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研究生:蔡明潔
研究生(外文):Ming-Chieh Tsai
論文名稱:健康生活分數對於心血管疾病的保護作用:台灣具代表性的世代研究
論文名稱(外文):The protective effects between Healthy Lifestyle scores and the Risk of Cardiovascular diseases: a representative Cohort study in Taiwan
指導教授:簡國龍簡國龍引用關係
指導教授(外文):Kuo-Liong Chien
口試委員:李文宗林先和葉宏一白其卉
口試委員(外文):WEN-CHUNG LEEHSIEN-HO LIN
口試日期:2020-06-02
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:流行病學與預防醫學研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2020
畢業學年度:108
語文別:英文
論文頁數:206
中文關鍵詞:健康生活分數心血管疾病
外文關鍵詞:LifestyleCardiovascular disease
DOI:10.6342/NTU202002676
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背景:
合併健康生活習慣,包括理想體重,健康飲食,適當運動,不抽菸,適量的飲酒,對於心血管疾病的保護效果過去有被證實,但是除了單純的五個健康生活習慣相加結合成健康生活分數外,沒有研究討論過在討論心血管疾病風險時是否需要加權不同的健康生活習慣,而且也不曾有研究將之與World Cancer Research Fund (WCRF)/American Institute for Cancer Research (AICR) 為了預防癌症所提出的健康生活分數,或是美國心臟醫學會所提出的Life’s Simple 7健康生活分數做心血管疾病發生風險預測比較。

方法:
我們使用一個平均年齡43歲,50.2%女性的全國代表性世代追蹤資料庫【三高主題資料庫】排除掉在2002年受訪前健保資料有記錄到心血管疾病的6042位受訪者,我們定義簡單台灣健康分數為一個包含理想體重、地中海飲食、適量運動、不抽菸、規則飲酒的五個向度的加總分數。我們並且使用這五個因子對於心血管疾病多變量模型中的係數值(coefficient)做為權重,另外加總成一個權重的台灣心血管健康分數。我們並且使用WCRF/AICR 2018年對於健康生活分數的定義和美國心血管協會對於Life’s Simple 7的定義,使用三高主題資料庫去驗證這健康生活分數對於心血管疾病的保護效果,並且比較四個健康生活分數對於心血管疾病的預測能力。
結果:
在一個平均13.4年的追蹤期間,全部共有520個心血管疾病發生,多變量的存活分析顯示,在簡單和加權台灣健康分數最高的組別,相較分數最低的組別,心血管疾病發生率顯著的下降56~57%,並且年紀是有意義的干擾因子。但在校正了許多臨床因子之後,WCRF/AICR 的健康生活分數和Life’s Simple 7 卻沒有辦法觀察到顯著的保護效果。在年紀小於60歲的族群,因著健康生活分數的保護讓心血管疾病下降的幅度顯著的大於等於60歲的族群。除此之外,在AUC 和 NRI, IDI 對模型的預測力統計量當中,簡單和權重的台灣健康生活分數相較於WCRF/AICR 健康生活分數和Life’s Simple 7 有較好且顯著的增加預測效果。
討論與結論:
我們證明了健康生活分數較高的人相較較低的人,心血管疾病發生率有顯著的下降,並且下降的幅度在年輕人更為明顯。進一步的研究探討綜合所有健康生活習慣對於心血管疾病的保護機轉是有必要的
Background
The protective effect of different healthy lifestyle scores for the risk of cardiovascular disease (CVD) was reported but the comparisons of performance were lack. We compared the performance measures of cardiovascular diseases from different healthy lifestyle scores among adult Taiwan.

