Baseline Cardiovascular Health Research Articles

Association of Cardiovascular Health in Young Adulthood With Long-Term Blood Pressure Trajectories.

Cardiovascular health (CVH) in young adulthood (YA) has been associated with cardiovascular outcomes in older age. However, little is known about the relationship between YA CVH and mid-life blood pressure (BP) trajectories. Baseline CVH (defined by 7 of the American Heart Association's [AHA] Life's Essential 8 [LE8] metrics, excluding BP) was measured in YA with individual metrics scored and averaged as a composite LE8 score. Categorical CVH status was defined as high, moderate, and low. Latent class analysis was used to identify trajectories of mid-BP (mean of systolic blood pressure [SBP] and diastolic blood pressure [DBP]) from average ages 35 to 55 years. Multinomial logistic regression was used to estimate the association of YA CVH status (continuously and categorically) with mid-life BP trajectory group membership. There were 3,688 participants from the Coronary Artery Risk Development in Young Adults (CARDIA) study in YA with follow-up data for mid-life BP trajectories. We observed 3 BP trajectory groups, labeled as Persistently-Low, Middle, and High-Increasing. On average, each 10-points higher baseline LE8 score (mean [SD] of 73.5 [13.1]) in YA was associated with adjusted odds ratios of 0.78 (95% CI, 0.72-0.84) for membership in the Middle and 0.65 (0.57-0.73) for membership in the High-Increasing trajectory groups. Compared with categorical low CVH status at baseline, those with high CVH were significantly less likely to be in the Middle and High-Increasing BP trajectory groups. Moderate or low CVH status in YA is associated with elevated mid-life BP trajectory. These data suggest that young adult CVH promotion may be important for the primordial prevention of hypertension.

Abstract P403: Distribution of Cardiovascular Health and Its Impact on Carotid Intima-Media Thickness Among Korean Adolescents

Introduction: Cardiovascular health (CVH) distribution and its impact on vascular health, particularly among Asian adolescents, is unclear. We aimed to examine (1) the CVH distribution and (2) the association between CVH and carotid intima-media thickness (cIMT) among Korean adolescents. Methods: We included 666 students (mean 15.4 years at baseline, 49.2% girls) from the JS High School cohort, a prospective single-school cohort. All participants completed a set of health examinations in a 2-year span. We classified and described participants’ CVH per AHA Life’s Essential 8, excluding diet and sleep. A cumulative CVH score was calculated as the total score of each visit (0-100 points for six components; cumulative score ranged 0-1200 points) and classified into quartiles. The association between cumulative CVH score and follow-up cIMT was assessed using the multivariable logistic regression model. Results: Baseline, follow-up, and cumulative CVH scores ranged from 300-600, 255-600, and 555-1180 points, respectively. Most participants achieved optimal nicotine exposure and blood glucose, whereas few achieved optimal physical activity. (Figure A) A sex difference was observed in blood pressure; 78.4% (257/328) and 36.6% (90/338) of girls and boys, respectively, maintained the optimal level. Participants with lower baseline or follow-up CVH scores tended to have greater cIMT. (Figure B) Gradually reduced odds for increased cIMT were observed according to higher CVH scores (Figure C). Conclusion: Among Korean adolescents, achieving higher cardiovascular health was associated with thinner cIMT. Our findings highlighted a disparity in the CVH distribution. Future studies should include information on diet and sleep.

Abstract 52: Associations of Ideal Cardiovascular Health and Its Change With Cardiovascular-Kidney Outcomes in Young Adults

Introduction: The AHA recently highlighted the linkage of cardiovascular (CVD) and chronic kidney disease (CKD) and the importance of promoting cardiovascular health (CVH) to prevent them. We hypothesized that attaining ideal CVH score or improving it in young adulthood is associated with low risk of cardiovascular-kidney events, but data are scarce. Methods: We studied 3,836,283 participants of the Korean national health screening in 2009-2010 (baseline age 20-39 y) without prior CVD or CKD. Participants were categorized by the number of ideal CVH components met (range 0-6; diet data unavailable). A subgroup of 2,768,705 participants who underwent follow-up health exam in 2011-2014 (median 4.2 y from baseline) were stratified by combination of baseline and follow-up CVH scores. The primary outcome was a composite of CVD events, incident CKD, and death from kidney disease or CVD, until 31 Dec 2021 (Fig, footnote). Results: At baseline, participants had median age 31 y, and 38.2% were female. During a median follow-up of 12.1 y, 172,217 cardiovascular-kidney events occurred. The multivariable-adjusted risk of cardiovascular-kidney event decreased gradually (HR 0.81 per 1 p higher CVH score) with higher CVH scores (Fig, A). A CVH score of 6 was associated with a 65% lower risk of cardiovascular-kidney event than a CVH score of 0. An increase in CVH score from the baseline to follow-up exam was associated with a lower risk of cardiovascular-kidney event (HR 0.87 per +1 p CVH score change). The risk was lowest in participants with high CVH at both baseline and follow-up; having high CVH at baseline, and improving from low to high CVH, were also associated with lower risk than those who maintained low CVH (Fig, B). Findings were similar for CKD and other individual endpoints. Conclusions: Achieving, maintaining, or improving ideal CVH during young adulthood was associated with lower risk of cardiovascular-kidney events, highlighting the importance of promoting early-life CVH for combined prevention of cardiovascular and kidney disease.

