Primordial prevention of cardiovascular disease: Several challenges remain

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The concept of primordial prevention, preventing the development of cardiovascular risk factors, has been re-emphasized by the American Heart Association (AHA) which has developed a simplified 7-item tool (body mass index, smoking status, diet, physical activity, blood pressure, blood cholesterol and glycaemia) to help promote cardiovascular health (CVH) in the population [ [1] Lloyd-Jones D.M. et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association's strategic impact goal through 2020 and beyond. Circulation. 2010; 121: 586-613 Crossref PubMed Scopus (2846) Google Scholar ] (Table 1). The AHA's goal was to increase overall CVH in the US population by 20% by 2020 while reducing death from cardiovascular disease (CVD) and stroke by 20%. This is of primary importance as several population-based cohort studies have reported substantial and progressive reductions in mortality and CVD events with higher CVH status [ [2] Younus A. et al. A systematic review of the prevalence and outcomes of ideal cardiovascular health in US and non-US populations. Mayo Clin. Proc. 2016; 91: 649-670 Abstract Full Text Full Text PDF PubMed Scopus (148) Google Scholar ]. Moreover, poorer CVH has been related to non-cardiovascular outcomes, such as depression, cancer and cognitive decline, highlighting the importance of maintaining an optimal level of CVH [ [2] Younus A. et al. A systematic review of the prevalence and outcomes of ideal cardiovascular health in US and non-US populations. Mayo Clin. Proc. 2016; 91: 649-670 Abstract Full Text Full Text PDF PubMed Scopus (148) Google Scholar ]. Table 1Definition of cardiovascular health metrics (CVH). CVH metric Status Definition Diet Ideal 4–5 components ⁎ Components (1): fruits and vegetables: ≥4.5 cups per day (2), fish: ≥two 3.5-oz servings per week (preferably oily fish) (3), fiber-rich whole grains (≥1.1 g of fiber per 10 g of carbohydrate): ≥three 1-oz-equivalent servings per day (4), sodium: <1500 mg per day and (5) sugar-sweetened beverages: ≤450 kcal (36 oz) per week. DBP = diastolic blood pressure; SBP = systolic blood pressure. Intermediate 2–3 components ⁎ Components (1): fruits and vegetables: ≥4.5 cups per day (2), fish: ≥two 3.5-oz servings per week (preferably oily fish) (3), fiber-rich whole grains (≥1.1 g of fiber per 10 g of carbohydrate): ≥three 1-oz-equivalent servings per day (4), sodium: <1500 mg per day and (5) sugar-sweetened beverages: ≤450 kcal (36 oz) per week. DBP = diastolic blood pressure; SBP = systolic blood pressure. Poor 0–1 component ⁎ Components (1): fruits and vegetables: ≥4.5 cups per day (2), fish: ≥two 3.5-oz servings per week (preferably oily fish) (3), fiber-rich whole grains (≥1.1 g of fiber per 10 g of carbohydrate): ≥three 1-oz-equivalent servings per day (4), sodium: <1500 mg per day and (5) sugar-sweetened beverages: ≤450 kcal (36 oz) per week. DBP = diastolic blood pressure; SBP = systolic blood pressure. Physical activity Ideal IntermediatePoor ≥150 min/week moderate intensity or ≥75 min/week vigorous intensity or combination1–149 min/week moderate intensity or 1–74 min/week vigorous intensity or 1–149 min/week moderate/vigorousNone Body mass index Ideal <25 kg/m2 Intermediate 25–29.9 kg/m2 Poor ≥30 kg/m2 Smoking Ideal Never or previous smoker + quit >12 months ago Intermediate Previous smoker + quit ≤12 months ago Poor Current smoker Blood pressure Ideal <120/80 mmHg Intermediate SBP 120–139 or DBP 80–89 mmHg or treated to goal Poor SBP ≥140 or DBP ≥90 mmHg Fasting plasma glucose Ideal <100 mg/dL Intermediate 100–125 mg/dL or treated to goal Poor ≥126 mg/dL Total cholesterol Ideal <200 mg/dL Intermediate 200–239 mg/dL or treated to goal Poor ≥240 mg/dL Components (1): fruits and vegetables: ≥4.5 cups per day (2), fish: ≥two 3.5-oz servings per week (preferably oily fish) (3), fiber-rich whole grains (≥1.1 g of fiber per 10 g of carbohydrate): ≥three 1-oz-equivalent servings per day (4), sodium: <1500 mg per day and (5) sugar-sweetened beverages: ≤450 kcal (36 oz) per week. DBP = diastolic blood pressure; SBP = systolic blood pressure. Open table in a new tab Poorer cardiovascular health is associated with psychiatric comorbidity: results from the ELSA-Brasil StudyInternational Journal of CardiologyVol. 274PreviewCommon psychiatric symptoms may hinder achieving ideal cardiovascular health (ICH). We aimed to investigate the association between the ICH score and psychiatric disorders in Brazilian adults. Full-Text PDF