Adherence to a healthy lifestyle and all-cause and cause-specific mortality in Chinese adults: a 10-year prospective study of 0.5 million people

Zhu, Nanbo; Yu, Canqing; Guo, Yu; Zheng, Bin; Han, Yuting; Yang, Ling; Chen, Yiping; Du, Huaidong; Li, Huimei; Liu, Fang; Chen, Junshi; Chen, Zhengming; Lv, Jun; Li, Liming

doi:10.1186/s12966-019-0860-z

Cited by 84 publications

(92 citation statements)

References 35 publications

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“…The 20-year prospective study included a relatively large sample size examining the association between high blood pressure and mortality from CVDs in rural China. The CVDs deaths in the current study were comparable with several previous studies in China 13 32. A previous study suggested a north-south gradient in the mortality of CVDs due to the difference in the prevalence of hypertension in China 33.…”

Section: Discussionsupporting

confidence: 90%

Association between blood pressure levels and cardiovascular deaths: a 20-year follow-up study in rural China

Wang

et al. 2020

BMJ Open

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ObjectivesThe 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guideline recommended 130/80 mm Hg as blood pressure (BP) target goals. However, the generalisability of this recommendation to populations at large with hypertension remains controversial. We assessed the association between BP and cardiovascular diseases (CVDs) mortality using a 20-year follow-up study among Chinese populations.DesignProspective cohort study.Participants7314 participants were followed up for a median of 20 years in Fangshan District, Beijing, China.MethodsThe primary outcome variable was death from cardiovascular causes. The adjusted HR for CVDs mortality associated with baseline BP was calculated using Cox regression analysis.ResultsWe identified 350 deaths from CVDs (148 stroke, 113 coronary heart disease and 89 other CVDs) during follow-up. Hypertension (defined by systolic BP (SBP)/diastolic BP (DBP) ≥140/90 mm Hg) was significantly associated with mortality due to CVDs (HR=2.49, 95% CI=1.77 to 3.50) among people aged 35–59 years rather than people aged ≥60 years. In addition, there was no significant association between stage 1 hypertension defined by the 2017 ACC/AHA (SBP/DBP of 130–139/80-89 mm Hg) and CVDs mortality when compared with SBP/DBP of <120/80 in neither the participants aged <60 years (HR=0.90, 95% CI=0.54 to 1.50) nor participants aged ≥60 years (HR=1.47, 95% CI=0.94 to 2.29).ConclusionThe study revealed hypertension of SBP/DBP≥140/90 mm Hg was an important risk factor of CVDs mortality, especially among people aged 35–59 years. However, stage 1 hypertension under the definition of 2017 ACC/AHA was not associated with an increased risk of CVDs mortality. This study indicated that whether adopting the new hypertension definition needs further consideration in rural Chinese populations.

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Section: Discussionsupporting

confidence: 90%

Association between blood pressure levels and cardiovascular deaths: a 20-year follow-up study in rural China

Wang

et al. 2020

BMJ Open

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“…Our results add to the evidence that a healthy lifestyle is associated with cardiovascular health and inversely associated with all-cause mortality [ 21 , 22 , 26 , 46 – 50 ]. In the large SUN cohort, comprising university graduates in Spain, a better adherence to a joint healthy lifestyle was associated with lower risk of hypertension [ 49 ], MS [ 51 ], and CVD [ 23 ].…”

Section: Discussionsupporting

confidence: 78%

Association between the Mediterranean lifestyle, metabolic syndrome and mortality: a whole-country cohort in Spain