Association of cardiovascular health with subclinical coronary atherosclerosis progression among five racial and ethnic groups: The MASALA and MESA studies

Background and aimsSouth Asian adults (SA) are at higher risk for atherosclerotic cardiovascular disease (ASCVD) compared with other racial/ethnic groups. Life's Simple 7 (LS7) is a guideline-recommended, cardiovascular health (CVH) construct to guide optimization of cardiovascular risk factors. We sought to assess if the LS7 metrics predict coronary artery calcium (CAC) incidence and progression in asymptomatic SA compared with four other racial/ethnic groups. MethodsWe assessed the distribution of CVH metrics (inadequate: score 0–8, average: 9–10, optimal: 11–14, and per 1-unit higher score) and its association with incidence and progression of CAC among South Asians in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study compared with other race/ethnic groups from the Multiethnic Study of Atherosclerosis (MESA). ResultsWe included 810 SA, 2622 Non-Hispanic White (NHW), and 4192 Other adults (collectively 1893 Black, 1496 Hispanic and 803 Chinese American participants, respectively). SA and White participants compared to Other race/ethnicity groups were more likely to have optimal CVH metrics (26% SA vs 28% White participants vs 21% Other, respectively, p < 0.001). Similar to NHW and the Other race/ethnic group, SA participants with optimal baseline CVH were less likely to develop incident CAC on follow-up evaluation compared to participants with inadequate CVH metrics, optimal CVH/CAC = 0: 24% SA, 28% NHW, and 15% Other (p < 0.01). In multivariable linear and logistic regression models, there was no difference in annualized CAC incidence or progression between each race/ethnic group (pinteraction = 0.85 and pinteraction = 0.17, respectively). Optimal blood pressure control was associated with lower CAC incidence among SA participants [OR (95% CI): 0.30 (0.14–0.63), p < 0.01] and Other race and ethnicity participants [0.32 (0.19–0.53), p < 0.01]. ConclusionsOptimal CVH metrics are associated with lower incident CAC and CAC progression among South Asians, similar to other racial groups/ethnicities. These findings underscore the importance of optimizing and maintaining CVH to mitigate the future risk of subclinical atherosclerosis in this higher risk population.

Longitudinal cardiovascular health measured by life's essential 8 metrics with incident diabetes: A 13-year prospective cohort study.

To investigate the associations of baseline and longitudinal cardiovascular health (CVH) measured by 'Life's Essential 8' (LE8) metrics with the risk of diabetes in Chinese people with normoglycaemia or prediabetes. A total 86,149 participants without diabetes were enroled from the Kailuan study and were stratified by baseline glycaemic status (normoglycaemia or prediabetes). Cardiovascular health score ranged from 0 to 100 points was categorised into low (0-49), middle (50-79), and high (80-100) CVH status. Cox regressions were used to assess the associations of baseline and time-updated CVH status with incident diabetes in the overall cohort and across baseline glycaemic statuses. During a median follow-up of 12.94 (interquartile rage: 12.48-13.16) years, we identified 13,097 (15.20%) cases of incident diabetes. Baseline and time-updated high CVH status was associated with a lower risk of diabetes, the corresponding hazard ratio (HR) versus low CVH status was 0.27 (95% confidence interval [CI], 0.23-0.31) and 0.26 (95% CI, 0.23-0.30) in the overall cohort, respectively. Additionally, the effect of high CVH on diabetes was more prominent in participants with normoglycaemia than those with prediabetes (P<0.0001), with an HR of 0.26 (95% CI, 0.22-0.31) versus 0.50 (95% CI, 0.41-0.62) for baseline CVH, and 0.25 (95% CI, 0.21-0.30) versus 0.39 (95% CI, 0.32-0.48) for time-updated CVH. Elevated baseline and longitudinal CVH score assessed by LE8 metrics is associated with a lower risk of subsequent diabetes, especially in normoglycaemic adults.

Baseline and longitudinal cardiovascular health using Life’s Essential 8 metrics with the risk of incident hypertension

ABSTRACT Objective The quantification of cardiovascular health (CVH) was updated by the American Heart Association recently by using the “Life’s Essential 8” (LE8) score. We aimed to investigate the associations of baseline and longitudinal CVH status measured by the new LE8 score (except for blood pressure) with the risk of hypertension. Methods A total of 52 990 participants with complete data on LE8 metrics and without hypertension were enrolled from the Kailuan study, Tangshan, China. The associations of incident hypertension with the overall baseline, time-updated, and time-varying CVH score (ranging 0 [lowest] to 100 [highest]), and each component of LE8, were assessed by Cox regressions. Results During a median follow-up of 10.73 years 28 380 cases of incident hypertension were identified. The risk of hypertension attenuated with increased CVH score (Ptrend < 0.0001), the hazard ratios (HRs) in high CVH versus low CVH group was 0.54 (95% confidence interval [CI], 0.51–0.57) for baseline CVH, 0.47 (95% CI, 0.45–0.50) for time-updated CVH, and 0.59 (95% CI, 0.55–0.63) for time-varying CVH. The predictive value of CVH in predicting hypertension improved by using LE8 than using Life’s Simple 7 metrics. Among LE8 components, body mass index score was the strongest risk factor for hypertension. Subgroup analyses showed that the benefit of a higher CVH score on hypertension was more prominent in young adults and in women (Pinteraction < 0.05). Conclusions A higher CVH score assessed by new LE8 is associated with a lower risk of subsequent hypertension, especially young adults and women.

