Objective: To analyze the mediating effect of cardiovascular health status (CVH) on the association between educational level and cardiovascular disease (CVD). Methods: The participants were from Shanghai Suburban Adult Cohort and Biobank, and questionnaire survey, physical examination, blood biochemistry were conducted from 2016 to 2020 for baseline information collection, and follow up was conducted until March 31, 2024 based on the medical data, CVD incidence data and death surveillance data at different levels. The associations of educational level, CVH and time to CVD onset of the study population were analyzed using the accelerated failure time model to analyze the mediating effects of CVH, health behaviors, and health factors in the association of educational level and time to CVD onset. The mediating effects of educational level, gender, and age moderated associations were also analyzed. Results: A total of 57 312 participants were included, with 2 780 new cases of CVD during a median follow-up of 6.71 (6.71-6.72) years, and a mean incidence density of 7.77/1 000 person-years (95%CI: 7.48/1 000 person-years -8.06/1 000 person-years). In total, the less educational level and the lower CVH, the higher CVD incidence density (P<0.05). The results of accelerated failure time models showed that the time ratio for CVD-free survival was 1.15 (95%CI: 1.06-1.24) and 1.33 (95%CI: 1.10-1.60) for moderate and high educational level, respectively. The results of the mediation effect analysis showed that the association between moderate and high educational level and time to CVD onset was 29.60% (20.50%-50.00%) and 36.10% (23.80%-59.00%), 9.97% (5.07%-20.00%) and 13.84% (6.84%-29.00%), 15.24% (9.64%-27.00%) and 17.55% (11.58%-33.00%) of mediators mediated by CVH, health behaviors, health factors, respectively. Among them, there was an exposure-mediated interaction of educational level and a positive moderating effect of age. Conclusion: CVH, health behaviors and health factors had a proportionate mediating effect in the association between educational level and risk of CVD development.
目的： 分析心血管健康状况（CVH）在文化程度与心血管疾病（CVD）关联中的中介效应。 方法： 研究对象来自上海郊区自然人群队列，2016-2020年对基线进行问卷调查、体格检查、血液生化检查，并通过各级医疗数据、CVD发病和死亡监测数据随访至2024年3月31日。采用加速失效时间模型分析研究对象的文化程度、CVH与CVD发病时间的关联，分析CVH、健康行为、健康因素在文化程度与CVD发病时间关联的中介效应，并分析文化程度、性别、年龄调节后的中介效应。 结果： 共纳入57 312名研究对象，随访时间M（Q1，Q3）为6.71（6.71，6.72）年，新发CVD 2 780名，平均发病密度为7.77/1 000人年（95%CI：7.48/1 000人年~8.06/1 000人年）。总体上，文化程度越低、CVH越低，CVD发病密度越高（P<0.05）。加速失效时间模型结果表明，中学和大学及以上文化程度的CVD发病时间比分别1.15（95%CI：1.06~1.24）和1.33（95%CI：1.10~1.60）。中介效应分析结果表明，中学和大学及以上文化程度与CVD发病时间的关联中，CVH的中介比例（95%CI）分别为29.60%（20.50%~50.00%）和36.10%（23.80%~59.00%）、健康行为的中介比例（95%CI）分别为9.97%（5.07%~20.00%）和13.84%（6.84%~29.00%）、健康因素的中介比例（95%CI）分别为15.24%（9.64%~27.00%）和17.55%（11.58%~33.00%）。其中文化程度存在暴露中介相互作用，年龄存在正向调节作用。 结论： CVH、健康行为、健康因素在文化程度与CVD的关联中存在一定比例的中介效应。.