BACKGROUND
Patients with atherosclerotic cardiovascular disease (ASCVD) have a high risk of recurrent major adverse cardiovascular events (MACE) and chronic kidney disease (CKD). Although Life's Essential 8 (LE8) has been studied for cardiovascular outcomes in secondary prevention, systematic evaluations of its association with cardiorenal events remain lacking.
OBJECTIVES
To evaluate whether optimal cardiovascular health (CVH) was associated with lower risks of MACE and CKD in ASCVD patients.
METHODS
This study included 10,253 UK Biobank participants with ASCVD, categorized into low (<50), moderate (50‒79), and high (≥80) CVH groups by LE8 score. Associations with MACE and CKD were assessed using Fine-Gray regression models, population-attributable fractions (PAF), and 1:2 propensity-matched analyses versus 16,545 non-ASCVD participants.
RESULTS
During a median 13.3 years follow-up, 2,069 MACE and 1,290 CKD events occurred. Compared with high CVH, low CVH was associated with higher risks of MACE (subdistribution HR [sHR] 2.68, 95% CI 2.02-3.56, p <0.001) and CKD (sHR 2.34, 95% CI 1.57-3.48, p <0.001). Glucose control contributed the largest PAF to both MACE (10.5%) and CKD (15.1%), followed by smoking cessation (6.9% for MACE and 11.1% for CKD). Compared with matched non-ASCVD participants, ASCVD patients with high LE8 attenuated MACE (sHR 0.83, 95% CI 0.58-1.20; p = 0.33) and CKD (sHR 0.69, 95% CI 0.42-1.13; p = 0.14) risks.
CONCLUSIONS
Higher LE8 scores were associated with lower risks of MACE and CKD in ASCVD patients. Glucose control and smoking were key modifiable contributors. High LE8 achievement may attenuate risks toward non-ASCVD levels.
AIMS
Depression and coronary heart disease (CHD) exhibit notable sex disparities; however, the sex-specific effect of depression on the development of CHD remains unexplored. We explored these effects using multi-omics approaches.
METHODS AND RESULTS
In the UK Biobank cohort, we conducted sex-stratified survival analyses and multi-omics investigations, including sex-specific two-sample and one-sample Mendelian randomisation (MR) analyses, reproductive factor assessments, Life's Essential 8 factor evaluations, and plasma proteomics analysis. Depression was associated with a higher risk of CHD in females (adjusted hazard ratio [aHR]: 1.30; 95% confidence interval [CI]: 1.24-1.37) than in males (aHR: 1.14; 95% CI: 1.09-1.19; P-interaction < 0.001), compared with individuals without depression. Sex-specific two-sample and one-sample MR analyses showed that genetically predicted depression in females was causally related to CHD, but no causal effect was observed in males. Some key reproductive factors in females with depression were associated with a high risk of CHD. Among the Life's Essential 8 factors, poor control of nicotine exposure, blood pressure, body mass index, and blood glucose had an additional effect on CHD risk in females with depression compared with that in males (all P-interaction < 0.05). Analysis of the UKB-PPP cohort revealed 26 proteins with sex-specific associations, predominantly significant in females.
CONCLUSIONS
Our findings highlight significant sex differences in the effect of depression on CHD risk, which could inform sex-specific preventive strategies for reducing the cardiovascular burden in individuals with depression.
Haozhang Huang, Ming Chen, Xiaozhao Lu et al.· European Journal of Preventi...· 0 citations
