In this study, we conducted a cross-sectional investigation involving 4,599 participants from the NHANES database to evaluate the association between OBS and 10-year ASCVD risk. Our study findings indicate that, after adjusting for relevant confounding variables, overall OBS, dietary OBS, and lifestyle OBS are inversely associated with 10-year ASCVD risk, whether considered as continuous or categorical variables. This implies that higher OBS levels are associated with a reduced risk of ASCVD, underscoring the significance of antioxidant dietary patterns and lifestyles in the context of ASCVD. Furthermore, subgroup analyses revealed that race and hypertension act as effect modifiers in the relationship between OBS and 10-year ASCVD risk.
Cardiovascular disease (CVD) is a significant threat to human life and health. Data shows that CVD is the leading cause of death in the global population aged 35–70, accounting for 40% of all deaths [14, 15]. Atherosclerotic cardiovascular disease (ASCVD) was first introduced by the ACC/AHA in 2013, encompassing ischemic or endothelial dysfunction-inflammatory diseases caused by atherosclerosis, such as coronary heart disease, ischemic stroke, and diabetes-related atherosclerotic vascular diseases [16]. Risk assessment forms the basis for primary prevention of ASCVD, as identifying the presence and severity of atherosclerotic lesions before clinical symptoms appear is essential for managing and treating risk factors and preventing further disease progression. The premise of early prevention of cardiovascular disease is the proper assessment of cardiovascular disease risk. The most commonly used and extensively validated risk assessment models internationally and domestically are the Framingham 10-year risk score [17] and the Pooled Cohort Equation for ASCVD risk calculation, developed by the ACC/AHA. The Framingham 10-year risk score was developed based on studies in the Caucasian population, limiting its applicability to specific ethnic groups and assessing only coronary heart disease risk. In contrast, the Pooled Cohort Equation assesses the 10-year fatal or non-fatal ASCVD risk, including ischemic heart disease, non-fatal myocardial infarction, coronary heart disease, and fatal and non-fatal stroke. This scoring system was developed based on extensive, multi-ethnic data and draws from large-scale community-based population studies. Previous research has confirmed the significant value of the 10-year ASCVD risk score in estimating cardiovascular disease risk [18]. The 10-year ASCVD risk score applies to adults aged 40–79, and according to the guidelines for risk management, a score below 7.5% indicates low risk, while a score equal to or above 7.5% indicates high risk. Individuals at high risk must choose appropriate intervention measures based on their medical history and lipid profile. Assessing an individual's 10-year ASCVD risk can guide preventive interventions matched to the individual, maximizing the expected benefits of prevention while minimizing the potential harm of over-treatment.
Oxidative stress (OS) is a series of adaptive responses in the body resulting from the imbalance between reactive oxygen species (ROS) and the antioxidant system [19]. ROS readily reacts with small molecules such as low-density lipoprotein (LDL) to form oxidized low-density lipoprotein (ox-LDL) [20]. Driven by chemotactic factors (e.g., matrix-derived factors, macrophage chemoattractants), ox-LDL, as a source of OS, is directed toward the heart and blood vessels. Under the action of adhesion factors (e.g., plasminogen activator inhibitor), it adheres to the vascular wall, leading to arterial hardening and narrowing, ultimately resulting in the development of fatal cardiovascular diseases such as hypertension, atherosclerosis, and coronary heart disease [21–23]. In recent years, changes in dietary habits and lifestyles have led to the body remaining in a state of continuous oxidative stress. As ROS acts as a critical signaling factor in the progression of inflammatory diseases, its overexpression can disrupt the balance between ROS generation and the antioxidant system, leading to immune activation, insulin resistance, endothelial cell damage, and the release of inflammatory mediators [24].
