American Heart Association Cardiovascular Health Research Articles

Cardiovascular health metrics and risk of heart failure in a Finnish population: a prospective cohort study.

This study aimed to examine the association between cardiovascular health (CVH) metrics and the risk of heart failure (HF) in a Finnish population. We used the prospective population-based Kuopio Ischaemic Heart Disease cohort study comprising men aged 42-60years at baseline (1984-89) and women aged 53-73years at baseline (1998-2001). The CVH scores were computed from American Heart Association's CVH metrics for 2385 men and 825 women without a history of HF at baseline. The CVH scores, ranging from 0 to 14, were categorized into three: inadequate, average, and optimal groups. Multivariable Cox regression models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for HF. During a median follow-up period of 27years for men, and 18years for women, 465 and 124 HF events were recorded, respectively. The mean ages for men and women were 53 and 63years, respectively. One hundred and thirty-three men (5.6%) and 73 women (8.8%) had five or more ideal CVH metrics. Participants with optimal CVH scores had a 64% and 48% lower risk of HF when compared with those with inadequate CVH scores among men and women, respectively (HR, 95% CI: men=0.36, 0.26-0.49, P<0.01; women=0.52, 0.31-0.89, P=0.02). Optimal CVH metrics is associated with a lower risk of HF among an ageing Finnish population. Optimal CVH score should be targeted among the general population to reduce the risk of HF.

Cardiovascular Health at Age 5 Years: Distribution, Determinants, and Association With Neurodevelopment.

BackgroundEarly childhood may represent an opportune time to commence primordial prevention of cardiovascular disease (CVD, i.e., prevention of risk factors onset), but epidemiological evidence is scarce. We aimed to examine the distribution and parental and early life determinants of ideal cardiovascular health (CVH) in children up to 5 years and to compare the level of cognitive development between children with and without ideal CVH at age 5 years.MethodsUsing data from the Etude sur les déterminants pré et post natals précoces du Développement psychomoteur et de la santé de l'Enfant (EDEN) study, a French population-based mother–child cohort study, CVH was examined in children at 5 years of age based on the American Heart Association CVH metrics (ideal body mass index, physical activity, diet, blood pressure, cholesterol and glucose levels, and passive smoking, considered in sensitivity analysis only). Children were categorized as having ideal (five to six ideal metrics) or non-ideal CVH (<5 ideal metrics). Intelligence quotient (IQ) at age 5 years was assessed using the French version of the Wechsler Preschool and Primary Scale of Intelligence.ResultsAmong the 566 children (55% boys), only 34% had ideal CVH. In fully adjusted logistic regression, boys compared to girls (OR = 1.77, 95% CI 1.13–2.78), children with intermediate (1.77, 1.05–2.98) or ideal (2.58, 1.38–4.82) behavioral CVH at age 3 years and children who spent < 30 min/day watching television (1.91, 1.09–3.34) at age 3 years were more likely to have ideal CVH at age 5 years. At age 5 years, there was a significant 2.98-point difference (95% CI 0.64–5.32) in IQ between children with and without ideal biological CVH after adjusting for confounders.ConclusionThis study highlights that only a third of children aged 5 years had ideal CVH and identified modifiable determinants of ideal CVH and is suggestive of an association between CVH and neurodevelopment at a young age.

Estimated Impact of Achieving Optimal Cardiovascular Health Among US Adults on Cardiovascular Disease Events.

