Journal of Preventive Medicine and Public Health

The Korean Society for Preventive Medicine (대한예방의학회)
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Cardiovascular Health Metrics and All-cause and Cardiovascular Disease Mortality Among Middle-aged Men in Korea: The Seoul Male Cohort Study

  • Kim, Ji Young (Department of Preventive Medicine, Seoul National University College of Medicine) ;
  • Ko, Young-Jin (Department of Preventive Medicine, Seoul National University College of Medicine) ;
  • Rhee, Chul Woo (Department of Preventive Medicine, Seoul National University College of Medicine) ;
  • Park, Byung-Joo (Department of Preventive Medicine, Seoul National University College of Medicine) ;
  • Kim, Dong-Hyun (Department of Social Medicine, Hallym University College of Medicine) ;
  • Bae, Jong-Myon (Department of Preventive Medicine, Cheju National University College of Medicine) ;
  • Shin, Myung-Hee (Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine) ;
  • Lee, Moo-Song (Department of Preventive Medicine, Ulsan University College of Medicine) ;
  • Li, Zhong Min (Department of Epidemiology and Statistics, School of Public Health Sciences, Jilin University) ;
  • Ahn, Yoon-Ok (Department of Preventive Medicine, Seoul National University College of Medicine)
  • Received : 2013.06.28
  • Accepted : 2013.10.04
  • Published : 2013.11.30
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Abstract

Objectives: This study estimated the association of cardiovascular health behaviors with the risk of all-cause and cardiovascular disease (CVD) mortality in middle-aged men in Korea. Methods: In total, 12 538 men aged 40 to 59 years were enrolled in 1993 and followed up through 2011. Cardiovascular health metrics defined the following lifestyle behaviors proposed by the American Heart Association: smoking, physical activity, body mass index, diet habit score, total cholesterol, blood pressure, and fasting blood glucose. The cardiovascular health metrics score was calculated as a single categorical variable, by assigning 1 point to each ideal healthy behavior. A Cox proportional hazards regression model was used to estimate the hazard ratio of cardiovascular health behavior. Population attributable risks (PARs) were calculated from the significant cardiovascular health metrics. Results: There were 1054 total and 171 CVD deaths over 230 690 person-years of follow-up. The prevalence of meeting all 7 cardiovascular health metrics was 0.67%. Current smoking, elevated blood pressure, and high fasting blood glucose were significantly associated with all-cause and CVD mortality. The adjusted PARs for the 3 significant metrics combined were 35.2% (95% confidence interval [CI], 21.7 to 47.4) and 52.8% (95% CI, 22.0 to 74.0) for all-cause and CVD mortality, respectively. The adjusted hazard ratios of the groups with a 6-7 vs. 0-2 cardiovascular health metrics score were 0.42 (95% CI, 0.31 to 0.59) for all-cause mortality and 0.10 (95% CI, 0.03 to 0.29) for CVD mortality. Conclusions: Among cardiovascular health behaviors, not smoking, normal blood pressure, and recommended fasting blood glucose levels were associated with reduced risks of all-cause and CVD mortality. Meeting a greater number of cardiovascular health metrics was associated with a lower risk of all-cause and CVD mortality.

