背景：自民國105年起，台灣心臟性疾病即位居國人十大死因中排名第二。2017年WHO指出心血管疾病是全球重要的死因之一，每年死於心血管疾病的人數遠多於其他的疾病。然而，早期心血管疾病的死亡有很大的程度可從改善生活型態來預防。回顧台灣目前已發表的文獻，雖有許多文獻探討生活型態因子對健康狀態的影響，但尚未有研究將美國心臟協會的Life’s Simple Seven (LS7)做為主要影響因子對心血管疾病死亡進行探討。

目的：本研究以心血管疾病死亡作為研究依變項，並參考由美國心臟協會所訂定的LS7作為本研究自變項，探討對國人死亡之影響。研究目的有二，(一)探討45歲以上國人Modified LS7對六年後全死因死亡及心血管死亡影響；(二)了解30歲以上國人於Modified LS7之社會人口學特性。

方法：使用2009年國民健康訪問調查資料庫（National Health Interview Survey, NHIS)年滿30歲以上之樣本15,009人，再根據研究目的一及目的二依序放入不同的排除條件，目的一同意串聯死因檔之樣本為13,957人，排除45歲以下者、居住機構者、訪問對象為代達者、Modified LS7中任何一項有遺漏者、2009當年死亡者，最終樣本數為8,323人目的二為2009年NHIS年滿30歲以上樣本，排除住機構者、訪問對象為代達者、失能者(ADL>=1)及Modified LS7任何一項有遺漏者，最終樣本數14,461人。自變項主要參考美國心臟協會於2010年發表之Life’s Simple Seven (LS7)之七項影響心血管健康之生活型態因子，包含：(一）控制血壓(二)控制血脂(三)控制空腹血糖(四)不吸菸(五)規律運動(六)健康飲食(七)維持BMI。本研究將樣本達成Modified LS7的程度分為0分、1分、2分，再加總七個變項得分後獲得0-11分之總分(三高分數為0-1分)，分數越高表示健康生活型態表現越佳。再依總分切為低中高分三個組別，探討樣本達成Modified LS7的程度，對六年後全死因死亡及心血管疾病死亡的影響。

結果：控制社會人口學特徵及健康狀態下，Modified LS7低分組全死因死亡的機率比高分組高出2.38倍的勝算，但對心血管疾病死亡則是無顯著差異。主要影響全死因死亡之Modified LS7因子為BMI；主要影響心血管疾病死亡的因子為運動。另外，進一步分析社會人口學特徵及健康狀態變項對樣本Modified LS7組別之間的多元羅吉斯迴歸分析得知，男性、青壯年（30-49歲）、低教育程度、未婚/無伴侶、有心臟病家族史者、有其他疾病者有較高的勝算偏向Modified LS7低分組。此外，職業類別部分，白領階層的職業類別較容易偏向Modified LS7的高分組。

討論：目前有關於Life’s Simple 7的文獻幾乎多由歐美國家所發表，顯示此議題尚未受到亞洲的關注，本研究結果能補充目前台灣對於Life’s Simple 7對心血管健康的影響資訊，亦可作為提供30歲以上國人健康生活型態的參考。另外，本研究發現職業類別與LS7高低分組之間確實有所差異，此部分結果可應用於未來制定心血管健康相關政策或衛教，使決策者更能清楚針對特定族群進行介入。

INTRODUCTION: Although many literatures have focused on the impact of lifestyles on health status, no study in Taiwan has included Life’s Simple Seven (LS7) from the American Heart Association as the influential factors to the death of cadivascular disease. There are two purposes in this study. First, to examine the effects of Modified LS7 on the all-cause mortality and cardiovascular death of adults aged 45 years old and over during 2009 to 2014. Sceond, to explore the sociodemographic characteristics of Modified LS7 of participants over 30 years old in Taiwan.
METHODS: Using the 2009 National Health Interview Survey (NHIS), a total of 15,009 participants aged 30 years old and over was included. According to the first and the second research purposes, different exclusion criteria were sequentially placed. Finally, there were 8,323 participants for the purpose one and 14,461 for purpose two. The Life's Simple Seven (LS7) included: controlling blood pressure, controlling fasting blood glucose, controlling blood lipids, no smoking, regular exercise, healthy diet, and maintaining BMI. We scored each item as 0 point, 1 point, 2 points and then to sum them up as a total score of Modified LS7 (0-11 points). In the analysis, the total score of Modified LS7 was divided into three groups: low, median, high.
RESULTS: The odds of all-cause death in the low-score group was 2.38 times higher than the high-score group. However, there was no significant difference in the low-score group and medium-score group on the odds of cardiovascular death. The main influencing factor of all-cause death is BMI, whereas the main influencing factor to cardiovascular death is no-exercise. In addition, participants who were male, young adults, low level of education, unmarried/ no partners, with family history and other diseases would possess higher odds to be the low-score group.
DISCUSSION: Nearly all studies related to the effects of Life's Simple 7 on cardiovascular health were examined by western countries; no study has been conducted in Asia. This study could provide the information of Life's Simple 7 on all-cause mortality and cardiovascular health in Taiwan. The results can also be a reference for future policy in desiging a healthy lifestyle for the middle-aged and elderly.

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