Abstract P655: Childhood and Lifecourse Socioeconomic Position and Cardiovascular Health in Hispanic/Latino Adults of the Hispanic Community Health Study/Study of Latinos

Introduction: The Hispanic/Latino population experiences extensive socioeconomic adversity across the lifespan. Yet little is known about the role of lifecourse socioeconomic position (SEP) on cardiovascular health (CVH) in this population. Hypothesis: Childhood and adulthood SEP as well as socioeconomic mobility are associated with changes in CVH over time in Hispanic/Latino adults. Methods: We used longitudinal data (N = 14,604) from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a population-based cohort study conducted in four major U.S cities. We determined childhood SEP using participant-reported parental education classified as No schooling; Elementary, middle, or high school; and more than high school (HS). Adulthood SEP was determined through an index with a score ranging from 0 to 9 combining participants’ education, occupation, annual household income, and assets, and classified as low (0), middle (1-4), and high SEP (5-9). Using childhood and adulthood SEP, we classified participants into socioeconomic mobility categories (e.g., persisting low, downward, or upward mobility, etc.). Using the four-health metrics of the American Heart Association “Life’s Essential 8” (i.e., body mass index, non-HDL cholesterol, fasting blood glucose or HbA1c, and blood pressure) we built a score of ideal CVH ranging from 0 to 100. CVH was assessed at baseline and at the 6-year follow-up. Since changes in CVH over time differed by CVH at baseline, we conducted linear mixed effects models stratifying by CVH at baseline, with random intercept and slope, adjusting for age, sex, Hispanic/Latino background, study center, U.S or foreign-born, years in the U.S, as well as baseline health insurance, diet, physical activity, hours of sleep per night, smoking, alcohol consumption, and antihypertensive and cholesterol medication use. Results: 8% of parents did not have any formal education, 11% of the population had low SEP in adulthood, and 37% showed upward socioeconomic mobility. Among those with low (CVH score &lt;50) and moderate to high (CVH score 50-100) baseline CVH, there was no association between childhood SEP and CVH at baseline. However, among those with moderate to high baseline CVH, high childhood SEP was associated with greater CVH over time (Coefficient for &gt;HS: 0.24, 95% CI: 0.00, 0.47). There was no longitudinal association among those with low baseline CVH. High adulthood SEP was associated with greater CVH at baseline for those with low (Coefficient: 2.55 95% CI: 1.25, 3.85) and moderate to high CVH (Coefficient: 1.36 95% CI: 0.09, 2.62). However, it was not associated with changes in CVH. Socioeconomic mobility was associated with greater baseline CVH as well as with improvements in CVH over time. Conclusion: Among Hispanic/Latino population with high initial CVH, high childhood SEP and socioeconomic mobility were associated with better CVH over time.

Abstract 39: Association of Cardiovascular Health With Time Lived Free of Coronary Artery Calcium

Introduction: Zero coronary artery calcium (CAC) is associated with lower risk of cardiovascular disease. More time lived without CAC may delay coronary artery disease morbidity, but prediction of when CAC will first develop is not well understood. To inform cardiovascular prevention, we evaluated how cardiovascular health (CVH) relates to time lived without CAC. Methods: In Multi-Ethnic Study of Atherosclerosis (MESA) participants with zero CAC at baseline followed up to 10 years, we used Kaplan-Meier curves to estimate restricted mean survival time since study entry lived with zero CAC, by baseline CVH per Life’s Simple 7 metrics categorized as high (score 12-14), moderate (8-11), and low (0-7), and stratified by sex and age (45-64, 65-84 years). Results: Among 3416 participants without CAC at baseline (63% female, mean age 58 [SD 9] years, mean CVH score 8.8 [2.1]), mean years lived with zero CAC was 4.9 (SD 3.5) years. Women with high CVH lived on average 6.6 (95% CI 6.4-6.8) years with zero CAC, with moderate CVH 6.2 (6.1-6.3) years with zero CAC, and with low CVH 5.6 (5.3-5.8) years with zero CAC. Men with high CVH lived on average 6.4 (5.9-6.9) years with zero CAC, with moderate CVH 6.1 (5.9-6.3) years with zero CAC, and with low CVH 5.5 (5.1-5.9) years with zero CAC (Figure A). Among participants aged 45-64 years, those with high CVH lived on average 7.4 (7.1-7.6) years with zero CAC, with moderate CVH 6.8 (6.6-6.9) years with zero CAC, and with low CVH 5.9 (5.7-6.2) years with zero CAC. Among participants aged 65-84 years, those with high CVH lived on average 5.1 (4.5-5.7) years with zero CAC, with moderate CVH 5.2 (5.0-5.4) years with zero CAC, and with low CVH 4.9 (4.6-5.2) years with zero CAC (Figure B). Conclusions: High CVH was associated with longer time lived with zero CAC in women and men. Adults aged 45-64 years with high or intermediate CVH at baseline had longer time lived with zero CAC compared with those with low CVH. Older adults had no difference in time lived with zero CAC based on CVH. Maintaining CVH in midlife may delay onset of CAC.

