Cardiovascular Health Score Research Articles

Association of cardiovascular health metrics with all-cause and cardiovascular disease mortality in chronic kidney disease: A cohort study

Background and aimsSince the global burden of chronic kidney disease (CKD) is rising rapidly, the study aimed to assess the association of cardiovascular health (CVH) metrics with all-cause and cardiovascular disease (CVD) mortality among individuals with CKD. Methods and resultsThe cohort study included 5834 participants with CKD from the National Health and Nutrition Examination Survey 1999–2018. A composite CVH score was calculated based on smoking status, physical activity, body mass index, blood pressure, total cholesterol, diet quality, and glucose control. Primary outcomes were all-cause and CVD mortality as of December 31, 2019. Multivariable-adjusted Cox proportional hazards models were used to estimate the association between CVH metrics and deaths in CKD patients. During a median follow-up of 7.2 years, 2178 all-cause deaths and 779 CVD deaths were documented. Compared to participants with ideal CVH, individuals with intermediate CVH exhibited a 46.0% increase in all-cause mortality (hazard ratio, 1.46; 95% confidence interval: 1.17, 1.83), while those with poor CVH demonstrated a 101.0% increase (2.01; 1.54, 2.62). For CVD mortality, individuals with intermediate CVH experienced a 56.0% increase (1.56; 1.02, 2.39), and those with poor CVH demonstrated a 143.0% increase (2.43; 1.51, 3.91). Linear trends were noted for the associations of CVH with both all-cause mortality (P for trend <0.001) and CVD mortality (P for trend = 0.02). ConclusionsLower CVH levels were associated with higher all-cause and CVD mortality in individuals with CKD, which highlights the importance of maintaining good CVH in CKD patients.

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.

Abstract 69: Trajectory of Cardiovascular Health Across Childhood and Adolescence in Project Viva

Introduction: The American Heart Association recently put forth the Life’s Essential 8 (LE8) algorithm to assess cardiovascular health (CVH) status based on 8 health and behavioral factors. Few studies, however, have characterized the natural history of CVH status across development or identified sociodemographic determinants of CVH trajectories in children. We sought to address this research gap using data from Project Viva, a pre-birth cohort in eastern Massachusetts. Methods: We applied the LE8 algorithm to derive CVH score (range 0-100 points) in early childhood (median age 3.2y), mid-childhood (7.7y), early adolescence (13y), and late adolescence (17.5y). We used segmented mixed-effect models to characterize sex-specific CVH trajectories across these life stages and estimate three subject-specific trajectory parameters: timing of inflection point when CVH score declines; slope before and after the inflection point. We used linear regression models to assess the association of child race and ethnicity, mother’s education level, and annual household income with each trajectory parameter. Results: Among 1,523 children included, 48.7% were female, 3.5% Asian, 15.2% Black, 4.8% Hispanic, 11.5% Other, and 65.0% White. The mean (SD) CVH score was 82.6 (8.6) points in early childhood, 84.1 (8.3) points in mid-childhood, 82.0 (9.8) points in early adolescence, and 73.8 (11.5) points in late adolescence. Females (vs. males) exhibited slower rate of CVH score gain before the inflection point (0.3 vs. 1.0 points/y), later timing of inflection point when CVH score started declining (10.1 vs. 9.6y), and slower rate of CVH score decline after the inflection point (-1.3 vs. -1.5 points/y). Children of Black (β 0.48y; 95% CI 0.28, 0.68) or Other (β 0.28y; 95% CI 0.08, 0.49) race had a later timing of inflection point compared with White children. Children whose mothers were college-educated (vs. non-college educated) had higher CVH score throughout childhood, and exhibited faster rate of CVH score gain before the inflection point (β 0.19 points/y; 95% CI 0.03, 0.34), earlier timing of inflection point (β -0.37y; 95% CI -0.53, -0.22), and faster rate of CVH score decline after the inflection point (β -0.24 points/y; 95% CI -0.38, -0.10). No associations were observed for household income. Conclusions: This cohort study identified a key timepoint between mid-childhood and early adolescence where CVH trajectory declines over time, as well as sociodemographic differences in CVH trajectory parameters. Future studies are warranted to assess other determinants and consequences of these trajectory parameters.

