Examining Healthy Lifestyles as a Mediator of the Association Between Socially Determined Vulnerabilities and Incident Heart Failure.

IF 6.2 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Circulation-Cardiovascular Quality and Outcomes Pub Date : 2025-01-16 DOI:10.1161/CIRCOUTCOMES.124.011107

Nickpreet Singh, Chanel Jonas, Laura C Pinheiro, Jennifer D Lau, Jinhong Cui, Leann Long, Samprit Banerjee, Raegan W Durant, Madeline R Sterling, James M Shikany, Monika M Safford, Emily B Levitan, Parag Goyal

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引用次数: 0

Abstract

Background: Increased burden of socially determined vulnerabilities (SDV), which include nonmedical conditions that contribute to patient health, is associated with incident heart failure (HF). Mediators of this association have not been examined. We aimed to determine if a healthy lifestyle mediates the association between SDV and HF.

Methods: We included adults aged 45 to 64 years old across the United States from the REGARDS cohort study (Reasons for Geographic and Racial Differences in Stroke) without evidence of HF at baseline. The primary exposure was a count of SDV based on the Healthy People 2030 framework. The primary outcome was incident HF. We assessed the role of a healthy behavior score (HBS range, 0-8) and its components (adherence to a Mediterranean diet, physical activity, lack of sedentary lifestyle, and smoking abstinence) as potential mediators of the association between SDV and incident HF.

Results: We included 13 on 525 participants. The median HBS was 4, with 16% with low HBS (0-2), 55% with moderate HBS (3-5), and 29% with high HBS (6-8). Increasing burden of SDV was associated with a stepwise increase in incident HF (adjusted hazard ratio, 1.84 [95% CI, 1.32-2.52] for 1 SDV, 2.59 [95% CI, 1.87-3.60] for 2 SDV, and 4.20 [95% CI, 3.08-5.73] for ≥3 SDV). There was no statistically significant mediation of HBS for the association of SDV count of 1 and incident HF. HBS score mediated 10.6% of the association between SDV count of 2 and incident HF and 11.1% of the association for those with ≥3 SDV. This increased to 10.8% and 18.3%, respectively, in the complete case analysis. Regarding individual components of HBS as mediators, only avoidance of a sedentary lifestyle was statistically significant (8.6% mediation) for the association of SDV count of 2 and incident HF.

Conclusions: A healthy lifestyle plays a small role in mediating the association between high SDV count and incident HF.

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检验健康生活方式在社会决定脆弱性和心力衰竭事件之间的中介作用。

背景：社会决定脆弱性（SDV）负担的增加，包括不利于患者健康的非医疗条件，与心力衰竭（HF）的发生有关。该协会的调解员尚未被审查。我们的目的是确定健康的生活方式是否介导SDV和HF之间的关联。方法：我们纳入了来自REGARDS队列研究（卒中的地理和种族差异的原因）的美国45 - 64岁的成年人，在基线时没有HF的证据。主要接触是根据《2030年健康人框架》计算的SDV计数。主要结局为偶发性心衰。我们评估了健康行为评分（HBS范围0-8）及其组成部分（坚持地中海饮食、体育活动、缺乏久坐生活方式和戒烟）作为SDV和心衰事件之间关联的潜在中介的作用。结果：我们纳入了525名参与者中的13名。中位HBS为4，其中16%为低HBS(0-2)， 55%为中等HBS(3-5)， 29%为高HBS（6-8）。SDV负担的增加与HF事件的逐步增加相关（校正风险比，1 SDV为1.84 [95% CI, 1.32-2.52]， 2 SDV为2.59 [95% CI, 1.87-3.60]，≥3 SDV为4.20 [95% CI, 3.08-5.73]）。HBS在SDV计数1与心衰发生率之间的中介作用无统计学意义。HBS评分介导了SDV计数为2和SDV≥3的患者之间10.6%和11.1%的关联。在完整的病例分析中，这一比例分别增加到10.8%和18.3%。将HBS的各个组成部分作为中介，只有避免久坐的生活方式对SDV计数2和心衰事件的关联具有统计学意义（8.6%的中介作用）。结论：健康的生活方式在高SDV计数与心衰发生率之间起着很小的中介作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Circulation-Cardiovascular Quality and Outcomes CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

8.50

自引率

2.90%

发文量

357

审稿时长

4-8 weeks

期刊介绍： Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal, publishes articles related to improving cardiovascular health and health care. Content includes original research, reviews, and case studies relevant to clinical decision-making and healthcare policy. The online-only journal is dedicated to furthering the mission of promoting safe, effective, efficient, equitable, timely, and patient-centered care. Through its articles and contributions, the journal equips you with the knowledge you need to improve clinical care and population health, and allows you to engage in scholarly activities of consequence to the health of the public. Circulation: Cardiovascular Quality and Outcomes considers the following types of articles: Original Research Articles, Data Reports, Methods Papers, Cardiovascular Perspectives, Care Innovations, Novel Statistical Methods, Policy Briefs, Data Visualizations, and Caregiver or Patient Viewpoints.