Abstract P447: Association Between Cardiovascular Health (CVH) Throughout Early Adulthood With Prevalent Non-Alcoholic Fatty Liver Disease (NAFLD) in Mid-Life: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Background: Nonalcoholic fatty liver disease (NAFLD) is associated with high prevalence of cardiovascular disease and its risk factors. More favorable cardiovascular health (CVH) profiles are associated with a lower prevalence of NAFLD in cross-sectional studies. However, the relationship between long-term CVH patterns in early adulthood and prevalence of NAFLD in midlife remains unknown. We aimed to assess these patterns. Methods: We used data from participants (18-30 years at baseline) of the CARDIA study who had individual CVH components measured at 7 examinations over 20 years and liver fat assessed by non-contrast computed tomography (CT) at year 25 follow up. Group-based trajectory modeling was used to create CVH trajectories, according to American Heart Association definitions, from baseline through follow-up year 20. NAFLD was defined as liver attenuation of &lt; 51 HU after exclusions. Dichotomous logistic regression was used to examine associations of baseline CVH scores (n=2618) or CVH trajectory group (n=2529) and prevalence of NAFLD at year 25. Results: At baseline, 39% of 2618 participants had high and 5% had low CVH, respectively. At year 25, NAFLD prevalence was 23% (n = 609). At year 25, compared to those without NAFLD, participants with NAFLD were more likely be male (54.2% vs. 37.3%) and be a current smoker (27.1% vs. 21.7%) at baseline. Participants with low (HR = 3.24, 95% CI = 2.13, 4.95) and moderate (HR = 1.85, 95% CI = 1.50, 2.29) CVH scores at baseline were more likely to have a higher risk of prevalent NAFLD compared to participants with high CVH scores. Five distinct trajectories of CVH were identified. Lower and decreasing trajectories were associated with higher risk of prevalent NAFLD at year 25 compared to the high stable trajectory (Figure). Conclusion: Low CVH scores in young adulthood and low and decreasing CVH trajectories throughout early adulthood are associated with higher prevalence of NAFLD in midlife. Optimizing CVH in early adulthood is critical for lowering risk for prevalent NAFLD in midlife.

Association of Cardiovascular Health With Risk of Clinically Relevant Depressive Symptoms

Cardiovascular health may be used for prevention of depressive symptoms. However, data on the association of cardiovascular health across midlife with depressive symptoms are lacking. To evaluate whether better baseline cardiovascular health and improvement of cardiovascular health over time are associated with a lower risk of both incident depressive symptoms and unfavorable trajectories of depressive symptoms. Participants without depressive symptoms were included from a prospective community-based cohort in France (GAZEL cohort). Cardiovascular health examinations occurred in 1990 and 1997 and assessment of depressive symptoms in 1997 and every 3 years thereafter until 2015. Data were analyzed from January to October 2022. Number of cardiovascular health metrics (smoking, body mass index, physical activity, diet, blood pressure, glucose, and cholesterol) at an intermediate or ideal level in 1997 (range, 0-7) and 7-year change in cardiovascular health between 1990 and 1997. Primary outcome was incident depressive symptoms (20-item Center for Epidemiologic Studies-Depression Scale [CES-D] score of 17 or greater in men or 23 or greater in women); secondary outcome was trajectories of depressive symptoms scores. Trajectories included consistently low scores, moderately elevated scores, low starting then increasing scores, moderately high starting, increasing, then remitting scores, and moderately high starting then increasing scores. Of 6980 included patients, 1671 (23.9%) were women, and the mean (SD) age was 53.3 (3.5) years. During a follow-up spanning 19 years after 1997, 1858 individuals (26.5%) had incident depressive symptoms. Higher baseline cardiovascular health in 1997 and improvement in cardiovascular health over 7 years were each associated with lower risk of depressive symptoms (odds ratio [OR] per additional metric at intermediate or ideal level at baseline, 0.87; 95% CI, 0.84-0.91; OR per 1 higher metric at intermediate or ideal level over 7 years, 0.91; 95% CI, 0.86-0.96). Also, better cardiovascular health was associated with lower risk of unfavorable depressive symptoms trajectories. Compared with the consistently low score trajectory, the lowest risks were observed for the low starting then increasing score trajectory (OR per additional metric at intermediate or ideal level at baseline, 0.70; 95% CI, 0.64-0.76; OR per 1 higher metric at intermediate or ideal level over 7 years, 0.73; 95% CI, 0.68-0.79) and the moderately high starting then increasing score trajectory (OR per additional metric at intermediate or ideal level at baseline, 0.71; 95% CI, 0.64-0.79; OR per 1 higher metric at intermediate or ideal level over 7 years, 0.71; 95% CI, 0.64-0.77). In this prospective community-based cohort study of adults, higher cardiovascular health was associated with a lower risk of depressive symptoms over time. Elucidating which set of cardiovascular factors may affect depression risk could be important for prevention.