Keywords

References

  1. World Health Organization. World health statistics 2012 [cited 2013 June 24 ]. Available from: http://www.who.int/gho/publications/world_health_statistics/EN_WHS2012_Full.pdf.
  2. Korea National Statistical Office. 2011 Annual report on the cause of death statistics. Seoul: Korea National Statistical Office; 2012, p. 6-7 (Korean).
  3. World Health Organization. Global health risks: mortality and burden of disease attributable to selected major risks. Geneva: World Health Organization; 2009, p. 28.
  4. Ford ES, Greenlund KJ, Hong Y. Ideal cardiovascular health and mortality from all causes and diseases of the circulatory system among adults in the United States. Circulation 2012; 125(8):987-995. https://doi.org/10.1161/CIRCULATIONAHA.111.049122
  5. Berry JD, Dyer A, Cai X, Garside DB, Ning H, Thomas A, et al. Lifetime risks of cardiovascular disease. N Engl J Med 2012; 366(4):321-329. https://doi.org/10.1056/NEJMoa1012848
  6. Folsom AR, Yatsuya H, Nettleton JA, Lutsey PL, Cushman M, Rosamond WD, et al. Community prevalence of ideal cardiovascular health, by the American Heart Association definition, and relationship with cardiovascular disease incidence. J Am Coll Cardiol 2011;57(16):1690-1696. https://doi.org/10.1016/j.jacc.2010.11.041
  7. Lloyd-Jones DM, Hong Y, Labarthe D, Mozaffarian D, Appel LJ, Van Horn L, et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association's strategic Impact Goal through 2020 and beyond. Circulation 2010;121(4):586-613. https://doi.org/10.1161/CIRCULATIONAHA.109.192703
  8. Korea Centers for Disease Control and Prevention. Nine healthy life habits for prevention and management of cardio-cerebrovascular diseases; 2009 [cited 2013 Jun 24]. Available from: http://www.cdc.go.kr/CDC/notice/CdcKrIntro0504.jsp? menuIds=HOME001-MNU0004-MNU0015-MNU0110&cid= 11063.
  9. Yang Q, Cogswell ME, Flanders WD, Hong Y, Zhang Z, Loustalot F, et al. Trends in cardiovascular health metrics and associations with all-cause and CVD mortality among US adults. JAMA 2012;307(12):1273-1283. https://doi.org/10.1001/jama.2012.339
  10. Shin MH, Kim DH, Bae JM, Lee HK, Lee MS, Noh JY, et al. The effect of coffee consumption on serum total cholesterol level in healthy middle-aged men. Korean J Prev Med 1994;27(2): 200-216 (Korean).
  11. Lee MS, Kang WC, Kim DH, Bae JM, Shin MH, Lee YJ, et al. Methodologic considerations on the cohort study of risk factors of stomach cancer: on the incompleteness of case ascertainment. Korean J Epidemiol 1997;19(2):152-160 (Korean).
  12. Bae JM, Ahn YO. A nested case-control study on the high-normal blood pressure as a risk factor of hypertension in Korean middle-aged men. J Korean Med Sci 2002;17(3):328-336. https://doi.org/10.3346/jkms.2002.17.3.328
  13. Rhee CW, Kim JY, Park BJ, Li ZM, Ahn YO. Impact of individual and combined health behaviors on all causes of premature mortality among middle aged men in Korea: the Seoul Male Cohort Study. J Prev Med Public Health 2012;45(1):14-20. https://doi.org/10.3961/jpmph.2012.45.1.14
  14. Eguchi E, Iso H, Tanabe N, Wada Y, Yatsuya H, Kikuchi S, et al. Healthy lifestyle behaviours and cardiovascular mortality among Japanese men and women: the Japan collaborative cohort study. Eur Heart J 2012;33(4):467-477. https://doi.org/10.1093/eurheartj/ehr429
  15. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004;363(9403):157-163. https://doi.org/10.1016/S0140-6736(03)15268-3
  16. Ahn Y, Paik HY, Ahn YO. Item non-responses in mailed food frequency questionnaires in a Korean male cancer cohort study. Asia Pac J Clin Nutr 2006;15(2):170-177.
  17. Kim MK, Lee SS, Ahn YO. Reproducibility and validity of a self-administered semiquantitative food frequency questionnaire among middle-aged men in Seoul. Korean J Community Nutr 1996;1(3):376-394 (Korean).
  18. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002;106(25):3143-3421.
  19. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003;289(19): 2560-2572. https://doi.org/10.1001/jama.289.19.2560
  20. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2007;30 Suppl 1:S42-S47. https://doi.org/10.2337/dc07-S042
