Association Between Life's Crucial 9 and the prevalence of coronary heart disease in U.S. adults: the potential role of the systemic inflammatory response index.
TL;DR
Higher LC9 scores were significantly associated with lower odds of prevalent self-reported CHD, while higher SIRI was associated with higher odds, which indicates that other factors may be the primary contributors to the LC9-CHD relationship.
Abstract
Background
This studyaimed to examine the association between Life's Crucial 9 (LC9) score and the prevalence of coronary heart disease (CHD) among U.S. adults, as well as explore the potential statistical contribution of Systemic Inflammatory Response Index (SIRI) in this association.
Methods
Data were obtained from 23,508 participants in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018. LC9 score quartiles were used to summarize continuous and categorical variables, which were then reported as weighted means ± standard deviations or weighted frequencies and proportions, respectively. Differences among groups were examined using weighted t-tests and weighted chi-square tests. The relationship between LC9 scores, Ln-SIRI values, and the prevalence of CHD was investigated using weighted logistic regression models following the natural logarithmic transformation of skewed SIRI results. Furthermore, restricted cubic spline regression was utilized to investigate plausible nonlinear connections, subgroup and likelihood ratio tests investigated interaction effects, and weighted quantile sum (WQS) regression was incorporated to determine the relative contributions of LC9 components to CHD. An exploratory non-causal mediation analysis using 1,000 bootstrap samples was conducted to assess SIRI as a potential statistical explanatory variable in the association between LC9 and the prevalence of CHD.
Results
In Model 3, a 10-point increase in the LC9 score correlated with a 24% decrease in the odds of CHD prevalence; participants in the Q4 group had 59% lower odds of CHD compared with those in the Q1 group (P < 0.001 trend). Each Ln-SIRI unit was associated with 56% higher odds of CHD, with Q4 showing 2.02-fold higher odds than Q1 (P < 0.001 trend). Restricted cubic spline regression revealed linear relationships between LC9, Ln-SIRI, and the prevalence of CHD. In particular, LC9 was negatively associated with CHD, whereas Ln-SIRI was positively associated with CHD. Age significantly moderated the association between LC9 and CHD (P for interaction < 0.05), with stronger inverse associations in younger adults. WQS regression identified glucose (weight = 0.34) and tobacco (weight = 0.33) as key CHD-associated factors. Exploratory non-causal mediation analysis revealed that about 6.5% of the LC9-CHD relationship was statistically accounted for by SIRI (P < 0.001), with the majority of factors associated with the link remaining unexplained. This indicates that other factors may be the primary contributors to the LC9-CHD relationship.
Conclusion
This study showed that higher LC9 scores were significantly associated with lower odds of prevalent self-reported CHD, while higher SIRI was associated with higher odds.