Abstract P406: Screen Time and Behavioral Cardiovascular Health in Youth by Age: The Young Hearts Study

Background: Research suggests that screen time is associated with negative health outcomes, including cardiovascular health (CVH) factors (BP, lipids, glucose, BMI) but seldom include CVH behaviors (diet, physical activity, nicotine exposure, and sleep). Methods: Young Hearts is an observational study of CVH trajectories in youth aged 0-20. This analysis includes 1749 participants aged 6-18 with complete baseline surveys. Parents (for 6-17 year olds) and adolescents aged 12+ (for themselves) completed surveys on CVH behaviors, medical history, and social context. Participants (stratified by age groups: 6-9, 10-14, and 15-18) reported hours spent on screens during a typical weekday and weekend day, excluding schoolwork and video calls. For 12-17-year-olds, we calculated the average reported screen time. We calculated CVH using the 4 health behaviors in the AHA’s Life’s Essential 8. Each behavior was assigned a score of 0 to 100 and averaged to create the behavioral CVH score. Linear regression assessed the association between screen time (continuous) and CVH score, adjusting for age, sex, race, ethnicity, income, parental education, chronic disease, insurance type, and depressive symptoms. Results: The mean age of 1749 participants was 12, 47% were female, 46% non-Hispanic White, 26% Hispanic, 20% non-Hispanic Black, and 9% identified as other. For participants aged 10-14, a 1-hour screen time increase was associated with a -0.9 CVH score (95% CI -1.4, -0.4). Inverse associations between screen time and sleep score were observed among youth aged 10-14 and 15-18 (-1.4; 95% CI -2.6, -0.2). Screen time was inversely related to diet across age groups. Among children aged 6-9, screen time was positively associated with physical activity (1.2; 95% CI 0.2 - 2.1). The findings were consistent by race/ethnicity. Conclusion: Higher screen time was associated with less favorable CVH scores due to sleep and diet scores. Future research is needed to better understand the relationship between screen time and physical activity among youth.

Abstract MP76: Street View Greenspace Exposures and Cardiovascular Health Among Children - Evidence From Project Viva

Introduction: Research on greenspace and cardiovascular health (CVH) in children is limited, and most previous studies rely on coarse satellite-based measurements of greenspace, which do not capture exposure as individuals experience it. Street View imagery (SVI) enables measurement of greenspace from a ground-level perspective and captures specific elements of greenspace that may be most relevant to health. This study aimed to examine associations of SVI-based greenspace with CVH in children in Project Viva, an eastern Massachusetts-based cohort. Methods: Using data from 1,163 children, we applied deep learning segmentation algorithms to SVI from 2007-2010 to derive metrics of greenspace (%of trees, or grass) within a 500m radius of participants’ residential addresses obtained during mid-childhood (mean age 7.9y). At mid-childhood and early adolescence (mean age 13.2y), we calculated CVH scores (range 0-100 units; higher scores represent better CVH) using the American Heart Association’s Life’s Essential 8 algorithm, based on 4 biomedical measures (body mass index, blood lipids, blood glucose, and blood pressure) and 4 behavioral measures (heart healthy levels of diet, physical activity, avoidance of nicotine, and sleep). Using linear regression, we examined associations of mid-childhood SVI-based greenspace metrics with mid-childhood (cross-sectional) and early adolescence (longitudinal) CVH scores, adjusting for child’s sex, race and ethnicity, and age at outcome, as well as an index score of socioeconomic status comprising individual and neighborhood metrics. Results: Among the 1163 participants, 65% were non-Hispanic White and 49% were female. The mean (SD) LE8 score was 83.3 (8.0) in mid-childhood and 81.7 (8.9) in early adolescence. In the unadjusted models, a higher %trees and grass per SD, as measured by SVI within children’s residence in mid-childhood, was associated with a higher overall CVH score (β 1.63 [95%CI: 0.93, 2.33] for trees; β 1.10 [95%CI: 0.36, 1.83] for grass). In longitudinal analyses, the results were similar (β 1.69 [95%CI: 0.87, 2.52] for trees; β 0.82 [95%CI: -0.01, 1.64] for grass). In fully-adjusted analyses, the cross-sectional and longitudinal results for %trees and grass were attenuated and not statistically significant. However, when CVH scores were disaggregated by behavioral and biomedical sub-scores, %trees was positively associated with behavioral sub-scores in cross-sectional fully-adjusted analyses at mid-childhood (β 0.89 [95%CI: 0.32, 1.46]). Conclusion: Among participants in Project Viva, SVI-based metrics of greenspace exposure in mid-childhood were cross-sectionally associated with behavioral factors promoting higher CVH. Greenspace may hold promise for improving children’s CVH through the behavioral pathway and should be considered in future health-promotion efforts.

