Unhealthy lifestyles are associated with incidence and mortality of chest pain among the U.S. population: a cross-sectional and cohort study based on NHANES

Background: Unhealthy lifestyles have been linked to a range of cardiovascular diseases (CVD) and unfavorable prognosis. However, there is insufficient evidence regarding the correlation between unhealthy lifestyles and chest pain. This study aimed to evaluated the relationship between unhealthy lifestyles and the occurrence of chest pain as well as overall mortality among subjests presenting with chest pain. Methods: The data utilized for this study were derived from the National Health and Nutrition Examination Survey (NHANES), which spans 2001 to 2018. Unhealthy lifestyles, ranging from 0 to 5, were constructed based on five factors: smoking, alcohol consumption, physical inactivity, unhealthy waist circumference, and unhealthy diet. Logistic regression models assessed the correlation between unhealthy lifestyles and chest pain. All-cause mortality was evaluated using Kaplan–Meier curves, Cox regression analysis, and restricted cubic splines (RCS). Mediation analysis was utilized to explore the indirect impact of unhealthy lifestyles on chest pain mediated through CVD. Results: A total of 11786 participants (8581 without pain, 3205 with pain) were enrolled. Multivariate-adjusted logistic regression analysis showed individuals with more unhealthy lifestyles were significantly more likely to suffer chest pain (odds ratio (OR) 1.22, 95% confidence interval (CI) 1.12-1.33). Notably, CVD partially mediated the association between unhealthy lifestyles and chest pain by a 24.85% proportion, respectively. Over a median follow-up of 6.42 years, 1811 subjects (15.4%) died. Weighted Cox proportional hazards models indicated that for each additional unit of unhealthy lifestyle, an adjusted hazard ratio (HR) for mortality was 1.43 (95% CI 1.32-1.56) for all participants, 1.59 (95% CI 1.36-1.86) for participants with chest pain and 1.37 (95% CI 1.24-1.50) for participants without chest pain. Conclusion: Unhealthy lifestyles were strongly linked to increased incidence of chest pain and all-cause mortality.