BackgroundBetter cardiovascular health (CVH) scores are associated with lower risk of cardiovascular disease (CVD). However, estimates of the potential population‐level impact of improving CVH on US CVD event rates are not currently available.Methods and ResultsUsing data from the National Health and Nutrition Examination Survey 2011 to 2016 (n=11 696), we estimated the proportions of US adults in CVH groups. Levels of 7 American Heart Association CVH metrics were scored as ideal (2 points), intermediate (1 point), or poor (0 points), and summed to define overall CVH (low, 0–8 points; moderate, 9–11 points; or high, 12–14 points). Using individual‐level data from 7 US community‐based cohort studies (n=30 447), we estimated annual incidence rates of major CVD events by levels of CVH. Using the combined data sources, we estimated population attributable fractions of CVD and the number of CVD events that could be prevented annually if all US adults achieved high CVH. High CVH was identified in 7.3% (95% CI, 6.3%–8.3%) of US adults. We estimated that 70.0% (95% CI, 56.5%–79.9%) of CVD events were attributable to low and moderate CVH. If all US adults attained high CVH, we estimated that 2.0 (95% CI, 1.6–2.3) million CVD events could be prevented annually. If all US adults with low CVH attained moderate CVH, we estimated that 1.2 (95% CI, 1.0–1.4) million CVD events could be prevented annually.ConclusionsThe potential benefits of achieving high CVH in all US adults are considerable, and even a partial improvement in CVH scores would be highly beneficial.

Occupations Associated with Poor Cardiovascular Health in Women: The Women's Health Initiative Observational Study.

Research on the effect of occupation on cardiovascular health (CVH) among older women is limited. Each of the 7 American Heart Association's CVH metrics was scored as ideal (1) or non-ideal (0) and summed. Multivariable logistic regression was used to estimate the odds of poor overall CVH (CVH score of 0-2) comparing women employed in each of the top 20 occupational categories to those not employed in that category, adjusting for age, marital status, and race/ethnicity. 1) Bookkeeping, accounting, and auditing clerks; 2) first-line supervisors of sales workers; 3) first-line supervisors of office and administrative support workers; and 4) nursing, psychiatric, and home health aides were more likely to have poor overall CVH compared to women who did not work in these occupations. Several commonly held occupations among women were associated with poor CVH.

Occupations Associated With Poor Cardiovascular Health in Women: The Women's Health Initiative Observational Study.

Research on the effect of occupation on cardiovascular health (CVH) among older women is limited. Each of the seven American Heart Association's CVH metrics was scored as ideal (1) or non-ideal (0) and summed. Multivariable logistic regression was used to estimate the odds of poor overall CVH (CVH score of 0 to 2) comparing women employed in each of the top 20 occupational categories to those not employed in that category, adjusting for age, marital status, and race/ethnicity. (1) Bookkeeping, accounting, and auditing clerks; (2) first-line supervisors of sales workers; (3) first-line supervisors of office and administrative support workers; and (4) nursing, psychiatric, and home health aides were more likely to have poor overall CVH compared to women who did not work in these occupations. Several commonly held occupations among women were associated with poor CVH.

Parental cardiovascular health predicts time to onset of cardiovascular disease in offspring.

Cardiovascular disease (CVD) risk factors are transmitted from parents to children. We prospectively examined the association between parental cardiovascular health (CVH) and time to onset of CVD in the offspring. The study consisted of a total of 5967 offspring-mother-father trios derived from the Framingham Heart Study. Cardiovascular health score was defined using the seven American Heart Association's CVH metrics attained at ideal levels: poor (0-2), intermediate (3-4), and ideal CVH (5-7). Multivariable-adjusted Cox proportional hazards regression models, Kaplan-Meier plots, and Irwin's restricted mean were used to examine the association and sex-specific differences between parental CVH and offspring's CVD-free survival. In a total of 71 974 person-years of follow-up among the offspring, 718 incident CVD events occurred. The overall CVD incidence rate was 10 per 1000 person-years [95% confidence interval (CI) 9.3-10.7]. Offspring of mothers with ideal CVH lived 9 more years free of CVD than offspring of mothers with poor CVH (P < 0.001). Maternal poor CVH was associated with twice as high hazard of early onset of CVD compared with maternal ideal CVH (adjusted Hazard Ratio 2.09, 95% CI 1.50-2.92). No statistically significant association was observed in the hazards of CVD-free survival by paternal CVH categories. We found that offspring of parents with ideal CVH had a greater CVD-free survival. Maternal CVH was a more robust predictor of offspring's CVD-free survival than paternal CVH, underscoring the need for clinical and policy interventions that involve mothers to break the intergenerational cycle of CVD-related morbidity and mortality.