Diet plays a crucial role in regulating systemic inflammation and oxidative stress. Poor dietary habits can increase systemic inflammation and oxidative stress, leading to weight gain enlargement of fat cells, promoting the progression of atherosclerosis, and ultimately resulting in fatalities among patients with atherosclerotic vascular diseases [25–27]. Research has found that dietary antioxidant components primarily include vitamins A, C, and E carotenoids, which have antioxidative, antiproliferative, anti-inflammatory, and cholesterol-lowering properties [28]. They also contain compounds such as retinol, vitamin D, zinc, calcium, flavonoids, and total catechins, but there is relatively limited research on these components. As for dietary pro-oxidants, details typically consist of iron, unsaturated fatty acids, and fatty acids [8]. Therefore, a balanced dietary pattern, such as the Mediterranean diet, which emphasizes the consumption of vegetables, fruits, fish, whole grains, legumes, and olive oil, offers the body an optimal balance to maintain antioxidative capacity, reducing the risk of cardiovascular diseases [29–31]. Several studies have shown that an antioxidant-rich dietary pattern can lower the risk of ASCVD [32–34], which aligns with our research findings.
Modifying a single factor in one's lifestyle can influence the risk of cardiovascular diseases, and multiple lifestyle changes can have a synergistic effect. In addition to dietary components, the impact of lifestyle on ASCVD cannot be underestimated. An increasing body of research indicates a connection between sedentary behavior and the incidence and mortality rates of cardiovascular diseases in adults [35, 36]. Maintaining a healthy body weight is a critical step in preventing cardiovascular diseases. Studies have shown that overweight and obesity significantly increase the risk of cardiovascular disease incidence and mortality [37, 38]. Therefore, weight control is an effective strategy for reducing the risk of cardiovascular diseases. Engaging in regular, long-term exercise not only effectively manages body weight but also reduces the release of inflammatory factors (e.g., IL-6/IL-10/TNF-α), protecting endothelial cells and thereby lowering the risk of cardiovascular diseases [39]. However, a study involving nearly 1.5 million individuals [40, 41] found that vigorous exercise in areas with severe air pollution could increase cardiovascular risk, highlighting the importance of selecting a suitable exercise environment when actively preventing cardiovascular diseases through physical activity. Smoking is a significant risk factor for ASCVD [42], given the diversity and complexity of compounds in tobacco smoke. Research on the association between representative compounds in tobacco smoke, such as nicotine and its metabolites, and ASCVD risk is currently limited. Cotinine is a metabolite of nicotine [43] with a longer half-life, which allows for a better assessment of nicotine exposure. The dangers of passive smoking are equally important. Brief exposure to secondhand smoke can increase platelet activity, damage endothelial cells, promote inflammation and oxidative stress responses, increase endothelial permeability, and, consequently, raise the risk of acute myocardial infarction [44].
Through further subgroup analysis, we found that the negative correlation between OBS and 10-year ASCVD risk was generally more significant in the white population and those without hypertension, with interactions being present. It is well-known that compared to the black population, white individuals have a lower prevalence of cardiovascular risk factors (such as hypertension, dyslipidemia, smoking, and physical inactivity), suggesting a lower incidence of adverse cardiovascular events in white populations [45]. However, the recent inclusion of race in the PCE equation for assessing ASCVD risk has been questioned due to biological differences, which may ultimately lead to treatment decisions based solely on racial disparities. Thus, it is recommended to develop race-free CVD risk prediction algorithms [46]. In individuals without hypertension, the negative correlation between OBS and 10-year ASCVD risk is more pronounced, indicating that antioxidant-rich diets and healthy lifestyles confer incredible benefits in participants without hypertension. Studies have shown that antioxidant-rich diets, including carotenoids, vitamin E, and magnesium supplements, are negatively associated with hypertension [47–49].
This is the first study to explore the relationship between OBS and 10-year ASCVD risk. The results indicate a negative association between both overall OBS and dietary OBS and lifestyle OBS with ASCVD risk, which could contribute to the development of cardiovascular disease prevention strategies in clinical practice. However, our study has several limitations. First, due to the cross-sectional design, it is impossible to establish causality in the relationship between OBS and 10-year ASCVD risk. Therefore, extensive prospective studies are needed to elucidate the causal relationship between these factors. Second, using self-reported 24-hour dietary recall to obtain dietary data may introduce recall bias. Additionally, despite adjusting for some potential covariates, we cannot eliminate the influence of other potential confounding factors.