Lifestyle, cardiometabolic disease, and multimorbidity in a prospective Chinese study

TLDR

The study investigates whether lifestyle factors differentially influence progression from healthy status to first cardiometabolic disease, cardiometabolic multimorbidity, and subsequent death. The authors used a multi‑state model on 461,047 China Kadoorie Biobank participants aged 30–79 without baseline heart disease, stroke, or diabetes to evaluate how five high‑risk lifestyle factors (smoking, excessive alcohol, poor diet, physical inactivity, unhealthy body shape) influence progression to cardiometabolic multimorbidity defined as two or three CMDs (IHD, stroke, T2D). Over a median 11.2‑year follow‑up, 87,687 participants developed at least one CMD, 14,164 developed CMM, and 17,541 died, with each additional high‑risk lifestyle factor increasing the hazard of transitioning from healthy to FCMD by 20 %, from FCMD to CMM by 14 %, and mortality from healthy, FCMD, and CMM by 21 %, 12 %, and 10 % respectively, and the effects varied by specific disease.

Abstract

Abstract Aims The potential difference in the impacts of lifestyle factors (LFs) on progression from healthy to first cardiometabolic disease (FCMD), subsequently to cardiometabolic multimorbidity (CMM), and further to death is unclear. Methods and results We used data from the China Kadoorie Biobank of 461 047 adults aged 30–79 free of heart disease, stroke, and diabetes at baseline. Cardiometabolic multimorbidity was defined as the coexistence of two or three CMDs, including ischaemic heart disease (IHD), stroke, and type 2 diabetes (T2D). We used multi-state model to analyse the impacts of high-risk LFs (current smoking or quitting because of illness, current excessive alcohol drinking or quitting, poor diet, physical inactivity, and unhealthy body shape) on the progression of CMD. During a median follow-up of 11.2 years, 87 687 participants developed at least one CMD, 14 164 developed CMM, and 17 541 died afterwards. Five high-risk LFs played crucial but different roles in all transitions from healthy to FCMD, to CMM, and then to death. The hazard ratios (95% confidence intervals) per one-factor increase were 1.20 (1.19, 1.21) and 1.14 (1.11, 1.16) for transitions from healthy to FCMD, and from FCMD to CMM, and 1.21 (1.19, 1.23), 1.12 (1.10, 1.15), and 1.10 (1.06, 1.15) for mortality risk from healthy, FCMD, and CMM, respectively. When we further divided FCMDs into IHD, ischaemic stroke, haemorrhagic stroke, and T2D, we found that LFs played different roles in disease-specific transitions even within the same transition stage. Conclusion Assuming causality exists, our findings emphasize the significance of integrating comprehensive lifestyle interventions into both health management and CMD management.