  21. Spiegelman D, Hertzmark E, Wand HC. Point and interval estimates of partial population attributable risks in cohort studies: examples and software. Cancer Causes Control 2007;18(5): 571-579. https://doi.org/10.1007/s10552-006-0090-y
  22. Hertzmark E, Wand H, Spiegelman D. The SAS PAR macro; 2012 [cited 2013 June 20]. Available from: http://www.hsph.harvard.edu/donna-spiegelman/files/2012/09/par_documentation-_march_2012.pdf.
  23. Bruzzi P, Green SB, Byar DP, Brinton LA, Schairer C. Estimating the population attributable risk for multiple risk factors using case-control data. Am J Epidemiol 1985;122(5):904-914. https://doi.org/10.1093/oxfordjournals.aje.a114174
  24. Khaw KT, Wareham N, Bingham S, Welch A, Luben R, Day N. Combined impact of health behaviours and mortality in men and women: the EPIC-Norfolk prospective population study. PLoS Med 2008;5(1):e12. https://doi.org/10.1371/journal.pmed.0050012
  25. Yun JE, Won S, Kimm H, Jee SH. Effects of a combined lifestyle score on 10-year mortality in Korean men and women: a prospective cohort study. BMC Public Health 2012;12:673. https://doi.org/10.1186/1471-2458-12-673
  26. Odegaard AO, Koh WP, Gross MD, Yuan JM, Pereira MA. Combined lifestyle factors and cardiovascular disease mortality in Chinese men and women: the Singapore Chinese health study. Circulation 2011;124(25):2847-2854. https://doi.org/10.1161/CIRCULATIONAHA.111.048843
  27. Tamakoshi A, Tamakoshi K, Lin Y, Yagyu K, Kikuchi S; JACC Study Group. Healthy lifestyle and preventable death: findings from the Japan Collaborative Cohort (JACC) Study. Prev Med 2009; 48(5):486-492. https://doi.org/10.1016/j.ypmed.2009.02.017
  28. Artinian NT, Fletcher GF, Mozaffarian D, Kris-Etherton P, Van Horn L, Lichtenstein AH, et al. Interventions to promote physical activity and dietary lifestyle changes for cardiovascular risk factor reduction in adults: a scientific statement from the American Heart Association. Circulation 2010;122(4):406-441. https://doi.org/10.1161/CIR.0b013e3181e8edf1
  29. Behrens G, Fischer B, Kohler S, Park Y, Hollenbeck AR, Leitzmann MF. Healthy lifestyle behaviors and decreased risk of mortality in a large prospective study of U.S. women and men. Eur J Epidemiol 2013;28(5):361-372. https://doi.org/10.1007/s10654-013-9796-9
  30. Emerging Risk Factors Collaboration, Wormser D, Kaptoge S, Di Angelantonio E, Wood AM, Pennells L, et al. Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: collaborative analysis of 58 prospective studies. Lancet 2011;377(9771):1085-1095. https://doi.org/10.1016/S0140-6736(11)60105-0
  31. Jee SH, Suh I, Kim IS, Appel LJ. Smoking and atherosclerotic cardiovascular disease in men with low levels of serum cholesterol: the Korea Medical Insurance Corporation Study. JAMA 1999;282(22):2149-2155. https://doi.org/10.1001/jama.282.22.2149
  32. Korea Centers for Disease Control and Prevention. Korea health statistics 2011: Korea National Health and Nutrition Examination Survey (KNHANES V-2). Cheongwon: Korea Centers for Disease Control and Prevention; 2012, p. 22-23 (Korean).
  33. Kim S, Popkin BM, Siega-Riz AM, Haines PS, Arab L. A cross-national comparison of lifestyle between China and the United States, using a comprehensive cross-national measurement tool of the healthfulness of lifestyles: the Lifestyle Index. Prev Med 2004;38(2):160-171. https://doi.org/10.1016/j.ypmed.2003.09.028
  34. Jiao L, Mitrou PN, Reedy J, Graubard BI, Hollenbeck AR, Schatzkin A, et al. A combined healthy lifestyle score and risk of pancreatic cancer in a large cohort study. Arch Intern Med 2009; 169(8):764-770. https://doi.org/10.1001/archinternmed.2009.46

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  28. Demographic and socioeconomic inequalities in ideal cardiovascular health: A systematic review and meta-analysis vol.16, pp.8, 2013, https://doi.org/10.1371/journal.pone.0255959
  29. Comparison of four healthy lifestyle scores for predicting cardiovascular events in a national cohort study vol.11, pp.1, 2013, https://doi.org/10.1038/s41598-021-01213-6