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 P396: Life’s Essential 8 Cardiovascular Health Metrics Are Deteriorating In South Korea: A Nationwide Survey 2007-2021

Introduction: The American Heart Association (AHA) recently updated the “Life’s Essential 8” (LE8) metrics for quantification of cardiovascular health (CVH). We investigated temporal trends of CVH status by LE8 metrics among Korean adults, using nationwide survey data. Methods: We analyzed data from the Korea National Health and Nutrition Examination Survey (KNHANES), 2007-2021, including 93,092 participants aged 20 years or older. The LE8 CVH score was calculated as the average score of 8 metrics: diet, physical activity, nicotine exposure, sleep health, body mass index (BMI), blood lipids, blood glucose, and blood pressure, each scaled 0 to 100 points. The CVH scores of 80 to 100 were categorized as high CVH, 50 to &lt;80 as moderate CVH, and 0 to &lt;50 as low CVH. All statistical analyses accounted for the complex survey design of the KNHANES data. Results: From the 4 th (2007-2009) to 8 th (2019-2021) cycle of the KNHANES, the mean LE8 CVH score declined from 68.9 to 66.6 in the Korean population. The proportion of adults with high CVH decreased from 22.5% to 16.9%, while the proportion of adults with low CVH increased from 8.4% to 10.6% (Figure A). Most adults had already lost ideal CVH by young adulthood; only 25% of adults aged 20-39 attained high CVH, and the proportion was lower at older ages. By individual metrics (Figure B), the score decreased in terms of physical activity (51.2 to 32.8), BMI (77.3 to 74.2), blood lipids (70.1 to 65.9), blood glucose (87.5 to 82.0), and blood pressure (75.9 to 72.3), remained stable in terms of sleep health (80.7 to 80.8), and increased in terms of diet (46.7 to 52.0) and nicotine exposure (63.6 to 73.3). The time-trends were similar across sex and age groups, although CVH scores were generally lower among men and older age. Conclusions: The CVH status of Korean adults has deteriorated over the past 15 years, especially in terms of physical activity, BMI, blood lipids, blood glucose, and blood pressure.

Abstract P394: Associations of Street-View Greenspace Exposure With Cardiovascular Health (Life’s Essential 8) Among Women in Midlife

Introduction: Many women experience suboptimal cardiovascular health (CVH) during midlife. Greenspace exposure has been inversely associated with cardiovascular disease outcomes and risk factors, but the majority of studies use satellite-based assessment of greenspace and limited evidence exists regarding overall CVH. Methods: We performed a longitudinal analysis of women in the Project Viva cohort based in Massachusetts. We applied deep learning algorithms to Google street view images to derive metrics of visible greenspace within 500m of participant’s residential addresses in 2012-2016 (median 46y). We calculated %greenspace from trees, grass, and other greenspace (i.e. plants, fields, flowers) within each image, separately and total combined, and transformed each into z-scores. At the Mid-Life Visit ~5 years later (51y), participants completed questionnaires and research staff measured their height, weight, blood pressure, and blood levels of glucose, HbA1c and cholesterol. We calculated CVH score using Life’s Essential 8 (LE8) algorithm (0-100 points, higher=better), that includes 8 components of CVH, including 4 behavioral measures (heart healthy levels of diet, physical activity, sleep, avoidance of nicotine) and 4 biomedical measures (body mass index (BMI), blood pressure, blood lipids, blood glucose). We used linear regression models adjusted for age, race and ethnicity, and an index score of socioeconomic status comprising both individual and neighborhood metrics. Results: Among 678 participants, 68% were non-Hispanic White and 74% were college grads. In midlife, mean (SD) LE8 score was 76 (12) points. In unadjusted models, greater total %greenspace (per SD) was associated with higher overall CVH score (β 3.09; 95% CI 2.01, 4.17), as well as higher behavioral (β 2.71; CI 1.69, 3.73) and biomedical (β 3.09; CI 1.56, 4.62) sub-scores. Covariate adjustment attenuated these associations but they remained statistically significant for overall (β 1.88; CI 0.58, 3.19), behavioral (β 1.61; CI 0.44, 2.77) and biomedical (β 2.20; CI 0.31, 4.10) CVH scores. When disentangling the components of greenspace, %trees (adjβ 1.83; CI 0.54, 3.13) was associated with overall CVH, but %grass was non-significant (adjβ 0.75; CI -0.53, 2.02). Greater %trees was associated with higher scores for each CVH component in unadjusted models (except lipids): diet (β 1.64; CI 0.41, 2.86), physical activity (β 4.19; CI 1.61, 6.76), nicotine avoidance (β 2.07; CI 0.40, 3.75), sleep (β 3.50; CI 1.93, 5.08), BMI (β 6.51; CI 3.89, 9.14), blood pressure (β 2.39; CI 0.30, 4.48) and glucose (β 3.09; 1.36, 4.83). Covariate adjustment attenuated these associations to non-significance except for diet (β 2.33; CI 0.90, 3.75), BMI (β 3.08; 0.10, 6.06) and glucose (β 2.82; CI 0.73, 4.91). Conclusions: Greater street-view greenspace exposure, especially %trees, was associated with better CVH among women in midlife.