Cardiovascular health metrics of 122,788 couples: analysis of a nationwide epidemiological database

Abstract Introduction The American Heart Association suggests that cardiovascular health (CVH) metrics based on established risk factors and behaviors to reduce the morbidity and mortality of cardiovascular disease. Couples share environmental and lifestyle habits, and therefore, there can be an intra-couple correlation of CVH metrics. However, the clinical data on the association of the CVH metrics among couples are limited. Purpose We aimed to explore the intra-couple relationship of the AHA-defined cardiovascular health metrics using a nationwide epidemiological database. Methods This study is a retrospective observational cross-sectional analysis using the health claims database of the Japan Medical Data Center between January 2005 and December 2016. We modified the American Heart Association CVH metrics and defined ideal CVH component as following: 1) nonsmoking, 2) body mass index &amp;lt;25 kg/m2, 3) physical activity at goal, 4) untreated blood pressure &amp;lt;120/80 mm Hg, 5) untreated fasting glucose &amp;lt;100 mg/dL, and 6) untreated total cholesterol &amp;lt;200 mg/dL. Results We analyzed 122,788 heterosexual couples enrolled in the Japan Medical Data Center database. The average age of participants was 50.2±9.5 years in men and 48.6±8.9 years in women. Good correlation was observed between couples in terms of the modified ideal CVH metrics (Figure 1A). The prevalence of meeting ≥5 ideal components in the female partners increased from 31% in the male partners meeting no ideal components to 55% in those meeting 6 ideal components. The concordance ratio is particularly higher in the component of smoking status, blood pressure, and fasting glucose level. A man who meets ≥5 ideal components probably had a woman partner who meets ≥5 ideal components (Odds ratio 1.6, 95% CI: 1.6–1.7, p&amp;lt;0.001). The P value for the McNemar test was significant for all components, indicating that women apparently met ideal metrics for metrics in discordant Couples (Figure 1B). Conclusion Our investigation showed that there was a good intra-couple correlation of the ideal modified CVH metrics, suggesting the potential of couple-based assessment and management for improving CVH status. Funding Acknowledgement Type of funding source: None

Cardiovascular health metrics and prevalence of cardiovascular disease in the Republic of Moldova

Abstract Background Achieving and maintaining cardiovascular health of individuals has a significant impact on reducing cardiovascular disease (CVD) and mortality at the population level. Methods We performed a cross-sectional community survey of 2,612 adult respondents in the Republic of Moldova. The American Heart Association cardiovascular health metrics score was used in total and by its two components: (1) health factors (blood pressure, total cholesterol, glucose, body mass index); (2) health behaviors (nonsmoking, physical activity, healthy diet score). The prevalence of CVD was identified as the main outcome measure. Results The prevalence of CVD was lower in study participants having all 7 cardiovascular health metrics (14.7%; 95% CI, 2.8% to 26.6%) compared to those with 0 to 1 cardiovascular health metrics (78.2%; 95% CI, 67.3% to 89.1%). Among participants who met all health factor metrics, the prevalence of CVD was lower (15.1%; 95% CI, 5.5% to 24.7%) compared to those with 0 to 1 health factor metrics (72.5 %; 95% CI, 69.9% to 75.0%). Study respondents who engaged in all health behaviors and those who engaged in 0 to 1 health behaviors had a similarly high prevalence of CVD (60.1%; 95% CI, 57.4% to 62.8% and 60.4%; 95% CI, 55.3% to 65.4%, respectively). Conclusions Lower prevalence of CVD was related to a greater total score of cardiovascular health metrics and with health factor components. While those diagnosed CVD appear willing to improve their behaviors, the population at risk is not likely to engage in health behaviors to prevent the onset of CVD. Key messages Increasing individual’s responsibility in addressing their own health implies improvement of community health. Strategies for health promotion should focus more on an individual’s motivation to assume personal responsibility for behaviors affecting their health.

