Exploring the association between lifestyle and cardiovascular health metrics and HPV infection risk: insights from the National Health and Nutrition Examination Survey 2005-2016 data

Abstract

Background: Human Papillomavirus (HPV) infection has garnered significant attention due to its high prevalence and association with various cancers and other health conditions. Composite lifestyle factors may influence the risk of HPV infection, yet their cumulative impact remains insufficiently explored. This study aims to explore the association between the Life's Essential 8 (LE8) Score and HPV infection status, highlighting the potential role of lifestyle and health behaviors in HPV infection prevention.

Methods: Utilizing data from the National Health and Nutrition Examination Survey (NHANES) spanning 2005-2016, we analyzed the health and nutritional statuses of 6,773 participants after excluding those with missing HPV infection status, inability to calculate the LE8 Score, and missing covariate data. The LE8 Score was computed based on eight cardiovascular health metrics, encompassing both health factors (BMI, non-HDL cholesterol, blood pressure, and blood glucose) and health behaviors (physical activity, diet, sleep duration, and nicotine exposure). HPV infection status was determined through vaginal swab specimens analyzed using various Roche assays. Multivariate logistic regression, the restricted cubic splines (RCS) analysis and weighted quantile sum (WQS) regression were employed to assess the association between LE8 Score and HPV infection risk.

Results: Our findings indicate a significant inverse association between the LE8 Score and HPV infection risk. Participants with medium and high LE8 Scores exhibited a 21% and 31% lower risk of HPV infection, respectively, compared to those with low LE8 Scores in multivariate logistic regression models. The analysis also revealed that lifestyle factors, particularly nicotine exposure and blood pressure, significantly contributed to the observed association.

Conclusion: The study underscores the importance of healthy lifestyle behaviors in reducing the risk of HPV infection. Public health strategies promoting such behaviors could complement existing HPV prevention measures, potentially lowering the burden of HPV-related diseases. Future research should further investigate the mechanisms underlying this association and the effectiveness of lifestyle interventions in diverse populations.

Keywords: Cardiovascular health (CVH); HPV Infection; Lifestyle Behaviors; Life’s essential 8; NHANES; Public health strategies.

Fig. 1

The flowchart of study and excluded participants, from NHANE 2005–2016. Legends: LE8, Life’s Essential 8; NHANES, National Health and Nutrition Examination Survey; HPV, Human Papillomavirus

Fig. 2

Adjusted restricted cubic spline curve between Life’s Essential 8 scores and HPV infection status. Legends: (A), no covariates were adjusted. (B), adjusted for race/ethnicity, educational level, PIR and drinking status. Data were fitted by a logistic regression model, and the model was conducted with 4 knots at the 5th, 35th, 65th, 95th percentiles of LE8 score (reference is the 5th percentile). The x-axis represents LE8 scores ranging from 0 to 100, while the left y-axis shows the odds ratio (OR) where the reference for LE8 is 49.375, and the right y-axis indicates the percentage of population. Gray histograms depict population distribution. Red solid lines represent the estimated OR trends, with red dashed lines showing 95% confidence intervals (CI). OR, odds ratio; CI, confidence interval

Fig. 3

Subgroup analysis of the association of the Life’s Essential 8 scores and HPV infection status, each stratifcation was adjusted for race/ethnicity, education level, PIR and drinking status. Legends: The figure displays the odds ratios (OR) and 95% confidence intervals (CI) for HPV infection across various demographic and socioeconomic subgroups. The characteristics include age groups, race/ethnicity categories, education levels, and poverty income ratio (PIR). Each OR represents the association between a characteristic and HPV infection status, adjusted for relevant covariates. “P for interaction” refers to the statistical test for interaction between each characteristic and the association between LE8 scores (lifestyle and cardiovascular health metrics) and HPV infection risk

Fig. 4

Weighted Quantile Sum (WQS) model regression index weights for the HPV infection, adjusted for race/ethnicity, education level, poverty income ratio (PIR) and drinking status. Legends: The figure presents the estimated weights of different lifestyle and cardiovascular health metrics as determined by the WQS model, showing their relative contributions to the overall risk of HPV infection. Tobacco/nicotine exposure is the most significant contributor, accounting for 53.20% of the total weight, indicating a strong link between tobacco use and increased HPV infection risk. Blood pressure follows, contributing about 11.91%, while sleep health and physical activity each account for approximately 11%, reflecting moderate associations with HPV risk. The HEI-2015 diet score, representing dietary quality, contributes about 9.01%, suggesting a smaller yet noteworthy role. Blood glucose and blood lipids have relatively minor contributions, with blood glucose slightly outweighing blood lipids. Body mass index (BMI) has a negligible contribution, implying little to no influence on HPV infection risk when considering the other factors in the model