Abstract P411: Child Opportunity and Behavioral Cardiovascular Health in Youth: The Young Hearts Study

Background: Low cardiovascular health (CVH) in childhood is linked to risk of cardiovascular events in adulthood in the US. Relationships between neighborhood characteristics could be important for CVH in children, as appears to be the case in adults. We sought to assess such associations, representing neighborhood characteristics by the Child Opportunity Index (COI) and using a composite behavioral CVH score in youth. Methods: We used baseline data from the Young Hearts study, which is studying CVH trajectories of children ages 0-20. We linked children’s addresses to the COI, with domains encompassing: (1) social and economic, (2) health and environmental, and (3) educational opportunity. CVH behaviors were defined using the Life’s Essential 8 framework and included: self-reported diet, physical activity, nicotine exposure, and sleep. Linear regression models assessed the association between COI and overall and component behavioral CVH scores after adjustment for child demographics, family SES, and moves in the last year. Overall CVH scores comprised of the mean value of 4 behavior-specific scores (each 0-100 points). Results: Participants (N=2202) were 9.5±5.4 years old; 46.3% were female, and 47.05% identified as non-Hispanic White, 25.3% as Hispanic, and 17.9% as non-Hispanic Black. Compared with high (favorable) COI, individuals with low COI had a 2.15-point lower (worse) mean behavioral CVH score (p=0.003); however, those with moderate COI did not have significantly lower mean scores. The pattern for the education domain was similar but weaker. In the social and economic domain, those with low and moderate COI both had lower behavioral CVH scores than those with high COI. The health and environment domain was not independently associated with CVH. Of individual metrics, only sleep scores (beta=68.32, p=0.005) were independently associated with COI after adjustment. Conclusion: COI, especially social and economic factors, were associated with overall behavioral CVH among a diverse population of children.

Abstract P360: Association of Neighborhood-Level Socioeconomic Disadvantage and Maternal Cardiovascular Health in Early Pregnancy: The nuMoM2b-HHS Study

Introduction: To determine whether residing in a more socioeconomically deprived area during early pregnancy is associated with worse maternal cardiovascular health (CVH), as quantified by the American Heart Association Life’s Essential 8 (LE8). Methods: Secondary analysis from the prospective Nulliparous Pregnancy Outcomes Study-Monitoring Mothers-to-Be Heart Health Study cohort. Participant home addresses in the first trimester were geocoded at the census-tract level. The exposure was neighborhood-level area deprivation index (ADI), categorized by tertile (least deprived [T1], reference; most deprived [T3]). The outcome was CVH defined by the LE8 assessed in the first trimester, which includes physical activity, diet quality, tobacco use, sleep quantity, body mass index (BMI), blood pressure, and serum fasting glucose and lipid levels to create a score ranging from 0 to 100 (higher being better). Multivariable linear regression models were used to examine associations between ADI tertile and CVH scores for each component and a summary CVH score. Results: In this cohort of nulliparous individuals in the first trimester, the mean ADI was 45.2 (SD: 30.7), and the mean overall LE8 was 82.2 (SD: 12.0). Compared with those with the least neighborhood disadvantage (i.e., T1), individuals living in neighborhoods with greater neighborhood disadvantage had lower mean LE8 scores, indicating worse CVH (T1 vs. T2 adjusted mean: 84.68 vs. 81.75; adj. ß: -2.92; 95% CI: -4.19, -1.66; and T1 vs. T3: 84.68 vs. 79.15; adj. ß: -5.52; 95% CI: -7.92, -3.12) (p&lt;0.01 for trend). The greatest neighborhood disadvantage (i.e., T3) was also associated with individual elements of the LE8, including poorer diet quality, higher BMI, and higher systolic and diastolic blood pressure. Conclusions: Neighborhood-level socioeconomic disadvantage was associated with worse CVH in early pregnancy. Multi-level interventions should consider structural approaches that address the social determinants of place-based disparities in maternal CVH.

