Abstract P003: Application of a Lifestyle-based Score to Predict Cardiovascular Health in the Coronary Artery Risk Development in Young Adults (CARDIA) Study

Abstract

Introduction: The Healthy Heart Score (HHS) is a lifestyle-based risk prediction tool developed to predict cardiovascular disease (CVD) events in young and middle-aged adults. We evaluated the performance of the HHS to predict cardiovascular health (CVH). Methods: We applied the HHS to 3288 white and black adults ages 18-30 years at the CARDIA study baseline exam in 1985-6. The HHS includes age, smoking status, body mass index, alcohol intake (g/d), exercise (hours/week) and a diet score composed of self-reported daily intake of cereal fiber, fruits/vegetables, nuts, sugar-sweetened beverages, and red/processed meats. We tested the utility of the HHS to predict having all ideal CVH factors at the year 25 exam when participants were ages 43-55 years, defined as the simultaneous presence of unmedicated blood pressure <120/80 mmHg, total cholesterol<200 mg/dl, fasting glucose<100 mg/dl and absence of diabetes or CVD. We assessed the HHS in the total population, in race and sex-specific groups, and in those with and without clinical CVD risk factors (RFs) at baseline. We first applied original HHS coefficients, then cohort specific coefficients. We assessed model discrimination in comparison to age-only models with Harrell’s C-statistic and model calibration with Hosmer-Lemeshow’s chi-square. Results: Mean (SD) age at baseline was 25.1 (3.6) years; 57% were female, 46% black, and 8% had at least one clinical CVD RF at baseline. Only 593 participants (18%) had all ideal CVH factors in middle age; the prevalence was lower in men compared to women, blacks compared to whites, and in those with vs. without clinical CVD RFs in young adulthood (Table). The HHS showed moderate discrimination for CVH prediction (Table). The HHS was adequately calibrated overall and within each sub-group. Conclusions: The HHS performs moderately well predicting CVH 25 years later when applied to young adults. Its reliance on self-reported, modifiable lifestyle factors makes it an attractive tool for the promotion of CVH across the lifespan.