Methods
We conducted a nationwide prospective cohort study of 6042 participants (median age 43 years, 50.2% women) in Taiwan’s Hypertensive, Hyperglycemia, Hyperlipidemia Survey, 2002 who were free of CVD at baseline. Simple Taiwan healthy lifestyle score was defined as a normal body mass index, Mediterranean diet >= points, adequately physical activity 1~150 mins/week, not smoking and regular healthy drinking. A weighted healthy Taiwan healthy lifestyle score also was created, where each dichotomous lifestyle factor was first weighted according to its independent magnitude of effect. World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) cancer prevention recommended lifestyle and Life's Simple 7 following the definition proposed by the American Heart Association were all created.
Results:
During a median 13.4 years follow-up period, totally 520 cases developed CVD events. In multivariate-adjusted Cox proportional hazard models, adherence to highest category compared with lowest one of simple Taiwan lifestyle score for hazard ratio 0.43 (95% confidence interval [CI] 0.2, 0.94) and weighted Taiwan lifestyle score for 0.44 (95%CI 0.28, 0.68) were independently and significantly (figure 1). In addition, age played a significant effect modifier for the protective effect of healthy lifestyle scores for CVD risk and more reduction of CVD incidence was observed among adults <60 years old and adults ≧60 years old. Specifically, when the simple and weighted Taiwan healthy lifestyle score were added to the classical model, the Harrell’s C-statistic increasing from 0.85 to 0.86 (95% confidence interval [CI], 0.84, 087; Pdiff=0.02) in both lifestyle scores. The performance measures by integrated discriminative improvement showed significant increasing after adding simple Taiwan healthy lifestyle score (integrated discriminative improvement: 0.51, 95% CI 0.16, 0.86, P=0.002) and weighted
Taiwan lifestyle score (integrated discriminative improvement: 0.38, 95% CI 0.01,0.74, P=0.021) information.


Conclusion:
We demonstrated that healthy lifestyle scores had protective effect of CVD, and the reduction of CVD risk was more for young adults than for old adult. Further investigations to study the mechanism of lifestyle role on CVD prevention are warranted.
Table of Contents
誌謝 2
摘要 3
Abstract 5
Table of Contents 8
List of Figures 11
List of Tables 13
Chapter One:Introduction 16
1.1 Ideal weight 16
1.2 Mediterranean diet 19
1.3 Physical activity 21
1.4 Tobacco control-- Non-smoking 22
1.5 Adequate Alcohol Consumption 23
1.6 Combined healthy lifestyle factors 24
1.7 Weighted combined healthy lifestyle score 26
1.10 Taiwanese Survey on Hypertension, Hyperglycemia, and Hyperlipidemia (TwSHHH) 29
1.11 Hypothesis and Research Gap 30
Chapter Two:Materials and Method 33
2.1 Study design and participants 33
2.2 Assessment of health lifestyle factors 34
2.3 Simple Taiwan healthy lifestyle scores 36
2.4 Weighted Taiwan healthy lifestyle score 37
2.5 The World Cancer Research Fund International/ American Institute for Cancer Research (WCRF/AICR) lifestyle score 37
2.6 Life’s Simple 7 score 39
2.7 Measurements of blood pressure, weight and height measurement 41
2.8 Measurement of biochemistry markers 41
2.9 Important covariates 42
2.10 Outcome ascertainment and prospective follow-up 44
2.11 Statistical Analyses 44
Chapter Three:Result 49
3.1 Demographic and lifestyle characteristics among participants at baseline 49
3.2 Lifetime risk of cardiovascular disease 50
3.3 Healthy lifestyle scores and lifetime risk of CVD 51
3.4 Healthy lifestyle scores and CVD risk in adult < 60 years old and ≧ 60 years old 53
3.5 Comparing different healthy lifestyle scores 53
3.6 Sensitivity analysis 54
Chapter Four:Discussion 56
4.1 Main finding 56
4.2 Comparing with previous studies 56
4.3 Biological mechanism 63
4.4 Clinical implication 64
4.5 Strengths and limitations 65
Chapter Five:Conclusion 67
Reference 68
Figure 91
Table 113
Appendix 184
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