Abstract P372: Behavioral Cardiovascular Health in Children With Chronic Conditions

Background: A quarter of children in the United States have at least one chronic condition which translates to worse health than their peers. However, there is little information about cardiovascular health (CVH) among children with chronic conditions. Methods: We used data from the Young Hearts study, an ongoing longitudinal cohort of CVH trajectories in youth aged 0-20 years. Parents (and children aged 12+ years) completed surveys on CVH behaviors, medical history, and social context. We included children with complete baseline data. Participants were categorized as having at least one self-reported chronic condition or no chronic condition. We calculated CVH using the behavioral components of the American Heart Association Life’s Essential 8 (diet, physical activity, nicotine exposure, sleep). Each component was scored from 0 (most adverse) to 100 (ideal) and averaged to create a composite behavioral (b) CVH score. We used linear regression to assess the association between chronic condition status (any, none) and bCVH score, adjusting for age, sex, race, ethnicity, insurance type, and household income. Results: We identified 1138 children with at least one chronic condition and 1406 children without any chronic conditions. Among those with chronic conditions, the most common were heart disease (14.9%), asthma (11.2%), and vision problems/blindness (9.7%). In fully adjusted models (Table), we found individuals with any chronic condition had a 1.3 point lower (95% CI -2.5, -0.2) bCVH score on average. Children with chronic conditions had lower (less favorable) scores for sleep (-4.2; 95% CI -7.1, -1.4) and physical activity (-3.7; 95% CI -6.3, -1.2) compared to their peers with no chronic conditions, but a higher (more favorable) nicotine exposure score (1.4; 95% CI 0.5, 2.4). Conclusion: As a group, children with chronic conditions had worse bCVH scores than their peers without chronic conditions. Further research is needed to understand these differences and support CVH promotion in children with chronic conditions.

Abstract P508: Comparisons of Cardiovascular Health in US Adults by Chronic Disease Status: National Health and Nutrition Examination Survey (NHANES), 2013-2018

Introduction: Cardiovascular health (CVH) assessment is typically applied to younger, healthy individuals in the setting of primordial prevention, but the concept may have important benefits for those with chronic diseases of aging (CDAs) at increased risk for incident cardiovascular disease (CVD). No studies have assessed CVH in adults with CDAs vs. healthy adults without CDAs using the new Life’s Essential 8 (LE8) metrics. Methods: We used NHANES data from 2013-2018 to identify presence of 15 CDAs by participant self-report of diagnosis. We included adults ages 20 to 79. CVH was defined by AHA’s LE8 metrics. Overall mean LE8 (range 0-100, higher = better CVH) and individual LE8 metric scores were calculated according to disease status for all participants and stratified by self-identified sex and race/ethnicity. Results: There were 12,296 adults, with mean age 46 years; 51% self-identified as female, 65% as White, 16% Hispanic, 11% Black, 5% Asian, 4% multiracial. Significantly, and often substantially, lower CVH scores were noted for adults with CDA (12 of 15 CDAs) vs. healthy adults, including all subtypes of CVD and lung diseases, liver disease, arthritis, cognitive decline, and depression. Greatest mean LE8 differences were detected for COPD, emphysema, and congestive heart failure. For example, mean overall LE8 score was 14.0 points lower in those with vs. without COPD (51.0 vs. 65.0, P&lt;0.0001) with smoking and physical activity having the largest absolute differences in individual metric scores (36.4 and 23.6, respectively). There were no significant differences in LE8 scores for participants with vs. without cancer, HIV, or osteoporosis. Males and Black adults consistently had lower LE8 scores. Conclusions: CVH is significantly poorer in adults with many of the CDAs compared to healthy adults. These data establish the utility of the LE8 CVH score to identify groups for targeted optimization of CVH to enhance primary and secondary prevention efforts for CVD and potentially for other concomitant CDAs.

