Association of cardiovascular health metrics with all-cause and cardiovascular disease mortality in chronic kidney disease: A cohort study

Shanshan Zhang; Qingping Xue; Di Li; Ying Xu; Yan-Bo Zhang; Jieru Peng; Shiyi Wu; Xingchen He; Xue Yang; Yanjun Liu; Tong Yan; Nianwei Wu; Ying Wen; Lauryn Cravens; Jason Hy Wu; Chun-Xia Yang; Xiong-Fei Pan

doi:10.1016/j.numecd.2024.03.024

Association of cardiovascular health metrics with all-cause and cardiovascular disease mortality in chronic kidney disease: A cohort study

Nutr Metab Cardiovasc Dis. 2024 Mar 23:S0939-4753(24)00126-1. doi: 10.1016/j.numecd.2024.03.024. Online ahead of print.

Authors

Shanshan Zhang¹, Qingping Xue², Di Li³, Ying Xu⁴, Yan-Bo Zhang⁵, Jieru Peng⁶, Shiyi Wu⁶, Xingchen He⁷, Xue Yang⁸, Yanjun Liu⁹, Tong Yan⁹, Nianwei Wu⁷, Ying Wen¹⁰, Lauryn Cravens¹¹, Jason Hy Wu¹², Chun-Xia Yang¹³, Xiong-Fei Pan¹⁴

Affiliations

¹ Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China; Section of Epidemiology and Population Health & Department of Gynecology and Obstetrics, Ministry of Education Key Laboratory of Birth Defects and Related Diseases of Women and Children & National Medical Products Administration Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
² Department of Epidemiology and Biostatistics, School of Public Health, Chengdu Medical College, Chengdu, Sichuan 610500, China.
³ New York University Shanghai, Pudong, Shanghai 200120, China.
⁴ Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310006, China.
⁵ Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
⁶ Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
⁷ Section of Epidemiology and Population Health & Department of Gynecology and Obstetrics, Ministry of Education Key Laboratory of Birth Defects and Related Diseases of Women and Children & National Medical Products Administration Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
⁸ MED-X Institute, Center for Immunological and Metabolic Diseases (CIMD), The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China.
⁹ Center for Obesity and Metabolic Health & Center of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, The Third People's Hospital of Chengdu & The Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan 610014, China.
¹⁰ Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong 518055, China.
¹¹ Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
¹² School of Population Health and The George Institute for Global Health, University of New South Wales, Sydney, New South Wales 2052, Australia.
¹³ Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China. Electronic address: yangchunxia@scu.edu.cn.
¹⁴ Section of Epidemiology and Population Health & Department of Gynecology and Obstetrics, Ministry of Education Key Laboratory of Birth Defects and Related Diseases of Women and Children & National Medical Products Administration Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China; Shuangliu Institute of Women's and Children's Health, Shuangliu Maternal and Child Health Hospital, Chengdu, Sichuan 610200, China; West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China. Electronic address: pxiongfei@scu.edu.cn.

PMID: 38760189
DOI: 10.1016/j.numecd.2024.03.024

Abstract

Background and aims: Since the global burden of chronic kidney disease (CKD) is rising rapidly, the study aimed to assess the association of cardiovascular health (CVH) metrics with all-cause and cardiovascular disease (CVD) mortality among individuals with CKD.

Methods and results: The cohort study included 5834 participants with CKD from the National Health and Nutrition Examination Survey 1999-2018. A composite CVH score was calculated based on smoking status, physical activity, body mass index, blood pressure, total cholesterol, diet quality, and glucose control. Primary outcomes were all-cause and CVD mortality as of December 31, 2019. Multivariable-adjusted Cox proportional hazards models were used to estimate the association between CVH metrics and deaths in CKD patients. During a median follow-up of 7.2 years, 2178 all-cause deaths and 779 CVD deaths were documented. Compared to participants with ideal CVH, individuals with intermediate CVH exhibited a 46.0% increase in all-cause mortality (hazard ratio, 1.46; 95% confidence interval: 1.17, 1.83), while those with poor CVH demonstrated a 101.0% increase (2.01; 1.54, 2.62). For CVD mortality, individuals with intermediate CVH experienced a 56.0% increase (1.56; 1.02, 2.39), and those with poor CVH demonstrated a 143.0% increase (2.43; 1.51, 3.91). Linear trends were noted for the associations of CVH with both all-cause mortality (P for trend <0.001) and CVD mortality (P for trend = 0.02).

Conclusions: Lower CVH levels were associated with higher all-cause and CVD mortality in individuals with CKD, which highlights the importance of maintaining good CVH in CKD patients.

Keywords: All-cause mortality; Cardiovascular disease mortality; Cardiovascular health; Chronic kidney disease; Cohort study.

Copyright © 2024 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.