P5296A healthier lifestyle increases circulating pro-atrial natriuretic peptide concentrations in overweight children

Abstract Background Higher concentrations of atrial natriuretic peptides (ANP) are associated with a poor prognosis among patients with cardiovascular disease (CVD). Counter-intuitively, higher ANP concentrations in healthy populations are associated with an ideal American Heart Association Cardiovascular Health score, which includes high level of physical activity, normal body mass index (BMI), optimal levels of lipids, blood pressure (BP) and glucose. Along this line, overweight individuals have lower than expected ANP concentrations, and it has been proposed that this natriuretic handicap could play a role in overweight related disorders. The mechanism behind the natriuretic handicap is still not clear, but presence of insulin resistance with hyperinsulinemia has been implicated. Purpose We investigated whether an intensive lifestyle intervention with an intended weight loss, including an increased level of physical activity and a healthy diet, could increase plasma concentrations of mid-regional pro-ANP (MR-proANP), a stable marker of ANP secretion, in overweight children. In a mechanistic perspective, we investigated metabolic changes associated with increases in MR-proANP concentrations. Methods This study is an extension of the Odense Overweight Intervention Study (OOIS) which included 99 overweight children (11–13 years, 55% girls). The children were randomised to a Day Camp Intervention Arm (DCIA) and a Standard Intervention Arm (SIA) for 6 weeks. DCIA included 3 hours physical activity per day and a healthy diet according to Danish recommendations. SIA included 1 weekly fun-based physical activity session and 1 lifestyle education session. OOIS included measurements of anthropometry, body composition, lipids, BP, glucose and insulin. Linear regression analyses, expressed as unstandardized regression coefficients, were used to examine between-group differences in MR-proANP concentrations and to examine the associations between changes in MR-proANP and variables of interest. As we wanted to study physiological relationships, we pooled both arms to one group to increase power in the latter. Results At week 6, children in DCIA had lower BMI (−2.4kg/m2) and lower total body fat (−6.5%) but higher level of fitness (4.1 ml/O2/min/kg) compared to children in SIA. From baseline to week 6 DCIA increased MR-proANP concentrations (B (95% CI): 5.7 (1.2 to 10.2) pmol/l, P=0.014) more than SIA. Of the variables studied, we found an inverse association between fall in insulin and increase in MR-proANP concentrations (B (95% CI): −0.52 (−1.02 to −0.02) pmol/l/mIU/ml, P=0.041). None of the other associations between changes in variables reached statistical significance. Conclusion A healthier lifestyle, based on a healthy diet and a higher level of physical activity, increases MR-proANP among overweight children. In a mechanistic perspective, improved insulin sensitivity with lower insulin appears to be a factor that leads to higher MR-proANP. Acknowledgement/Funding Trygfonden (Grant number: 7-11-0700)

Twenty-Year Trends in the American Heart Association Cardiovascular Health Score and Impact on Subclinical and Clinical Cardiovascular Disease: The Framingham Offspring Study.

BackgroundData on the temporal trends in ideal cardiovascular health (CVH) as well as on their association with subclinical/overt cardiovascular disease (CVD) and death are limited.Methods and ResultsThis study included 3460 participants attending ≥1 of 4 consecutive exams of the Framingham Heart Study (1991–2008, mean age 55.4 years, CVH score ranged 0–14). We created 4 groups describing changes in CVH score between examination cycles 5 and 8, using first and last exams attended (high‐high: starting CVH score ≥8, last score of ≥8, referent; high‐low: ≥8 start and ≤7 last; low‐high: ≤7 start and ≥8 last; and low‐low: ≤7 start and ≤7 last) and related them to subclinical CVD cross‐sectionally, and incident CVD and death. Fewer people have ideal CVH scores over the past 20 years (8.5% for 1991–1995, 5.9% for 2005–2008, P=0.002), because of decreases in those with ideal status of body mass index, blood glucose, and serum cholesterol levels (P<0.05 for all). The odds of subclinical disease and risk of CVD and death were higher for all compared with the high‐high group (428 CVD and 367 death events, median follow‐up 5.1 years, hazard ratios for CVD: 1.39, 1.73, 1.9 and death: 1.12, 1.57, 1.4 and odds ratios for subclinical disease: 1.61, 1.98, 2.86 for high‐low, low‐high, and low‐low, respectively).ConclusionsThe decreased presence of ideal CVH scores over the past 20 years resulted in increasing odds of subclinical disease and risk of CVD and death, emphasizing the importance of maintaining ideal CVH over the life course.

