Association between cardiovascular health status and cardiovascular diseases across different ages of hypertension onset: a prospective cohort study
10.3760/cma.j.cn114798-20250723-00906
- VernacularTitle:不同发病年龄的高血压患者心血管健康状态与心血管事件的关联分析：一项前瞻性队列研究
- Author:
Maoxiang ZHAO
1
;
Hao XUE
;
Shouling WU
Author Information
1. 首都医科大学附属北京安贞医院心脏瓣膜介入中心，北京 100029
- Publication Type:Journal Article
- Keywords:
Hypertension;
Age of onset;
Cardiovascular diseases;
Cardiovascular health status
- From:
Chinese Journal of General Practitioners
2025;24(11):1344-1352
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the association between cardiovascular health status and cardiovascular events in hypertensive patients with different ages of onset.Methods:This study was a prospective cohort study. Participants who were free of hypertension, myocardial infarction, stroke, heart failure, and other cardiovascular diseases at their first annual health examination at Kailuan Group from 2006 to 2012, but were newly diagnosed with hypertension during subsequent follow-up, were included. Clinical data was collected, and cardiovascular health status was assessed using the Life′s Essential 8 (LE8) score (categorized as low level and moderate-to-high level). Based on changes in LE8 scores from the first to the second health examination, transitions in cardiovascular health status were classified into 4 patterns: consistently low, low to moderate-to-high, moderate-to-high to low, and consistently moderate-to-high. Newly diagnosed hypertensive patients were stratified by age at diagnosis into 3 groups:<45 years, 45-<60 years, and ≥60 years. Participants were followed up, with the primary outcome being cardiovascular events, including myocardial infarction and stroke. Multivariable Cox regression models with age as the time scale were used to analyze the association between cardiovascular health status, its transitions, and cardiovascular events across different ages of hypertension onset. Restricted cubic spline models were employed to examine the patterns of association between LE8 scores, their changes, and cardiovascular events.Results:A total of 22 217 newly diagnosed hypertensive patients were included, with a mean age of (53.68±11.45) years and 18 260 males (75.13%). The median follow-up time was 9.62 years. Across all three age strata, compared with participants with low cardiovascular health status, those with moderate-to-high cardiovascular health status had a lower risk of cardiovascular events: HR=0.53 (95% CI: 0.36-0.79) for onset age <45 years; HR=0.64 (95% CI: 0.58-0.82) for onset age 45-60 years; and HR=0.71 (95% CI: 0.54-0.93) for onset age ≥60 years. Among newly diagnosed hypertensive patients with onset age <45 years and 45-<60 years, those with consistently moderate-to-high cardiovascular health status had a reduced risk of cardiovascular events compared to those with consistently low status (all P<0.05); however, the difference was not statistically significant in patients with onset age ≥60 years ( P>0.05). The protective effect of consistently moderate-to-high cardiovascular health status was strongest in patients with onset age <45 years ( HR=0.47, 95% CI: 0.25-0.88). Across all age strata, the risk of cardiovascular events decreased with increasing LE8 score ( P<0.05), with the most pronounced reduction observed in patients with onset age <45 years. For every 10-point increase in LE8 score, the risk of cardiovascular events decreased by 29% in this group ( HR=0.71, 95% CI: 0.56-0.89). Restricted cubic spline analysis indicated a linear dose-response relationship between LE8 scores, their changes, and the risk of cardiovascular events ( P<0.05). Conclusions:Hypertensive patients with moderate-to-high cardiovascular health status across different ages of onset have a lower risk of cardiovascular events, with the strongest protective effect observed among younger individuals. Moreover, different patterns of change in cardiovascular health status have distinct impacts on cardiovascular events. Improvement in cardiovascular health status can reduce the risk of cardiovascular events in newly diagnosed hypertensive patients, and this protective effect is more pronounced in younger adults.
