Abstract P175: Maintaining Ideal Cardiovascular Health and Freedom From Coronary Artery Calcification

Abstract

Introduction: Ideal cardiovascular health (CVH), as defined by American Heart Association (AHA), is associated with low levels of cardiovascular disease (CVD) risk factors and freedom from coronary artery calcium (CAC). Hypothesis: Baseline ideal CVH predicts freedom from CAC progression. Methods: In the Framingham Heart Study (FHS), we evaluated prevalence of ideal CVH and investigated associations between ideal CVH and CAC progression. We included 1969 participants who attended the first and second rounds of the FHS Multi-Detector Computed Tomography study (MDCT-I and MDCT-II). The presence and burden of calcification was defined by a modified Agatston score. We calculated the repeatability of two CAC readings performed during MDCT-I and quantified the uncertainty estimate to define CAC progression. At follow-up, an increase in CAC score of 3.4 or higher was defined as positive CAC progression for those free of CAC at baseline. Using criteria modified from the AHA’s Strategic Impact Goal, we defined the prevalence of poor, intermediate and ideal CVH using five of the seven metrics: blood pressure, total-cholesterol, cigarette smoking, body mass index, and fasting glucose. For each metric of CVH, we assigned a score of 0, 1, and 2 points for poor, intermediate, and ideal CVH, respectively, to quantify CVH and extent of change in ideal CVH. Baseline age, baseline CVH status, and change in CVH category were independent variables for logistic regression models to test significant associations between CAC progression and change in ideal CVH. Results: The prevalence of ideal, intermediate, and poor CVH for 1148 participants who were free of baseline CAC were 15.77%, 43.73%, 40.51%, respectively. After an average 6.1 years of follow-up, the prevalence of ideal, intermediate, and poor CVH changed to 6.5%, 43.4%, and 50.1%, respectively, while the CAC progression rates were 8.0%, 13.1%, and 21.6%, respectively. In logistic regression models, there was a non-significant trend for CAC progression by CVH group. Compared to those with poor CVH at baseline, the presence of ideal CVH at baseline was significantly protective against the occurrence of CAC progression; the hazard ratio (HR) for occurrence of CAC progression was 0.36 (95%C.I. 0.19, 0.66, p<0.001). Compared to those with intermediate CVH, there was potential protection against CAC progression, although the HR 0.66 was not statistically significant (95%C.I. 0.36, 1.21, p=0.62). Conclusions: In a community-based study, we observed significant protection from progression of CAC at follow-up for participants who were free of CAC with ideal CVH at baseline. These findings support continued public health measures to promote ideal CVH.