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Original research
Impact of cardiovascular health and genetic risk on coronary artery disease in Chinese adults
  1. Qingmei Cui1,2,
  2. Zhongying Liu1,2,
  3. Jianxin Li1,
  4. Fangchao Liu1,
  5. Xiaoge Niu1,3,
  6. Chong Shen4,
  7. Dongsheng Hu5,6,
  8. Keyong Huang1,
  9. Shufeng Chen1,
  10. Yingxin Zhao7,
  11. Fanghong Lu7,
  12. Xiaoqing Liu8,
  13. Jie Cao1,
  14. Laiyuan Wang1,
  15. Hongxia Ma4,
  16. Ling Yu9,
  17. Xianping Wu10,
  18. Ying Li1,
  19. Huan Zhang11,
  20. Xingbo Mo11,
  21. Liancheng Zhao1,
  22. Zhibin Hu4,
  23. Hongbing Shen4,12,
  24. Jianfeng Huang1,
  25. Xiangfeng Lu1,2,
  26. Dongfeng Gu1,2,13
  1. 1 Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  2. 2 Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
  3. 3 Department of Nephrology, Henan Provincial Key Laboratory of Kidney Disease and Immunology, Henan Provincial Clinical Research Center for Kidney Disease, Henan Provincial People's Hospital, Zhengzhou, Henan, China
  4. 4 Department of Epidemiology and Biostatistics, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
  5. 5 Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
  6. 6 Department of Prevention Medicine, Shenzhen University College of Medicine, Shenzhen, Guangdong, China
  7. 7 Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, Shandong, China
  8. 8 Division of Epidemiology, Guangdong Provincial People's Hospital Guangdong Cardiovascular Institute, Guangzhou, Guangdong, China
  9. 9 Department of Cardiology, Fujian Provincial People's Hospital, Fuzhou, Fujian, China
  10. 10 Department of Chronic and Non-communicable Disease Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, China
  11. 11 Center for Genetic Epidemiology and Genomics, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Soochow University Medical College, Suzhou, Jiangsu, China
  12. 12 Research Units of Cohort Study on Cardiovascular Diseases and Cancers, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Beijing, China
  13. 13 School of Medicine, Southern University of Science and Technology, Shenzhen, Guangdong, China
  1. Correspondence to Dr Xiangfeng Lu, Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; luxf{at}; Professor Dongfeng Gu; gudongfeng{at}


Objective To examine whether adherence to ideal cardiovascular health (CVH) can mitigate the genetic risk of coronary artery disease (CAD) in non-European populations.

Methods Fine and Grey’s models were used to calculate HRs and their corresponding 95% CIs, as well as the lifetime risk of CVH metrics across Polygenic Risk Score (PRS) categories.

Results We included 39 755 individuals aged 30–75 years in Chinese prospective cohorts. 1275 CAD cases were recorded over a mean follow-up of 12.9 years. Compared with unfavourable CVH profile (zero to three ideal CVH metrics), favourable CVH profile (six to seven ideal CVH metrics) demonstrated similar relative effects across PRS categories, with the HRs of 0.40 (95% CI 0.24 to 0.67), 0.41 (95% CI 0.32 to 0.52) and 0.36 (95% CI 0.26 to 0.52) in low (bottom quintile of PRS), intermediate (two to four quintiles of PRS) and high (top quintile of PRS) PRS categories, respectively. For the absolute risk reduction (ARR), individuals with high PRS achieved the greatest benefit from favourable CVH, mitigating the risk to the average level of population (from 21.1% to 8.7%), and the gradient was strengthened in individuals at the top 5% of PRS. Moreover, compared with individuals at low PRS, those at high PRS obtained longer CAD-free years (2.6 vs 1.1) from favourable CVH at the index age of 35 years.

Conclusion Favourable CVH profile reduced the CAD relative risk by similar magnitude across PRS categories, while the ARR from favourable CVH was most pronounced in high PRS category. Attaining favourable CVH should be encouraged for all individuals, especially in individuals with high genetic susceptibility.

  • coronary artery disease
  • genetics
  • epidemiology
  • risk factors

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • QC and ZL contributed equally.

  • Contributors DG and XL conceptualised and designed the study and were the guarantors of this work; as such, they had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. QC and ZL analysed the data and drafted the manuscript. All study authors contributed to interpretation, revision, writing and finalisation of the final submission version of the manuscript.

  • Funding This work was supported by Chinese Academy of Medical Sciences (CAMS) Innovation Fund for Medical Sciences (2021-I2M-1-010, 2019-I2M-2-003 and 2017-I2M-1-004), Research Unit of Prospective Cohort of Cardiovascular Diseases and Cancers, CAMS (2019RU038), the National Key Research and Development Program of China (2018YFE0115300 and 2017YFC0211700), the National Natural Science Foundation of China (82030102, 12126602 and 91857118) and the Taikang Yicai Public Health and Epidemic Control Fund (TKYC-GW-2020).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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