The American Heart Association Ideal Cardiovascular Health and Incident Type 2 Diabetes Mellitus Among Blacks: The Jackson Heart Study.

BackgroundThe concept of ideal cardiovascular health (CVH), defined by the American Heart Association primarily for coronary heart disease and stroke prevention, may apply to diabetes mellitus prevention among blacks.Methods and ResultsOur sample included 2668 adults in the Jackson Heart Study with complete baseline data on 6 of 7 American Heart Association CVH metrics (body mass index, healthy diet, smoking, total cholesterol, blood pressure, and physical activity). Incident diabetes mellitus was defined as fasting glucose ≥126 mg/dL, physician diagnosis, use of diabetes mellitus drugs, or glycosylated hemoglobin ≥6.5%. A summary CVH score from 0 to 6, based on presence/absence of ideal CVH metrics, was derived for each participant. Cox regression was used to estimate adjusted hazard ratios. Mean age was 55 years (65% women) with 492 incident diabetes mellitus events over 7.6 years (24.6 cases/1000 person‐years). Three quarters of participants had only 1 or 2 ideal CVH metrics; no participant had all 6. After adjustment for demographic factors (age, sex, education, and income) and high‐sensitivity C‐reactive protein, each additional ideal CVH metric was associated with a 17% diabetes mellitus risk reduction (hazard ratio, 0.83; 95% CI, 0.74–0.93). The association was attenuated with further adjustment for homeostasis model assessment for insulin resistance (hazard ratio, 0.89; 95% CI, 0.79–1.00). Compared with participants with 1 or no ideal CVH metric, diabetes mellitus risk was 15% and 37% lower in those with 2 and ≥3 ideal CVH metrics, respectively.ConclusionsThe AHA concept of ideal CVH is applicable to diabetes mellitus prevention among blacks. These associations were largely explained by insulin resistance.

Job Strain and Cardiovascular Health Score (from the Brazilian Longitudinal Study of Adult Health [ELSA-Brasil] Baseline)

We aimed to study the association between the American Heart Association cardiovascular health (CVH) score and job strain in the Brazilian Longitudinal Study of Adult Health baseline. We analyzed data from 11,351 active workers (aged 35 to 74years) without overt cardiovascular disease and who had complete data. Job strain was assessed using the 17-item Brazilian version of the Swedish Job Demand-Control-Support Questionnaire. Clinical (fasting plasma glucose, total cholesterol, and blood pressure) and lifestyle (diet, physical activity, smoking, and body mass index) components of CVH score were assessed according to the American Heart Association criteria. We used quasi-Poisson and multinomial regression models, adjusted for age, gender, race, educational level and income, and positive relative predicted score differences (rPSDs) indicate greater predicted scores. Subjects with low skill discretion scores had lower global (rPSD:-1.8%; p= 0.021) and lifestyle (rPSD:-3.6%; p= 0.018) CVH scores. Participants with low decision authority (rPSD:-2.4%; p= 0.029) and low social support scores (rPSD:-3.3%; p= 0.001) also had lower lifestyle CVH scores. In conclusion, we found significant associations between job strain and CVH scores in this large multicenter sample.

Abstract P021: Association of AHA Cardiovascular Health Metrics With Cognitive Function, Depression, and Anxiety: The Emory Healthy Aging Study

