老年人群不同健康生活方式评分下认知功能与心脑血管疾病死亡的关联研究

Association between cognitive function and cardiac-cerebral vascular disease mortality in the elderly with different healthy lifestyles

摘要:

目的 探讨老年人不同健康生活方式评分组中认知功能与心脑血管疾病死亡的关联。方法 北京城乡健 康老龄队列研究（BHACS）中 6 817 名≥60 岁老年居民进行问卷调查、体格检查和实验室检测。认知功能采用简易智能 精神状态检查量表（MMSE），根据吸烟、饮酒、锻炼和体型构建健康生活方式评分（0~4 分）。利用多因素Cox比例风险回 归模型探究老年人群MMSE与心脑血管疾病死亡风险关联，并对单一健康生活方式与MMSE进行联合效应分析。结果 截至 2021 年 3 月 31 日，该研究中位随访时间为 5.67（5.34~6.73）a，随访期间共 397 人死亡，死亡密度为 89.17/（10 000 人 · 年）。低、中、高水平健康生活方式的老年居民分别为 1 390 人（20.4%）、4 475 人（65.6%）和 952 人（14.0%）。中水平 健康生活方式和中MMSE评分及高MMSE评分参与者的心脑血管疾病死亡风险分别降低 37.1%和 57.3%（HR=0.629， 95%CI：0.417~0.950；HR=0.427，95%CI：0.258~0.708）， 高水平健康生活方式和高 MMSE 评分参与者降低 61.5% （HR=0.385，95%CI：0.168~0.887）。与低MMSE评分组的吸烟者和不锻炼者相比，中、高MMSE评分组的从不吸烟者死 亡风险分别降低 46.3%和 56.2%（HR=0.537，95%CI：0 349~0.827；HR=0.438，95%CI：0 265~0.726），锻炼者死亡风险 分别降低 46.5%和 67.2%（HR=0.535，95%CI：0.369~0.776；HR=0.328，95%CI：0.205~0.524）。结论 老年人群中，高 MMSE评分与心脑血管疾病死亡风险降低相关，而健康的生活方式与较好认知功能的联合效应可增强认知功能对心脑 血管疾病死亡风险的保护作用。

Abstract:

Objective To investigate the association between cognitive function and cardiac-cerebral vascular disease (CCVD) mortality in the elderly with different healthy lifestyle scores. Methods A total of 6 817 elderly residents aged 60 years or more from Beijing Healthy Aging Cohort Study (BHACS) received questionnaire survey, physical examination and laboratory tests. The cognitive function was evaluated using Mini-Mental State Examination (MMSE), and healthy lifestyle score (0-4 points) was constructed using smoking, drinking, exercise and body shape. The association between MMSE and the risk of CCVD mortality was assessed by multivariate Cox proportional hazards regression model, and the joint effect between single healthy lifestyle and MMSE was also analyzed in the elderly. Results By March 31, 2021, the median follow-up period was 5.67 (5.34, 6.73) years, with 397 deaths and mortality rate of 89.17/10 000 person-years. The number of elderly residents with low, moderate and high healthy lifestyle was 1 390 (20.4%), 4 475 (65.6%) and 952 (14.0%), respectively. The risk of CCVD mortality was reduced by 37.1% and 57.3% in participants with moderate healthy lifestyle and moderate and high MMSE scores, respectively (HR=0.629, 95%CI: 0.417-0.950; HR=0.427, 95%CI: 0.258-0.708). Participants with high healthy lifestyle and MMSE scores had 61.5% reduction (HR=0.385, 95%CI: 0.168-0.887). Compared with smokers with low MMSE scores and non-exercisers, the mortality risk decreased by 46.3% and 56.2% (HR=0.537, 95%CI: 0.349-0.827; HR=0.438, 95%CI: 0.265-0.726) in non-smokers with moderate and high MMSE scores, and 46.5% and 67.2% (HR=0.535, 95%CI: 0.369- 0.776; HR=0.328, 95%CI: 0.205-0.524) in exercisers with moderate and high MMSE scores. Conclusion Higher MMSE scores can be associated with reduced risk of CCVD mortality in the elderly, while the combined impact of healthy lifestyle and better cognitive function could enhance the protective effect of cognitive function on the risk of CCVD mortality.