Abstract
The American Heart Association 2020 Strategic Impact Goals target an improvement in overall cardiovascular health, as assessed by 7 health metrics (smoking, body weight, physical activity, diet, plasma glucose level, plasma cholesterol level, and blood pressure). To examine whether trajectories of overall cardiovascular health over time, as assessed by the cardiovascular health score (CHS) in 2006, 2008, and 2010, are associated with subsequent risk of CVD. The Kailuan study is a prospective, population-based study that began in 2006. The cohort included 74 701 Chinese adults free of myocardial infarction, stroke, and cancer in or before 2010. In the present study, CHS trajectories were developed from 2006 to 2010 to predict CVD risk from 2010 to 2015. Data analysis was performed from January 1, 2006, to December 31, 2015. The CHS trajectories during 2006-2010 were identified using latent mixture models. Incident CVD events (myocardial infarction and stroke) during 2010-2015 were confirmed by review of medical records. The CHS trajectories were determined using 7 cardiovascular health metrics scored as poor (0 points), intermediate (1 point), and ideal (2 points); total score ranges from 0 (worst) to 14 (best). Based on the baseline CHS and patterns over time, 5 trajectories were categorized (low-stable, moderate-increasing, moderate-decreasing, high-stable I, and high-stable II). Of the 74 701 adults included in the study (mean [SD] age at baseline, 49.6 [11.8] years), 58 216 (77.9%) were men and 16 485 (22.1%) were women. Five CHS trajectories were identified from 2006 to 2010: low-stable (n = 4393; range, 4.6-5.2), moderate-increasing (n = 4643; mean increase from 5.4 to 7.8), moderate-decreasing (n = 14 853; mean decrease from 7.4 to 6.3), high-stable I (n = 36 352; range, 8.8-9.0), and high-stable II (n = 14 461; range, 10.9-11.0). During 5 years of follow-up, 1852 incident CVD cases were identified. Relative to the low-stable trajectory, the high-stable II trajectory was associated with a lower subsequent risk of CVD (adjusted hazard ratio, 0.21; 95% CI, 0.16-0.26, after adjusting for age, sex, educational level, income, occupation, alcohol intake, and serum high-sensitivity C-reactive protein concentration at baseline). Cardiovascular health trajectories may be associated with subsequent CVD risk.
Highlights
In 2010, the American Heart Association published its 2020 Strategic Impact Goals to improve the cardiovascular health of all Americans and changed the focus from primary prevention of cardiovascular disease (CVD) to primordial prevention.[1]
Relative to the low-stable trajectory, the highstable II trajectory was associated with a lower subsequent risk of CVD
Cardiovascular health trajectories may be associated with subsequent CVD risk
Summary
In 2010, the American Heart Association published its 2020 Strategic Impact Goals to improve the cardiovascular health of all Americans and changed the focus from primary prevention of cardiovascular disease (CVD) to primordial prevention.[1] The committee proposed a new concept of ideal cardiovascular health, defined as the presence of 7 favorable health metrics and the absence of clinical CVD (eg, coronary heart disease and stroke).[1] The 7 health metrics include 4 health behaviors (smoking, body weight, physical activity, and diet) and 3 health factors (blood pressure, plasma glucose level, and cholesterol level).[1] Built on this concept and intended to capture individual-level changes in cardiovascular health factors and behaviors, a cardiovascular health score (CHS) was created based on the individual-level composite of all 7 cardiovascular health metrics to evaluate overall cardiovascular health status.[2]. We investigated whether the trajectories of CHS over 4 years were associated with lower risks of developing CVD in a large, prospective cohort including 74 701 Chinese adults after controlling for potential confounders
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