'Life's Essential 8' cardiovascular health with premature cardiovascular disease and all-cause mortality in young adults: the Kailuan prospective cohort study.

Whereas cardiovascular disease (CVD) metrics define risk in individuals aged over 40 years, the earliest lesions of CVD appear well before this age. Cardiovascular health (CVH) was proposed to improve cardiovascular risk factors and was updated recently. This study aimed to explore the associations of baseline and long-term CVH assessed by 'Life's Essential 8' metrics with premature CVD and all-cause mortality in young Chinese adults. A total of 16 011 CVD-free participants aged 18-40 years were enrolled from the Kailuan cohort study. The CVH score ranged from 0 to 100 and was categorized into low, moderate, and high. Cox regressions were used to assess the hazard ratios (HRs) for the associations of baseline, time-updated mean, and time-varying CVH with the risk of outcomes. During a median follow-up of 13 years, we identified 271 cases (1.7%) of CVD and 219 cases (1.4%) of all-cause mortality. A lower CVH was associated with a higher risk of CVD and all-cause mortality; the adjusted HR in the low CVH vs. the high CVH group was 7.34 [95% confidence interval (CI), 3.19-16.89] and 2.54 (95% CI, 1.27-5.06) for baseline CVH, 4.38 (95% CI, 2.14-8.97) and 1.99 (95% CI, 1.06-3.71) for time-updated CVH, and 8.19 (95% CI, 2.70-24.88) and 4.28 (95% CI, 1.70-10.81) for time-varying CVH, respectively. We observed an inverse gradient association of baseline and long-term CVH with the risk of premature CVD and all-cause mortality in young adults, emphasizing the importance of keeping health behaviours and factors earlier in life. This longitudinal prospective cohort study showed an inverse gradient association of baseline and long-term cardiovascular health, as measured by the new updated Life's Essential 8 metrics, with the risk of premature cardiovascular disease and all-cause mortality in Chinese young adults, emphasizing the importance of keeping health behaviours and factors earlier in life.Baseline and longitudinal low cardiovascular health (CVH) status (measured by time-updated mean and time-varying CVH score) was associated with a higher risk of cardiovascular disease (CVD) and all-cause mortality in young adults aged <40 years.Among the eight metrics of LE8, lower scores of health factors were associated with a higher risk of CVD and all-cause mortality in young adults, while the associations of health behaviours with CVD and all-cause mortality were non-significant.

Abstract 15816: Cardiovascular Health Status in Young Adulthood and Incident Diabetes Mellitus by Middle Age: The Coronary Artery Risk Development in Young Adults (Cardia) Study

Background: Data are sparse on the association of cardiovascular health (CVH), and change in CVH, during young adulthood with incidence of diabetes mellitus (DM) by middle age. Methods: We characterized CVH at baseline (Year [Y]0), 1985-1986) in 4916 CARDIA participants (ppts) based on six of the AHA’s Life’s Simple 7 definitions for diet, physical activity, smoking, BMI, lipids, and blood pressure metrics, excluding fasting blood glucose (FBG) data. We created a CVH score ranging from 0 (all poor CVH metrics) to 12 (all ideal) points. We also examined change in CVH score from Y0 to Y7. Incident DM was defined as meeting at least one of the following criteria: HbA1c level ≥6.5%, oral glucose tolerance test ≥200 mg/dL, FBG ≥126, or taking glucose lowering medications. We used Cox models to quantify the association between baseline CVH status and incident DM over 30 years of follow up. Results: At Y0, 46% of ppts were men, 51% Black, and the mean age was 24 years; 22% of ppts had low (0-6 points), 73% had moderate (7-10), and 5% had high (11-12) CVH scores. Of note, FBG levels were similar across CVH strata at baseline. Over 30 years, incident DM occurred in 518 ppts (10.5%). Higher CVH level in young adulthood was associated with lower DM incidence by middle age (Table); ppts with high CVH were at 86% lower and ppts with moderate at 62% lower hazards for DM, compared to ppts with low CVH. Improvement in CVH score from Y0 to Y7 was also associated with lower incidence of DM, even after adjustment for Y0 CVH (Table). There were no significant interactions by race or sex. Results were similar using all 7 CVH metrics (including FBG) in secondary analysis. Conclusions: Higher CVH scores in young adulthood, regardless of baseline glucose levels, are associated with substantially lower risk of incident diabetes mellitus by middle age. Improvements in CVH score over time are also associated with lower risk of diabetes mellitus. Focusing on CVH from early life may assist in reducing risk for diabetes in later life.

Association Between Behavioral, Biological, and Genetic Markers of Cardiovascular Health and MRI Markers of Brain Aging: A Cohort Study.

