Association Between Comprehensive Health Assessment and Cardiac Mortality and All-Cause Mortality in Patients With Coronary Heart Disease.

Abstract

Coronary heart disease (CHD) confers a substantial global burden, and comprehensive health assessment is critical for secondary prevention. However, the independent and joint associations of multidimensional health with long-term mortality in CHD patients remain unclear in population-based studies. This prospective cohort study included 4823 U.S. adults with self-reported CHD using linked data from the National Health and Nutrition Examination Survey 1999-2018 and National Center for Health Statistics mortality files (through 2019). Associations were evaluated using Cox proportional hazards and Fine-Gray competing risk models, with hazard ratios (HRs) and 95% confidence intervals (CIs) estimated. Over a median follow-up of 6.2 years (IQR: 3.5-9.1), 1542 deaths occurred, including 587 cardiac deaths. After full adjustment, compared with low Comprehensive Health Assessment Score (CHAS [reference]), moderate CHAS was associated with lower all-cause mortality (HR = 0.68; 95% CI: 0.59-0.78) and cardiac mortality (HR = 0.62; 95% CI: 0.51-0.76); High CHAS showed further risk reductions (all-cause mortality: HR = 0.45; 95% CI: 0.38-0.53; cardiac mortality: HR = 0.39; 95% CI: 0.30-0.51). Dose-response relationships were observed (P for trend < 0.001). Physical activity (≥ 150 MET-min/week) (all-cause mortality: HR = 0.71; 95% CI: 0.63-0.80) and statin use (cardiac mortality: HR = 0.58; 95% CI: 0.49-0.69) were the strongest independent predictors. Subgroup analyses showed consistent associations across age, sex, and obesity. A favorable lifestyle, physical function, metabolic health, and comorbidity control, was strongly associated with lower cardiac and all-cause mortality in patients with CHD, supporting multidimensional health management for secondary prevention of CHD.