Background: The American Heart Association (AHA) has developed the Life’s Simple 7 metric (no smoking, high levels of physical activity, normal body mass index, no hypertension, no diabetes, no hyperlipidemia, healthy diet) to track behaviors and risk factors associated with cardiovascular health (CVH). Given the potential role that CVH has in cognition and psychological well-being, we aimed to study the association of the Life’s Simple 7 with cognitive function, anxiety, and depressive symptoms in the Emory Health Aging Study (EHAS). Methods: EHAS is an ongoing cohort study with the overall goal of understanding determinants of healthy aging in the general population. Participants 18 years of age or older are recruited at primary care clinics, community events, and through social media, primarily from the Atlanta (GA) area. Information on sociodemographic variables (age, sex, race, education, income), anthropometrics (weight, height), lifestyles (smoking, physical activity), and clinical variables (history of hypertension, diabetes, hypercholesterolemia, cardiovascular disease [CVD]) was collected through online questionnaires. Life’s Simple 7 score (excluding diet; information not available) was defined based on self-reported data, giving 1 point per achieved metric [range 0 (lowest)-6(highest CVH)]. Neurobehavioral variables were measured using validated scales (Cognitive Function Instrument (CFI), range 0-14, for cognition; Patient Health Questionnaire (PHQ)-8, range 0-24, for depressive symptoms; Generalized Anxiety Disorder (GAD) questionnaire, range 0-21, for anxiety; higher scores represent worse function/symptoms). Cross-sectional associations between Life’s Simple 7 score and these scales were assessed using multivariable linear regression adjusting for sociodemographic variables. Results: We included 3,774 participants [mean age (standard deviation, SD) 58 (13), 79% women, 84% white, 9% African American, 7% other) free of self-reported CVD, recruited between October 2015 and October 2016. Levels of CVH in the cohort were relatively high, with 62% participants meeting at least 4 health criteria [mean (SD) score 3.9 (1.3)]. The mean (SD) of CFI, PHQ-8, and GAD were 1.9 (2.1), 3.2 (3.8), 2.4 (3.4), respectively. In analyses adjusted for age, sex, race, education, and income, higher values of Life’s Simple 7 score were related to better cognitive function and lower levels of depressive symptoms and anxiety: estimates (95% confidence interval) per 1-point in Life’s Simple 7 score were -0.16 (-0.22, -0.11) for CFI, -0.5 (-0.6, -0.4) for PHQ-8, and -0.3 (-0.4, -0.2) for GAD. Conclusion: Higher levels of CVH, as assessed with the AHA Life’s Simple 7, were cross-sectionally associated with a beneficial neurobehavioral profile. Prospective studies should evaluate the impact of improving CVH on cognitive and emotional health.

Association between Cardiovascular Health Score and Carotid Intima-Media Thickness: Cross-Sectional Analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) Baseline Assessment

The American Heart Association aims to reduce the burden of cardiovascular disease in this decade by improving seven ideal cardiovascular health (CVH) characteristics in the population. The aim of this study was to quantify the association between the American Heart Association's CVH score and values for carotid intima-media thickness (CIMT) in the Brazilian Longitudinal Study of Adult Health baseline assessment. The Brazilian Longitudinal Study of Adult Health is a multicenter cohort study of civil servants aged 35 to 74years in Brazil. In this study, the investigators analyzed 9,662 individuals with no previous cardiovascular disease. The distribution of CIMT values (categorized into age-, sex-, and race-specific quartiles) was analyzed according to CVH scores using χ2 trend tests. Linear and multinomial regression models were built to evaluate the association between CIMT and CVH score. A significant increase was observed in the proportion of individuals within the first and second CIMT quartiles, as well as a decrease within the fourth quartile with higher CVH score strata (P for trend<.001). A 1-point increase in CVH score was associated in adjusted models with a decrease of 0.011mm in CIMT and an odds ratio of 0.79 (95% CI, 0.77-0.81) of having CIMT in the fourth quartile. However, nearly 16% of individuals with optimal CVH scores had CIMT values in the highest quartile. In this study, significant associations were found between CIMT and CVH score in a large sample of middle-aged adults. However, a high CVH score did not warrant the absence of a significant subclinical atherosclerotic burden.

Changes in Cardiovascular Health Status and the Risk of New-Onset Hypertension in Kailuan Cohort Study.