The life's simple 7 approach was proposed to define cardiovascular health (CVH) metrics. We sought to investigate the associations between behavioral, biological, and genetic markers for CVH and vascular brain aging in older adults. This population-based cohort study included participants who had repeated brain MRI measures from 2001 to 2003 to 2007-2010 (i.e., count of perivascular spaces, volumes of white matter hyperintensity [WMH] and gray matter, and lacunes). At baseline, global, behavioral, and biological CVH metrics were defined and scored following the life's simple 7 approach and categorized into unfavorable, intermediate, and favorable profiles according to tertiles. The metabolic genetic risk score was calculated by counting 15 risk alleles associated with hypertension, diabetes, or dyslipidemia. Data were analyzed using linear mixed-effects and Cox proportional hazards models, adjusting for age, sex, and education. The study sample consisted of 317 participants (age 60 years or older; 61.8% women). Favorable and intermediate (vs unfavorable) global CVH profiles were related to slower WMH progression, with β-coefficients (95% CI) being -0.019(-0.035-0.002) and -0.018(-0.034-0.001), respectively. Favorable and intermediate (vs unfavorable) biological CVH profiles were significantly related to slower WMH increase only in people aged 60-72 years. CVH profiles were not related to progression of other brain measures. Furthermore, a higher metabolic genetic risk score (range: 6-21) was associated with faster WMH increase (β-coefficient = 0.005; 95% CI: 0.003-0.008). There were statistical interactions of metabolic genetic risk score with global and behavioral CVH profiles on WMH accumulation. A higher metabolic genetic risk score was related to faster WMH accumulation, with β-coefficients being 0.015(0.007-0.023), 0.005(0.001-0.009), and 0.003(-0.001 to 0.006) among people with unfavorable, intermediate, and favorable global CVH profiles, respectively; the corresponding β-coefficients were 0.013(0.006-0.020), 0.006(0.003-0.009), and 0.002(-0.002 to 0.006) among people with unfavorable, intermediate, and favorable behavioral CVH profiles. Intermediate to favorable global CVH profiles in older adults are associated with slower vascular brain aging. The association of metabolic genetic risk load with accelerated vascular brain aging was evident among people with unfavorable to intermediate, but not favorable, CVH profiles. These findings highlight the importance of adhering to favorable CVH profiles, especially healthy behaviors, in vascular brain health.

Dynamic Change of Cardiovascular Health Metrics and Long-Term Risk of Sudden Cardiac Death: The ARIC Study.

Background The change of cardiovascular health (CVH) status has been associated with risk of cardiovascular disease. However, no studies have explored the change patterns of CVH in relation to risk of sudden cardiac death (SCD). We aim to examine the link between baseline CVH and change of CVH over time with the risk of SCD. Methods and Results Analyses were conducted in the prospective cohort ARIC (Atherosclerosis Risk in Communities) study, started in 1987 to 1989. ARIC enrolled 15 792 individuals 45 to 64 years of age from 4 US communities (Forsyth County, North Carolina; Jackson, Mississippi; suburbs of Minneapolis, Minnesota; and Washington County, Maryland). Subjects with 0 to 2, 3 to 4, and 5 to 7 ideal metrics of CVH were categorized as having poor, intermediate, or ideal CVH, respectively. Change in CVH over 6 years between 1987 to 1989 and 1993 to 1995 was considered. The primary study outcome was physician adjudicated SCD. The study population consisted of 15 026 subjects, of whom 12 207 had data about CVH change. Over a median follow-up of 23.0 years, 583 cases of SCD were recorded. There was a strong inverse association between baseline CVH metrics and time varying CVH metrics with risk of SCD. Compared with subjects with consistently poor CVH, risk of SCD was lower in those changed from poor to intermediate/ideal (hazard ratio [HR], 0.67 [95% CI, 0.48-0.94]), intermediate to poor (HR, 0.73 [95% CI, 0.54-0.99]), intermediate to ideal (HR, 0.49 [95% CI, 0.24-0.99]), ideal to poor/intermediate CVH (HR, 0.23 [95% CI, 0.10-0.52]), or those with consistently intermediate (HR, 0.49 [95% CI, 0.36-0.66]) or consistently ideal CVH (HR, 0.31 [95% CI, 0.13-0.76]). Similar results were also observed for non-SCD. Conclusions Compared with consistently poor CVH, other patterns of change in CVH were associated with lower risk of SCD. These findings highlight the importance of promotion of ideal CVH in the primordial prevention of SCD.

Association of cardiovascular health and incident atrial fibrillation in elderly population

ObjectiveTo evaluate whether baseline and changes in cardiovascular health (CVH) were related to incident atrial fibrillation (AF) risk in the elderly population.MethodsFrom the Korea National Health Insurance Service-Senior cohort, we...

Longitudinal association between cardiovascular health and arterial stiffness in the Chinese adult population.