Sotos-Prieto

Ortolá²,

Ruiz‐Canela

et al. 2021

Cardiovasc Diabetol

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Background Evidence is limited about the joint health effects of the Mediterranean lifestyle on cardiometabolic health and mortality. The aim of this study was to evaluate the association of the Mediterranean lifestyle with the frequency of the metabolic syndrome (MS) and the risk of all-cause and cardiovascular mortality in Spain. Methods Data were taken from ENRICA study, a prospective cohort of 11,090 individuals aged 18+ years, representative of the population of Spain, who were free of cardiovascular disease (CVD) and diabetes at 2008–2010 and were followed-up to 2017. The Mediterranean lifestyle was assessed at baseline with the 27-item MEDLIFE index (with higher score representing better adherence). Results Compared to participants in the lowest quartile of MEDLIFE, those in the highest quartile had a multivariable-adjusted odds ratio 0.73 (95% confidence interval (CI) 0.5, 0.93) for MS, 0.63. (0.51, 0.80) for abdominal obesity, and 0.76 (0.63, 0.90) for low HDL-cholesterol. Similarly, a higher MELDIFE score was associated with lower HOMA-IR and highly-sensitivity C-reactive protein (P-trend < 0.001). During a mean follow-up of 8.7 years, 330 total deaths (74 CVD deaths) were ascertained. When comparing those in highest vs. lowest quartile of MEDLIFE, the multivariable-adjusted hazard ratio (95% CI) was 0.58 (0.37, 0.90) for total mortality and 0.33 (0.11, 1.02) for cardiovascular mortality. Conclusions The Mediterranean lifestyle was associated with lower frequency of MS and reduced all-cause mortality in Spain. Future studies should determine if this also applies to other Mediterranean countries, and also improve cardiovascular health outside the Mediterranean basin.

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“…We multiplied the drinking frequency by quantity consumed per drinking day to compute the weekly consumption of alcohol. As in previous literatures from other investigators (Xi et al, 2017;Zhu et al, 2019), we defined heavy drinking as consuming more than 14 drinks per week for men (7 for women). Physical activity was estimated based on recall of a typical week, by asking the frequency and time spent on leisure-time exercise, such as walking, dancing, jogging or playing sports.…”

Section: Behaviors Variablesmentioning

confidence: 99%

Clustering of multiple health risk behaviors and its association with diabetes in a Southern Chinese adult population: a cross-sectional study

Zhang

Luo

Cui

et al. 2020

PeerJ

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Background Identifying the clustering patterns of health risk behaviors (HRBs) within individuals and their health impacts are essential to develop lifestyle promotion strategies. This study aimed to explore the clustering of a range of HRBs and the associations between such identified clusters and diabetes in Southern Chinese adults. Methods Data from 5,734 adults aged 35–75 years and underwent health examinations from November 2012 to December 2013 at a tertiary hospital in Guangzhou were analyzed. Behavioral characteristics, including smoking, alcohol use, physical activity, and sleep duration and quality, were measured by questionnaires. Latent class analysis was conducted by gender to identify HRBs clustering patterns, and logistic regression models were used to estimate the associations between behavioral patterns and diabetes. Results Three distinct behavioral clusters emerged in both genders. Male classes were defined as: (1) healthy lifestyle (Class 1, 62.9%); (2) cumulate harmful habits (Class 2, 27.1%); (3) poor sleep and risky habits (Class 3, 10.0%). Female classes were: (1) healthy lifestyle (Class 1, 83.0%); (2) inactive, daytime dysfunction (Class 2, 5.7%); (3) poor sleep habits (Class 3, 11.3%). Individuals of Class 2 and Class 3 showed a higher likelihood of diabetes across genders (multivariable-adjusted ORs [95% CIs], 2.03 [1.49–2.76] and 2.61 [1.78–3.81] among males, 2.64 [1.16–5.98] and 1.81 [1.07–3.06] among females) when compared with those of Class 1. Conclusions Our data provided additional evidence of HRBs clustering among adults, and such clustering was associated with an increased risk of diabetes. These findings have implications for identifying vulnerable subgroups and developing diabetes prevention programs.

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Adherence to a healthy lifestyle and all-cause and cause-specific mortality in Chinese adults: a 10-year prospective study of 0.5 million people

Cited by 84 publications

References 35 publications

Association between blood pressure levels and cardiovascular deaths: a 20-year follow-up study in rural China

Association between blood pressure levels and cardiovascular deaths: a 20-year follow-up study in rural China

Association between the Mediterranean lifestyle, metabolic syndrome and mortality: a whole-country cohort in Spain

Clustering of multiple health risk behaviors and its association with diabetes in a Southern Chinese adult population: a cross-sectional study

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