Abstract P444: Pre-Pregnancy Substance Use and First Trimester Cardiovascular Health Among Nulliparous Pregnant People: The nuMoM2b Study

Introduction: Pre-pregnancy health, including substance use and cardiovascular risk factors, have been associated with higher risks of maternal-fetal morbidity and mortality. The objective of this study was to determine if pre-pregnancy substance use is associated with early pregnancy cardiovascular health (CVH). Hypothesis: Pre-pregnancy use of alcohol, tobacco, marijuana, or illicit substances are associated with worse CVH as early as the first trimester of pregnancy. Methods: This is a secondary analysis using data collected in the first trimester of pregnancy in the nuMoM2b cohort (n=9,895). Pre-pregnancy alcohol, tobacco, marijuana, and illicit substance use were assessed through standardized questionnaires. Latent class analysis categorized participants into four subgroups based on their reported pre-pregnancy substance use characteristics: [1] Illicit substances, marijuana, and alcohol use (n=1,234); [2] marijuana and alcohol use (n=2,066); [3] tobacco and alcohol use (n=636); and [4] alcohol use (n=3,194). Non-users were referent (n=2,765). CVH score was assessed using the American Heart Association Life’s Essential 8 (LE8) framework and included scoring of measured height, weight, resting blood pressure, blood glucose, and non-HDL cholesterol as well as self-reported diet, sleep, and exercise from 0 (least healthy) to 100 (most healthy). Multiple linear regression evaluated the relationship between pre-pregnancy substance use subgroups and LE8 score (overall and specific components). Results: Mean LE8 score varied by pre-pregnancy substance use subgroup: non-users Mean 65, SD ± 1.3, illicit substances, marijuana, and alcohol use 68 ± 1.3, marijuana and alcohol use 67 ± 1.3, tobacco and alcohol use 62 ± 1.4, and alcohol use 67 ± 1.3 (p&lt;.0001). In adjusted models and compared to non-users, those who used tobacco and alcohol had a lower LE8 score (-2.8, p&lt;.0001), other pre-pregnancy substance use classes had slightly higher scores ranging from 1.8-2.5 points (p&lt;.0001). Similar patterns were observed for individual components of the LE8 score. Conclusion: Individuals who used tobacco and alcohol prior to pregnancy, as opposed to other substance use subgroups, begin pregnancy with worse cardiovascular risk and may benefit from CVH promotion efforts.

Abstract P378: Life’s Essential 8 and Personal Income Level in Korean Adults

Introduction: The COVID-19 pandemic has raised global income inequality. This study analyzes the association between personal income level and cardiovascular health matrix (CHM) utilizing AHA life’s essential 8 in Koreans. Methods: This study used the 2019-2021 Korean National Health and Nutrition Examination Survey. Those who have missing data for assessing Life’s essential 8 were excluded. A final total of 12,923 participants were enrolled in this study. We used Life's essential 8 CHM Metrix as exposure, defined by the AHA. Diet redefined them appropriately for the Korean population. The unweighted average of each CHM score was calculated, and the cardiovascular health assessment groups were categorized as "high (80-100)," "medium (50-79)," and "low (0-49)" and then subjected to logistic regression analysis. The results were adjusted for sex, age, education, drinking status, perceived stress, and family history of physician chronic disease diagnosis. Results: Score of diet, physical activity, nicotine exposure, sleep health, body mass index, blood glucose, and blood pressure were positively associated with personal income level (Figure 1). Compared to the middle CVH group and lower income level group, higher income levels were associated with being in the high CVH group before (OR 1.6, 95%CI 1.4-1.8) and after adjusted (OR 1.5, 95%CI 1.2-1.7) confounders. Conclusions: This study showed that personal income was positively associated with the total life’s essential 8 CVH score and individual factors of life’s essential 8. Our results imply that socioeconomic factors, specifically personal income levels, exert influence even within what is considered an individual's realm (diet, physical activity, nicotine exposure, sleep health, body mass index, blood glucose, blood pressure) of control.

Abstract MP44: Non-Genetic Component of Height as a Surrogate Marker for Childhood Socioeconomic Status and Its Association With Cardiovascular and Brain Health: Results From HCHS/SOL

