Ideal Cardiovascular Health Assessments and All-cause and Cardiovascular Disease Mortality

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The American Heart Association (AHA)'s National Goals are based on the novel term Ideal Cardiovascular Health, a measurable construct more positive than just the absence of clinical disease. PURPOSE: We examined the effect of the simultaneous presence of 7 favorable health behaviors and factors on all-cause and cardiovascular disease (CVD) mortality in 11,240 adults (23.5% women) aged 20-82 years enrolled in the Aerobics Center Longitudinal Study from 1987 to 2003. METHODS: All participants were free of CVD, cancer and abnormal electrocardiogram; had a body mass index (BMI) ≥18.5 kg/m2; and achieved ≥85% of age-predicted maximal heart rate on the treadmill test at baseline. Ideal Cardiovascular Health behaviors included not currently smoking, having a BMI=18.5-24.9 kg/m2, being physically active at or above 500 MET-minutes per week, and having a dietary pattern that includes at least two from a) ≥4.5 servings of fruit and vegetables per day, b) ≥ two 3.5-oz servings of fish per week; c) ≥ three 1-oz-equivalent servings of whole grains per day]. Ideal factors included serum total cholesterol <200 mg/dL, blood pressure <120/<80 mmHg, and fasting plasma glucose <100 mg/dL). RESULTS: During 11.6 ± 3.5 years of follow-up there were 268 deaths, 60 from CVD. Compared to participants with Poor Cardiovascular Health (0 to 2 behaviors/factors), hazard ratios (HR) of all-cause mortality were 0.73 (0.56-0.97) for those with Intermediate Cardiovascular Health (3 to 5 behaviors/factors), and 0.79 (0.52-1.21) for those with Ideal Cardiovascular Health (≥6 behaviors/factors), after adjustment for age, sex and examination year. Adjusted HRs for CVD mortality were 0.40 (0.24-0.68) and 0.22 (0.06-0.74) for Intermediate and Ideal groups respectively. The inclusion of cardiorespiratory fitness (CRF) as a health factor (>20% of age- and sex-specific ACLS cohort) decreased the adjusted HRs of Intermediate and Ideal groups for both all-cause (0.46 (0.33-0.64), 0.49 (0.31-0.79)) and CVD mortality (0.29 (0.16-0.53), 0.14 (0.04-0.50). CONCLUSION: AHA's definition of Ideal Cardiovascular Health presented a strong protective effect against CVD mortality. The diagnostic power of this tool can be improved by including CRF. Supported by NIH Grant AG06945, HL62508, DK088195, and an unrestricted research grant from the Coca-Cola Company.