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. 2025 Jul 16;4(8):102003.
doi: 10.1016/j.jacadv.2025.102003. Online ahead of print.

Cardiovascular Health Metrics, Genetic Susceptibility, and Incident Chronic Obstructive Pulmonary Disease: A Prospective Cohort Analysis

Jing-Wei Gao  1 , Si You  1 , Wan-Bing He  1 , Ze-Gui Huang  1 , Yang-Wei Cai  1 , Yu-Biao Wu  1 , Qian Chen  1 , Jing-Feng Wang  1 , Hai-Feng Zhang  2 , Shao-Ling Zhang  3 , Pin-Ming Liu  4
Affiliations

Cardiovascular Health Metrics, Genetic Susceptibility, and Incident Chronic Obstructive Pulmonary Disease: A Prospective Cohort Analysis

Jing-Wei Gao et al. JACC Adv. .

Abstract

Background: Evidence on the prospective relationship between cardiovascular health (CVH) and chronic obstructive pulmonary disease (COPD) risk is limited, particularly regarding genetic susceptibility as an effect modifier.

Objectives: We aimed to investigate the association between CVH levels and COPD risk and to determine whether genetic susceptibility influences this relationship.

Methods: We included 293,342 participants free of COPD from the UK Biobank cohort. CVH levels were assessed using the Life's Essential 8 (LE8) and the Life's Simple 7 scores. Genetic predisposition to COPD was quantified via the polygenic risk score. Cox proportional hazard models examined the impacts of CVH levels and polygenic risk score on COPD incidence.

Results: During a median follow-up of 12.89 (Q1-Q3: 12.22-13.54) years, 9,481 participants developed COPD, with an incidence rate of 2.533 per 1,000 person-years (95% CI: 2.482-2.584). Compared to low CVH levels measured by LE8, the HRs (95% CI) for incident COPD were 0.468 (0.446-0.490) for moderate and 0.201 (0.177-0.227) for high CVH levels. No statistically significant interactions were observed between CVH levels and genetic susceptibility to COPD. LE8 showed better predictive accuracy for COPD incidence than Life's Simple 7, with a higher area under the receiver operating characteristic curve (0.698 [95% CI: 0.693-0.704] vs 0.677 [95% CI: 0.672-0.682], PDeLong < 0.001).

Conclusions: High CVH levels are significantly associated with a lower risk of incident COPD, regardless of genetic predisposition. These findings highlight the importance of maintaining optimal CVH in COPD prevention. (Predictors of coronary artery calcification [CAC] progression in the UKB population; 91090).

Keywords: Life's Essential 8; Life's Simple 7; cardiovascular health; chronic obstructive pulmonary disease; polygenic risk score.

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Conflict of interest statement

Funding support and author disclosures This work was supported by grants from the National Natural Science Foundation of China [82170457, 82200464, and 82371573] and the Guangdong Basic and Applied Basic Research Foundation [2025A1515010683 and 2023A1515011730]. The funders had no role in the study design, data collection and analysis, publication decision, or manuscript preparation. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Dose-Response Curves for Cardiovascular Health Scores and Incidence of COPD Association between the Life's Essential 8 score (A), the Life's Simple 7 score (B), and the risk of incident COPD. HRs were adjusted for age, alcohol intake frequency, C-reactive protein, ethnicity, education levels, household incomes, particulate matter 2.5, sex, and the Townsend deprivation index. COPD = chronic obstructive pulmonary disease.
Figure 2
Figure 2
Receiver Operating Characteristic Curves Comparing the Predictive Performance of the LS7 Score and the LE8 Score for Incident Chronic Obstructive Pulmonary Disease AUC = area under receiver operating characteristic curve; LE8 = Life's Essential 8; LS7 = Life's Simple 7.
Central Illustration
Central Illustration
Cardiovascular Health Metrics, Genetic Susceptibility, and Incident Chronic Obstructive Pulmonary Disease The risk of COPD in the UK Biobank cohort based on CVH levels defined by the LE8, considering both the presence and absence of genetic risk factors. BMI = body mass index; BP = blood pressure; COPD = chronic obstructive pulmonary disease; CVH = cardiovascular health; LE8 = Life's Essential 8.
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