Importance of healthy lifestyle factors and ideal cardiovascular health metrics for risk of heart failure in Chinese adults
Authors: Yang Ruotong , Lv Jun , Yu Canqing , Guo Yu , Bian Zheng , Han Yuting , Yang Ling , Chen Yiping , Du Huaidong , Liu Jianjun , Qu Chan , Chen Junshi , Chen Zhengming , Clarke Robert , Huang Tao , Li Liming ,   the China Kadoorie Biobank Collaborative Group, Chen Junshi , Chen Zhengming , Clarke Robert , Collins Rory , Guo Yu , Li Liming , Lv Jun , Peto Richard , Walters Robin , Avery Daniel , Boxall Ruth , Bennett Derrick , Chang Yumei , Chen Yiping , Chen Zhengming , Clarke Robert , Du Huaidong , Gilbert Simon , Hacker Alex , Hill Mike , Holmes Michael , Iona Andri , Kartsonaki Christiana , Kerosi Rene , Kong Ling , Kurmi Om , Lancaster Garry , Lewington Sarah , Lin Kuang , McDonnell John , Millwood Iona , Nie Qunhua , Radhakrishnan Jayakrishnan , Ryder Paul , Sansome Sam , Schmidt Dan , Sherliker Paul , Sohoni Rajani , Stevens Becky , Turnbull Iain , Walters Robin , Wang Jenny , Wang Lin , Wright Neil , Yang Ling , Yang Xiaoming , Bian Zheng , Guo Yu , Han Xiao , Hou Can , Lv Jun , Pei Pei , Liu Chao , Yu Canqing , Pang Zengchang , Gao Ruqin , Li Shanpeng , Wang Shaojie , Liu Yongmei , Du Ranran , Zang Yajing , Cheng Liang , Tian Xiaocao , Zhang Hua , Zhai Yaoming , Ning Feng , Sun Xiaohui , Li Feifei , Lv Silu , Wang Junzheng , Hou Wei , Zeng Mingyuan , Jiang Ge , Zhou Xue , Yang Liqiu , He Hui , Yu Bo , Li Yanjie , Xu Qinai , Kang Quan , Guo Ziyan , Wang Dan , Hu Ximin , Chen Jinyan , Fu Yan , Fu Zhenwang , Wang Xiaohuan , Weng Min , Guo Zhendong , Wu Shukuan , Li Yilei , Li Huimei , Fu Zhifang , Wu Ming , Zhou Yonglin , Zhou Jinyi , Tao Ran , Yang Jie , Su Jian , liu Fang , Zhang Jun , Hu Yihe , Lu Yan , Ma Liangcai , Tang Aiyu , Zhang Shuo , Jin Jianrong , Liu Jingchao , Tang Zhenzhu , Chen Naying , Huang Ying , Li Mingqiang , Meng Jinhuai , Pan Rong , Jiang Qilian , Lan Jian , Liu Yun , Wei Liuping , Zhou Liyuan , Chen Ningyu , Wang Ping , Meng Fanwen , Qin Yulu , Wang Sisi , Wu Xianping , Zhang Ningmei , Chen Xiaofang , Zhou Weiwei , Luo Guojin , Li Jianguo , Chen Xiaofang , Zhong Xunfu , Liu Jiaqiu , Sun Qiang , Ge Pengfei , Ren Xiaolan , Dong Caixia , Zhang Hui , Mao Enke , Wang Xiaoping , Wang Tao , zhang Xi , Zhang Ding , Zhou Gang , Feng Shixian , Chang Liang , Fan Lei , Gao Yulian , He Tianyou , Sun Huarong , He Pan , Hu Chen , Zhang Xukui , Wu Huifang , He Pan , Yu Min , Hu Ruying , Wang Hao , CDC Tongxiang , Qian Yijian , Wang Chunmei , Xie Kaixu , Chen Lingli , Zhang Yidan , Pan Dongxia , Gu Qijun , Huang Yuelong , Chen Biyun , Yin Li , Liu Huilin , Fu Zhongxi , Xu Qiaohua , Xu Xin , Zhang Hao , Long Huajun , Li Xianzhi , Zhang Libo , Qiu Zhe 
Published: November 2021

Abstract

Background
The relative importance of healthy lifestyle factors and cardiovascular health metrics for the risk of heart failure is uncertain in Chinese populations. We aimed to compare the strength of associations between healthy lifestyle factors and ideal cardiovascular health metrics in the risk of heart failure in middle-aged Chinese adults.

Methods
A healthy lifestyle score (HLS) was constructed using smoking, drinking, physical activity, diet, body mass index and waist circumference, and compared with a more comprehensive set of metrics that included cardiovascular-disease risk biomarkers (blood pressure, blood glucose and blood lipids) in addition to the HLS. This broader set of factors [called ‘ideal cardiovascular health metrics’ (ICVHMs)] was evaluated in 487 197 participants in the China Kadoorie Biobank.

Results
A total of 4208 incident cases of heart failure were recorded during a median follow-up of 10 years. Both HLS [hazard ratio (HR), 0.88; 95% confidence interval (CI), 0.85, 0.91] and ICVHMs (0.87: 0.84, 0.89) were inversely associated with risk of heart failure (P &lt; 0.001 for linear trend). Compared with participants with 0–1 HLS, the multivariable-adjusted HR of those with 4–5 HLS was 0.68 (0.59, 0.77). Compared with participants with 0–2 ICVHMs, the adjusted HR (95% CIs) of those who had 7–8 ICVHMs was 0.47 (0.36, 0.60). ICVHMs were more strongly predictive of risk of heart failure (area under curve, 0.61 vs 0.58, P &lt; 0.001) than healthy lifestyle factors alone.

Conclusions
Higher levels of healthy lifestyle factors and ICVHMs were each inversely associated with heart failure, and lifestyle factors combined with cardiometabolic factors improved the prediction of heart failure compared with healthy lifestyle factors alone.