, P＜0.01). The restricted cubic spline plot showed that LE8 score was negatively correlated with IASBPD in a nonlinear manner (Poverall＜0.01, Pnon-linear＜0.01). Stratified analysis showed that there was an interaction between LE8 score groups and gender and age (both P＜0.01). Gender stratification showed that in the female population, the risk of abnormal IASBPD in the high CVH group reduced by 72% (OR=0.28, 95%CI: 0.20–0.38), and in the male population, the risk reduced by 43% (OR=0.57, 95%CI: 0.44–0.74). Age stratification showed that in the middle-aged and young group, the risk of abnormal IASBPD in the high CVH group reduced by 63% (OR=0.37, 95%CI: 0.30–0.46), and in the elderly group, the risk reduced by 53% (OR=0.47, 95%CI: 0.29–0.76).
    Conclusion The LE8 score is negatively correlated with IASBPD, and this association is more pronounced in females and middle-aged and young adults.

     

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