American Heart Association cardiovascular health metrics are intimately related to cardiovascular diseases. Acting as a key independent risk factor for high morbidity and mortality of cardiovascular diseases, hypertension and its relationship between health status get urgent attention. While the influence of individual health status changes and the future risk of new-onset hypertension is rarely understood, the present study applied this construct to assess the changes of cardiovascular health status and the morbidity of hypertension in Kailuan cohort study in north China. The Cardiovascular Health Score (CHS) was evaluated by the follow-ups of 2006–2007, 2008–2009, 2010–2011 and 2012–2013. The study population (n = 19381) was divided into 5 groups based on the changes in their CHS score between the first two follow-ups (△CHS) of 2006–2007 and 2008–2009 (≤-2, -1, 0, 1, ≥2). The morbidity of hypertension was collected during 2010–2011 and 2012–2013 follow-ups. Data analysis showed that during a median follow-up of 3.79±0.96 years, morbidity of hypertension had a graded relationship with △CHS. As △CHS scored from low to high, the standardized morbidity of hypertension for all participants were 81.40, 75.47, 68.37, 71.43 and 83.13 per 1000 person-year, respectively. An increased △CHS score of 1 was associated with a 10% decrease in the future risk of new-onset hypertension(HR: 0.90, 95% CI: 0.88–0.92). In conclusion, there was a strong inverse relationship between the incidence of new-onset hypertension and elevation of cardiovascular health metrics. Population-wide prevention, especially the promotion of lifestyle improvements, is critical to reducing the morbidity of new-onset hypertension.

Immigrant status and cardiovascular risk over time: results from the Multi-Ethnic Study of Atherosclerosis

PurposeDespite cross-sectional evidence that foreign-born United States (US) residents often have better health than US-born residents of similar race and/or ethnicity, we know little about overall cardiovascular risk progression over time among immigrants as they age in the US. MethodsUsing longitudinal data from the Multiethnic Study of Atherosclerosis on 6446 adults aged 45–84 years at baseline, we examined how nativity and length of US residence related to change in cardiovascular health (CVH) and cardiovascular event incidence over 11-year follow-up. CVH was measured using the American Heart Association's CVH measure (range, 0–14; higher is better). ResultsImmigrants, particularly those with shorter US residence, had better baseline CVH and lower cardiovascular event incidence than the US born. Baseline CVH scores ranged from 8.67 (8.42–8.92) among immigrants living in the US less than 10 years to 7.86 (7.76–7.97) among the US born. However, recent immigrants experienced the largest CVH declines over time: 10-year declines ranged from −1.04 (−1.27 to −0.80) among immigrants living in the US less than 10 years at baseline to −0.47 (−0.52 to −0.42) among the US born. ConclusionsPublic health prevention efforts targeting new immigrants may help slow the deterioration of CVH and reduce future cardiovascular risk.

Cardiovascular Health Status and Incidence of Heart Failure in the Framingham Offspring Study.

The American Heart Association Cardiovascular Health (CVH) score is inversely associated with cardiovascular disease, but its relations to cardiac remodeling traits and heart failure (HF) incidence have not been examined. A 14-point score was constructed for each participant based on the presence of poor, intermediate, or ideal status on each of the 7 CVH metrics (ideal score=14). We related the CVH score to echocardiographic traits cross-sectionally and to HF incidence prospectively in the Framingham Offspring Study. In age- and sex-adjusted models, a higher CVH score was associated with lower left ventricular (LV) mass, LV wall thickness, LV diastolic dimension, and left atrial dimension (P<0.01 for all; n=2392; mean age, 58 years; 56% women), and with a 12% to 15% lower odds of prevalent LV concentric remodeling and concentric hypertrophy, respectively (P<0.0001 for both). On follow-up (mean, 12.3 years), 188 incident HF events were observed in 3201 participants (mean age, 59 years; 53% women). In age- and sex-adjusted Cox proportional hazard models, the CVH score was inversely associated with HF incidence (hazard ratio per 1-point higher CVH score, 0.77; 95% confidence interval, 0.72-0.83). This association was partially attenuated upon adjustment for LV mass and interim myocardial infarction (hazard ratio, 0.84; 95% confidence interval, 0.76-0.93), and it was consistent for HF with preserved and reduced ejection fractions. In our community-based sample, comprised predominantly of middle-aged white individuals of European descent, better CVH was associated with lower HF incidence, in part due to a lower prevalence of adverse cardiac remodeling.

