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已发表论文
女性心血管健康（Life’s Crucial 9）与压力性尿失禁的关联：氧化应激因素的中介作用（NHANES 2005—2018）
Authors Li Y, Huang H, Lin M, Fang X, Huang L, Ye M, Wang W, Yang Y, Li X
Received 8 September 2025
Accepted for publication 15 January 2026
Published 27 January 2026 Volume 2026:18 566005
DOI https://doi.org/10.2147/IJWH.S566005
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 4
Editor who approved publication: Dr Vinay Kumar
Ying Li,1,* Haiyan Huang,1,* Meizhu Lin,2 Xuanmo Fang,1 Lanping Huang,1 Minhua Ye,1 Wanqing Wang,1 Yang Yang,2 Xiaoyan Li2
1Department of Obstetrics & Gynecology, The Affiliated People’s Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, People’s Republic of China; 2Department of Obstetrics & Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Yang Yang, Department of Obstetrics & Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, People’s Republic of China, Email yangyangyang410@163.com Xiaoyan Li, Department of Obstetrics & Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, People’s Republic of China, Email xiaoyanshu11163@163.com
Objective: Cardiovascular disease and stress urinary incontinence (SUI) may be interconnected. This study aimed to investigate whether indicators of oxidative stress play a moderating role in the relationship between SUI and Life’s Crucial 9 (LC9), a cardiovascular health (CVH) index incorporating mental health.
Methods: Data from 5,292 US women aged 20 and older were analyzed using the National Health and Nutrition Examination Survey database from 2005 to 2018. The LC9 score, which was determined by averaging the sum of the eight LE8 component scores and the depression score. To assess the relationship between LC9 and SUI, restricted cubic splines (RCS) analysis and weighted multivariate logistic regression were employed. Additionally, mediation analysis was conducted to evaluate the indirect impact of oxidative stress markers on this relationship.
Results: After adjusting for potential confounders, individuals in the second and highest tertiles of LC9 exhibited significantly higher odds of SUI [odds ratios (OR) for each 1-point increase were 0.817 and 0.765; 95% confidence intervals (CI), 0.673– 0.993 and 0.600– 0.975, respectively]. Furthermore, RCS results suggested an approximately linear dose-response relationship between LC9 and the prevalence of SUI. Additionally, mediation analysis indicated that oxidative stress biomarkers, specifically bilirubin and uric acid, mediated the relationship between LC9 and SUI, with mediation proportions of 2.22% and 2.64%, respectively (P < 0.05).
Conclusion: The present study suggests that higher LC9 scores, which represent ideal CVH, are significantly associated with reduced odds of SUI. Additionally, oxidative stress biomarkers may play a mediating role in this relationship.
Keywords: life’s crucial 9, stress urinary incontinence, cardiovascular health, oxidative stress, NHANES
1Department of Obstetrics & Gynecology, The Affiliated People’s Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, People’s Republic of China; 2Department of Obstetrics & Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Yang Yang, Department of Obstetrics & Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, People’s Republic of China, Email yangyangyang410@163.com Xiaoyan Li, Department of Obstetrics & Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, People’s Republic of China, Email xiaoyanshu11163@163.com
Objective: Cardiovascular disease and stress urinary incontinence (SUI) may be interconnected. This study aimed to investigate whether indicators of oxidative stress play a moderating role in the relationship between SUI and Life’s Crucial 9 (LC9), a cardiovascular health (CVH) index incorporating mental health.
Methods: Data from 5,292 US women aged 20 and older were analyzed using the National Health and Nutrition Examination Survey database from 2005 to 2018. The LC9 score, which was determined by averaging the sum of the eight LE8 component scores and the depression score. To assess the relationship between LC9 and SUI, restricted cubic splines (RCS) analysis and weighted multivariate logistic regression were employed. Additionally, mediation analysis was conducted to evaluate the indirect impact of oxidative stress markers on this relationship.
Results: After adjusting for potential confounders, individuals in the second and highest tertiles of LC9 exhibited significantly higher odds of SUI [odds ratios (OR) for each 1-point increase were 0.817 and 0.765; 95% confidence intervals (CI), 0.673– 0.993 and 0.600– 0.975, respectively]. Furthermore, RCS results suggested an approximately linear dose-response relationship between LC9 and the prevalence of SUI. Additionally, mediation analysis indicated that oxidative stress biomarkers, specifically bilirubin and uric acid, mediated the relationship between LC9 and SUI, with mediation proportions of 2.22% and 2.64%, respectively (P < 0.05).
Conclusion: The present study suggests that higher LC9 scores, which represent ideal CVH, are significantly associated with reduced odds of SUI. Additionally, oxidative stress biomarkers may play a mediating role in this relationship.
Keywords: life’s crucial 9, stress urinary incontinence, cardiovascular health, oxidative stress, NHANES