Introduction: Childhood socioeconomic status (SES) has been recognized to have lifelong effects on health, but often studies rely on recollected information subject to bias. Several studies suggest taller adult height is a surrogate for favorable childhood SES, likely due to better nutrition during skeletal development. We aimed to parse out the non-genetic component of height as a refined surrogate marker of childhood SES. Hypothesis: We hypothesized that the higher non-genetic component of height is associated with higher childhood SES, and further, with better cardiovascular and brain health in adulthood. Methods: Self-reported information such as parental education, nativity (born in US 50 states/DC), age at migration, and economic hardship to pay for basic needs and access to household utilities during childhood were collected from US Hispanics/Latinos aged 18-74 years in HCHS/SOL (2008-2011). A non-genetic component of height (height non-pgs ) was estimated by subtracting genetically predicted height from the measured height, where a height genetic prediction model was fitted on sex-standardized height with Hispanic-specific height polygenic score (height pgs ), genetic ancestry components, and sex. The AHA-LE8 cardiovascular health (CVH) clinical score was derived. Neurocognitive function (6-item screener, Spanish English Verbal Learning Test, Word fluency test, Digit symbol substitution test) was assessed among &gt;45 years. We examined the associations of height non-pgs with childhood environment and health outcomes by survey linear regressions. Results: A higher height non-pgs was associated with better childhood environment - younger generation (mean height non-pgs = 0.37 (SE=0.02) for born in 1980-1999 vs -0.45 (0.03) for born in 1930-1949), higher parental education (0.28 (0.02) for college vs -0.11 (0.02) for elementary), US born or migrated at younger age, and availability of plumbing, electricity, and phone during childhood - but not with childhood economic hardship. Further, height non-pgs was positively associated with better cognitive functions in all domains, adjusting for demographics, participants’ SES, and cardiovascular risk factors. These associations with height non-pgs were more pronounced than those with measured height. Height non-pgs showed positive associations with better clinical CVH score among 45+ aged people. Among &lt;45 years, height non-pgs was negatively associated with clinical CVH score. Conclusions: We observed that height non-pgs reflects childhood SES, potentially through better nutrition and greater access to resources that promote growth. Stronger associations of height non-pgs and health, compared to associations with measured height, suggest that height non-pgs is a good proxy for childhood environment. The paradoxical association of height non-pgs with CVH among &lt;45 years old needs further investigation.

Abstract 61: Differential Associations of Cardiovascular Health Factors With Vascular Health in Adults Free of Cardiovascular Disease

Background: There is limited understanding of the association of the AHA's Life's Essential 8 (LE8), reflecting cardiovascular health (CVH) behaviors and factors, with vascular stiffness and hemodynamics in adults without cardiovascular diseases (CVD). Methods: In 2330 Framingham Heart Study Offspring participants (Exam 7, 1998-2002) with applanation tonometry and LE8 data (diet, physical activity, smoking, sleep health, BMI, lipids, glucose, blood pressure), we calculated CVH scores per AHA guidelines. In multivariable linear regression analyses adjusting for CV risk factors, we analyzed LE8 as a predictor of vascular health, assessed by carotid femoral pulse wave velocity (PWV) and central pulse pressure (CPP). We examined for effect modification by age (dichotomized at median) and sex in the associations between LE8 and arterial stiffness. We set p=0.05 and p=0.10 as thresholds for significance in primary and secondary analyses, respectively. Mediation analysis was utilized to discern the indirect effects of PWV and CPP on the relationship between LE8 and both all-cause and CVD mortality. Results: In our sample (60±9 years; 57% women; LE8 = 69±12), higher LE8 indicating better CVH, was associated with lower PWV and CPP (Table). Age and sex interactions were noted for PWV (p=0.01 and 0.07, respectively). Higher LE8 was associated with lower PWV in adults ≥59 years and women but not in &lt;59 years or men (Table). With low CVH category as referent, intermediate CVH category had no significant association with PWV and high CVH category had lower PWV. CPP was lower in the intermediate and high CVH categories compared to low CVH category (Table). PWV mediated 19% and CPP 10% of the association between LE8 and CVD mortality and 17% and 15%, respectively, for all-cause mortality. Conclusion: In our community cohort, we observed age and sex differences in the relationship between CVH and vascular health. Mediation analyses revealed indirect effects on mortality, warranting further study. Table

Abstract P380: Fatherhood and Cardiovascular Health: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Introduction: Emerging literature links fatherhood to men’s health but lacks comprehensive investigation of associations with cardiovascular health (CVH). Hypothesis: Fatherhood will be associated with total CVH and individual CVH metrics. Methods: We included men from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a prospective cohort study which enrolled Black and White individuals aged 18-30 years at baseline (1985-86). CVH was defined using the American Heart Association's Life’s Essential 8 (LE8) scores (0-100) and was calculated at the year 20 follow-up examination to most accurately classify men’s fatherhood status. Multivariable linear regression tested for difference in total CVH and CVH metrics by fatherhood status (father vs non-father vs stepfather &amp; living with children vs not) and age at transition to fatherhood; models adjusted for age, race, marital status, education, having a primary care clinician, income, current alcohol consumption &amp; CESD depression score. Results: In this sample of 1026 men, mean age at LE8 assessment was 45.4 (SD=3.5) years, 720 (70.2%) were fathers, 243 (23.6%) were non-fathers, 63 (6.1%) were stepfathers, and 384 (37.4%) self-identified as Black. The mean age men became fathers was 29.2 years. In adjusted models, there was evidence of interaction between the age at fatherhood and race on total CVH score ( p =0.07). For white men, becoming a father at &lt;20 years was associated with lower total CVH, compared with 30-34 ( p &lt;.01) and ≥35 years ( p =0.02); this association was not found for Black fathers (Figure 1). In adjusted models, stepfathers had worse BMI scores than non-fathers (least squares mean 51.1 vs 64.3, p&lt;0.01), but otherwise there was no difference in total CVH or CVH metrics between non-fathers, fathers, stepfathers, or men living with or without children. Conclusion: Fatherhood is a social determinant of health and understanding its influence may provide opportunities to improve men’s health, particularly among men who become fathers at young ages.