Trends in Ideal Cardiovascular Health Metrics Among Employees of a Large Healthcare Organization (from the Baptist Health South Florida Employee Study)

The American Heart Association (AHA)'s 2020 goal is to improve the cardiovascular health (CVH) of people living in the United States (US) by 20% and reduce mortality from cardiovascular diseases and stroke by 20%. Given that 155 million adults are in the US workforce, and >60% have employee-based insurance, workplace studies provide an important opportunity to assess and potentially advance CVH through the use of comprehensive workplace wellness programs. Among a cohort of employees of the Baptist Health System, CVH was assessed annually during voluntary health fairs and health risk assessments (HRA) from 2011 to 2014 using the AHA's 7 CVH metrics: smoking, body mass index (BMI), physical activity, diet, blood pressure, total cholesterol, and blood glucose. Each metric was categorized as ideal, intermediate, or poor according to the AHA criteria. Cochrane-Armitage test was used to detect trends in CVH by year. Ideal CVH, defined as meeting ideal criteria for all 7 metrics, was assessed and compared across years. The overall cohort was 34,746 with 4,895 employees in 2011, 10,724 in 2012, 9,763 in 2013, and 9,364 in 2014. Mean age (SD) was between 43 (±12) and 46 years (±12). Female to male ratio was 3:1. The prevalence of study participants who met the ideal criteria for diet, physical activity, and blood pressure increased significantly from 2011 to 2014 but for BMI, total cholesterol, and blood glucose, a significant decrease was noticed. In addition, the prevalence of study participants in ideal CVH although low, increased significantly over time (0.3% to 0.6%, p <0.0001). In conclusion, this study shows the trends of the AHA's CVH metrics in a large health care organization. The positive findings noted for the metrics of smoking, physical activity, total cholesterol, and blood glucose should be reinforced. However, the metrics of diet, BMI, and blood pressure need more attention.

GW26-e4689 Cardiovascular Health Score and the Risk of Cardiovascular Diseases

The American Heart Association (AHA) proposed a definition of ideal cardiovascular health behaviors and risk factors to estimate cardiovascular health status in 2010. Huffman created the AHA cardiovascular health score (CVH score) to estimate cardiovascular health status in individual-level. We

Association of Ideal Cardiovascular Health and Brachial–Ankle Pulse Wave Velocity: A Cross-Sectional Study in Northern China

Brachial-ankle pulse wave velocity (baPWV) is an index for evaluating arterial stiffness and is recognized as an independent predictor of an impending cardiovascular event. Limited large-scale population data are available regarding the relationship between baPWV and the change in ideal cardiovascular health (CVH) status, particularly among Asians. A random sample of 5199 participants (≥40 years of age; 40% women) was enrolled in a cross-sectional study in China to examine the association between ideal CVH and baPWV. Arterial stiffness was defined as a baPWV of 1400 cm/second or higher. Information on CVH was collected based on the American Heart Association's CVH definition by measuring all 7 components (nonsmoking status, body mass index, physical activity, healthy diet, normal total cholesterol, blood pressure, and fasting blood glucose), with 1 or 0 for each component, and a score from 0 to 7 for each participant. A significant and inverse association was found between the ideal CVH score and baPWV (P <.001). The adjusted odds ratios for arterial stiffness prevalence were .17 (95% confidence interval [CI], .11-.26), .26 (95% CI, .19-.35), .42 (95% CI, .32-.52), .54 (95% CI, .42-.69), and .69 (95% CI, .54-.89) for those with CVH scores of 7-6, 5, 4, 3, and 2, respectively, compared with those with a CVH score of 1-0 (P <.001). Similarly graded relationships were observed in different age and gender subgroups (P <.001). The favorable score of ideal CVH was inversely related to baPWV in Chinese adults, supporting the use of ideal CVH metrics as a useful tool for public health efforts.