Cardiovascular health status and its associations with cardiovascular disease and ischemic heart disease prevalence in Australian adults

Abstract

BackgroundCardiovascular disease (CVD) and ischemic heart disease (IHD) are two major health burdens. It has been suggested that the improvement of modifiable lifestyle factors could substantially reduce the CVD and IHD risk. To define and monitor the cardiovascular health (CVH) status in the general population, the American Heart Association has outlined seven modifiable lifestyle-related factors [smoking, body mass index (BMI), physical activity, dietary pattern, total cholesterol (TC), blood pressure (BP), and fasting plasma glucose (FPG)] and they were also called Life’s Simple 7. A number of studies have measured the CVH status and explored its association with CVD/IHD risk. However, very few studies have used Life’s Simple 7 in Australian adults. MethodsFirstly, we conducted two systematic reviews to estimate the CVH status and explore the association between the CVH status and CVD/IHD related events in adults worldwide. We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials and relevant articles published between 2010 and 2018. Secondly, we used the core sample of the 2011-2012 Australian Health Survey and included 7499 adults (≥ 18 years) with available TC and FPG tests. We estimated the proportions of ideal status for the seven CVH metrics and the prevalence of overall poor (having 0-2 ideal CVH metrics) and ideal (having 5-7 ideal CVH metrics) CVH status in the overall Australians and sex/age subpopulations. In addition, we explored the associations between the ideal status of individual metrics, using Poisson regression analysis and population attributable fractions, and overall CVH status, using logistic regression analysis, on the CVD and IHD prevalence in the overall Australians and sex/age subpopulations.ResultsThe first systematic review indicated that FPG has the highest proportion of ideal status (69.1%) whereas the dietary pattern has the lowest (12.1%) for adults worldwide. 32.2% and 19.6% of adults have overall poor and ideal CVH status. Compared to males and older adults (≥ 60 years), females and younger adults (< 60 years) have lower proportions of the overall poor CVH status and higher proportions of ideal status for most CVH metrics and the overall ideal CVH status. The CVH status has improved over study time and there may exist regional variations in CVH status. The second systematic review suggested that a higher number of ideal CVH metrics was associated with a reduced risk of CVD-related events. The separate effects of ideal metrics on CVD risk were inconsistent. Very few studies have explored the sex and age variations in the magnitude of associations between CVH status and CVD/IHD risk.Among Australian adults, the ideal status was highest for FPG (83.6%) and was lowest for dietary pattern (4.8%). 39.85% and 18.72% of adults were having overall poor and ideal status, respectively. Females and younger adults (18-39 years) have better CVH status, in terms of proportions of ideal metrics and the overall CVH status, in comparison to that in males, middle-aged (40-59 years), and older adults (≥ 60 years). We noticed that smoking, high BMI, elevated BP, elevated TC, elevated FPG, and physical inactivity were significant CVD risk factors and contributors in Australian adults. Physical inactivity, high BMI, and elevated TC were found to be significant IHD risk factors and contributors. The higher number of ideal metrics was associated with a substantial reduction in CVD and IHD prevalence in Australian adults. Our findings illustrated the possible sex and age disparities in the strengths of association between the CVH status and CVD/IHD prevalence.ConclusionsThe thesis indicated that the CVH status was poor for adults worldwide and in Australia, and the proportion of ideal status was especially low for some metrics, such as dietary pattern. The higher number of ideal CVH metrics was associated with a lower risk of CVD and IHD. There existed some sex and age disparities in the CVH status and its association with CVD/IHD risk. More studies are needed to carry out population-based strategies to monitor and improve the CVH status in adults from worldwide and Australia.