ObjectiveArterial stiffness may be an intermediary biological pathway involved in the association between cardiovascular health (CVH) and cardiovascular disease. We aimed to evaluate the effect of CVH on progression of brachial–ankle pulse wave velocity (baPWV) over approximately 4 years.MethodsWe included 1315 cardiovascular disease-free adults (49±12 years) who had two checkups from 2010 to 2019. CVH metrics (current smoking, body mass index, total cholesterol, blood pressure, and fasting plasma glucose) were assessed at baseline, and the number of ideal CVH metrics and CVH score were calculated. Additionally, baPWV was examined at baseline and follow-up.ResultsMedian baPWV increased from 1340 cm/s to 1400 cm/s, with an average annual change in baPWV of 15 cm/s. More ideal CVH metrics and a higher CVH score were associated with lower baseline and follow-up baPWV, and the annual change in baPWV, even after adjustment for confounding variables. Associations between CVH parameters and baseline and follow-up baPWV remained robust in different sex and age subgroups, but they were only able to predict the annual change in baPWV in men and individuals older than 50 years.ConclusionsOur findings highlight the benefit of a better baseline CVH profile for progression of arterial stiffness.

Abstract 195: Associations of Cardiovascular Health During Late Adolescence and Young Adulthood With Incident Premature Cardiovascular Events and Mortality: The Coronary Risk Development in Young Adults Study (CARDIA)

Introduction: Mid-life cardiovascular health (CVH) is strongly associated with risks of later-life CVD and mortality across race and sex groups. Adolescent and young-adult CVH are associated with risk of subclinical CVD, but data are lacking regarding CVD events or mortality. Hypotheses: (1) CVH in late adolescence/young adulthood (18-30y) is associated with risks of premature CVD and mortality; (2) Event rates are uniformly low across sociodemographic subgroups with high baseline CVH. Methods: CVH (defined by AHA’s 7 metrics) was measured at baseline and total CVH scores were categorized as high (12-14 pts), moderate (8-11) or low (0-7). CVD events and cause-specific mortality were adjudicated over 32y of follow-up. We estimated adjusted associations of baseline CVH with outcomes using Cox models and calculated population attributable fractions (PAFs; adjusted for competing risk of death as applicable) and event rates by CVH category. Results: See Table . Among 4836 participants, mean age was 24.9y (SD 3.6), 44.1% were aged 18-24y, 54.8% were female, and 50.5% were black. Baseline CVH was high in 28.8%, moderate in 65.0%, and low in 6.3%. In total, 306 CVD events and 431 deaths occurred. CVH was significantly associated with all outcomes, with similar patterns by age, sex, and race. PAFs for moderate/low (vs high) CVH ranged from 0.42 (all-cause mortality) to 0.63 (CVD) to 0.81 (CVD mortality) overall; PAFs were not significantly different across sociodemographic subgroups. Among individuals with high CVH, event rates were low across all sociodemographic subgroups (e.g., CVD rates/1000 person-yrs: age 18-24y 0.64, 25-30y 0.65, women 0.36, men 1.04, black 0.90, white 0.50). Conclusions: High CVH at age 18-30y was associated with low rates of premature CVD and mortality. Preservation of high CVH to at least age 18y may reduce CVD and mortality burdens and disparities, and adolescent/young-adult CVH may be a valid intermediate outcome for early-life determinants of risk.

Associations of Late Adolescent or Young Adult Cardiovascular Health With Premature Cardiovascular Disease and Mortality

BackgroundWhen measured in adolescence or young adulthood, cardiovascular health (CVH) is associated with future subclinical cardiovascular disease (CVD), but data are lacking regarding CVD events or mortality. ObjectivesThis study examined associations of CVH at ages 18 to 30 years with premature CVD and mortality. MethodsThis study analyzed data from the CARDIA (Coronary Artery Risk Development in Young Adults Study). CVH was scored at baseline (1985 to 1986) using Life’s Simple 7 metrics and categorized as high (12 to 14 points), moderate (8 to 11), or low (0 to 7). CVD events and cause-specific mortality were adjudicated over 32 years of follow-up. Adjusted associations were estimated using Cox models and event rates and population attributable fractions were calculated by CVH category. ResultsAmong 4,836 participants (mean age: 24.9 years, 54.8% female, 50.5% Black, mean education: 15.2 years), baseline CVH was high (favorable) in 28.8%, moderate in 65.0%, and low in 6.3%. During follow-up, 306 CVD events and 431 deaths occurred. The adjusted hazard ratios for high (vs. low) CVH were 0.14 (95% confidence interval [CI]: 0.09 to 0.22) for CVD and 0.07 (95% CI: 0.03 to 0.19) for CVD mortality, and the population attributable fractions for combined moderate or low (vs. high) CVH were 0.63 (95% CI: 0.47 to 0.74) for CVD and 0.81 (95% CI: 0.55 to 0.92) for CVD mortality. Among individuals with high CVH, event rates were low across sociodemographic subgroups (e.g., CVD rates per 1,000 person-years: age 18 to 24 years, 0.64; age 25 to 30 years, 0.65; men, 1.04; women, 0.36; Blacks, 0.90; Whites, 0.50; up to/through high-school education, 1.00; beyond high-school education, 0.61). ConclusionsHigh CVH in late adolescence or young adulthood was associated with very low rates of premature CVD and mortality over 32 years, indicating the critical importance of maintaining high CVH.

Value of baseline clinical and CMR characteristics for the prediction of cancer therapeutics-related cardiac dysfunction: results from the Cardiotoxicity Prevention Research Initiative (CAPRI)

Abstract Background Whether baseline cardiovascular health status significantly influences the risk of Cancer Therapeutics-Related Cardiac Dysfunction (CTRCD) in patients receiving de-novo chemotherapy exposure is an important clinical question for both surveillance and management decisions. The reference standard technique for the serial monitoring of left ventricular (LV) volumes and ejection fraction (EF) is cardiovascular magnetic resonance (CMR). Using this technique, we sought to prospectively evaluate baseline clinical risk factors and CMR-based pre-exposure characteristics for their influence on the incident occurrence of CTRCD. Methods We prospectively enrolled 371 cancer patients referred for baseline (pre-chemotherapy) followed by surveillance CMR imaging as part of the Cardiotoxicity Prevention Research Initiative (CAPRI). We also recruited 62 healthy volunteers to evaluate for referral population differences in CMR-based markers. Study subjects and healthy volunteers underwent identical CMR imaging protocols inclusive of cine imaging, T1 and T2 mapping. CTRCD was defined according to surveillance CMR imaging with criteria established as a drop in LVEF by &amp;gt;5% (meaningful detectable difference for CMR technique) to a value ≤56% (lower limit of normal) at any time point during chemotherapy surveillance. A total of 1474 CMR studies were performed over a median surveillance period of 12.5 months (range 2.3 to 68.9 months). Results The majority of patients were female (77%), being referred for breast cancer (64%) or lymphoma (36%), with a mean age of 54.0±14 years. The baseline prevalence of hypertension, diabetes, hyperlipidemia, and current smoking were 32%, 11%, 46%, and 13%, respectively. Compared to healthy volunteers, cancer patients at baseline showed smaller indexed LV and RV volumes, higher indexed LV mass, and higher native T1 values (mean difference +33 msec; p&amp;lt;0.001). LV and right ventricular (RV) EF and T2 mapping values were not significantly different. CTRCD criteria were met in 22% of patients. Figure 1 shows a forest plot of univariable and multivariable predictors of CTRCD occurrence. Following multivariable adjustment, only combined anthracycline/trastuzumab regimen (OR 4.4, 95% CI 2.0–9.5) and baseline indexed LVEDV (OR 2.3, 95% CI 1.2–4.5) were found to be significant predictors of this outcome. Conclusion Using the reference standard of serial CMR imaging we identified that of all baseline (pre-chemotherapy) clinical and CMR-based markers of cardiovascular health, only indexed LV end-doastolic volume (EDV) was independently associated with future occurrence of CTRCD following adjustment for chemotherapy regimen. We did not observe significant associations with conventional cardiac risk factors in our study population. The observed risk for indexed LVEDV was clinically meaningful (2.3-fold risk per 10 ml/m2) and warrants further investigation as a relevant baseline marker of risk in this referral population. Figure 1. Forest plot of predictors of CTRCD Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Alberta Innovates/Genome Alberta: CAPRI

Cardiovascular Health Score and Lifetime Risk of Cardiovascular Disease: The Cardiovascular Lifetime Risk Pooling Project.

Long-term risks of cardiovascular disease (CVD) according to levels of cardiovascular health (CVH) have not been characterized in a diverse, representative population. We pooled individual-level data from 30 447 participants (mean [SD] age, 55.0 [13.9] years; 60.6% women; 31.8% black) from 7 US cohort studies. We defined CVH based on levels of 7 American Heart Association health metrics, scored as ideal (2 points), intermediate (1 point), or poor (0 points). The total CVH score was used to quantify overall CVH as high (12-14 points), moderate (9-11 points), or low (0-8 points). We used a modified Kaplan-Meier analysis, accounting for the competing risk of death, to estimate the lifetime risk of CVD (composite of incident myocardial infarction, stroke, heart failure, or CVD death) separately in white and black men and women free of CVD at index ages of <40, 40 to 59, and ≥60 years. High CVH was more prevalent among women compared with men, white compared with black participants, and in younger compared with older participants. During 538 477 person-years of follow-up, we observed 6546 CVD events. In women aged 40 to 59 years, those with high CVH had lower lifetime risk (95% CI) of CVD (white women, 12.6% [2.6%-22.6%]; black women, 0.0%) compared with moderate (white women, 16.6% [13.0%-20.2%]; black women, 12.7% [6.8%-18.5%]) and low (white women, 33.8% [30.6%-37.1%]; black women, 34.7% [30.4%-39.0%]) CVH strata. Patterns were similar for men and individuals <40 and ≥60 years of age. Higher baseline CVH at all ages in adulthood is associated with substantially lower lifetime risk for CVD compared with moderate and low CVH, in white and black men and women in the United States. Public health and healthcare efforts aimed at maintaining and restoring higher CVH throughout the life course could provide substantial benefits for the population burden of CVD.