Abstract P173: Examining Sexual Identity Differences in Ideal Cardiovascular Health

Introduction: Recent evidence suggests that sexual minority (e.g., gay, lesbian, bisexual, queer) adults in the United States are at increased risk of cardiovascular disease compared to heterosexual adults. However, the majority of cardiovascular health (CVH) research among sexual minority adults has focused on investigating differences in individual CVH metrics rather than comprehensive measures of CVH. Methods: We analyzed nationally representative data from the National Longitudinal Study of Adolescent to Adult Health to examine sexual identity differences in ideal CVH (i.e., individual CVH metrics and cumulative ideal CVH score) among adults. Participants received a score of 0 (poor), 1 (intermediate), or 2 (ideal) for each CVH metric, and scores were summed to calculate cumulative ideal CVH scores (continuous; range 0-12). We ran sex-stratified multiple logistic and linear regression models to examine sexual identity differences in ideal CVH. Models were adjusted for demographics, health insurance coverage, and adverse childhood experiences. Results: The final sample included 3,492 participants with a mean age of 21.8 (+/- 1.76) years. Approximately 60% were female, over 76% were White and around 90% were non-Hispanic. Compared to exclusively heterosexual women, mostly heterosexual (AOR 0.89, 95% CI = 0.79-0.99) and lesbian (AOR 0.73, 95% CI = 0.55-0.91) women had lower odds of meeting ideal criteria for tobacco use. In contrast, lesbian women had higher odds of meeting ideal criteria for glycosylated hemoglobin (AOR 1.22, 95% CI = 1.09-1.35). Among men, compared to exclusively heterosexual men, mostly heterosexual (AOR 0.87, 95% CI = 0.76-0.97) and bisexual (AOR 0.86, 95% CI = 0.74-0.97) men had lower odds of meeting ideal criteria for tobacco use and blood pressure, respectively. Gay (AOR 0.79, 95% CI = 0.67-0.90) and bisexual (AOR 0.75, 95% CI = 0.54-0.96) men had lower odds of meeting ideal criteria for physical activity, but gay men had higher odds of meeting ideal criteria for body mass index (AOR 1.25, 95% CI = 1.00-1.55). No sexual identity differences were observed for cumulative ideal CVH scores among women and men. Conclusions: As one of the first studies to use nationally representative longitudinal data to examine sexual identity differences in ideal CVH, this study makes an important contribution to the literature on CVH among sexual minority adults. Findings highlight significant CVH disparities in sexual minority adults and suggest there is a need to develop interventions that focus on improving their CVH. Future research is needed to investigate factors that may contribute to the CVH disparities observed among sexual minority adults in this study.

Abstract 62: Association of Cardiovascular Health Trajectories Through Young Adulthood With Later-Life Incident Cardiovascular Disease and Mortality: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Introduction: Associations of mid-life cardiovascular health (CVH) and incident cardiovascular disease (CVD) are well-studied. Less is known about patterns of young adulthood (YA) CVH, including its changes, and associations with later-life CVD outcomes. Methods: CVH was defined by Life’s Essential 8 (LE8) score. First, we used latent class modeling (SAS Proc Traj) to determine trajectories of continuous CVH scores (0-100) for CARDIA participants with ≥3 CVH measurements in YA (from year [Y]0, mean age 25, to Y20, mean age 45). Second, we examined direction and magnitude of change in CVH status (low, moderate, or high) between 2 CVH measurements (at Y0 and Y20), comparing participants with increased, decreased, or stable CVH status. Outcomes included incident CVD (MI, heart failure, stroke, CVD death) after Y20. Cox proportional hazards regression was used to estimate HRs for associations of YA CVH patterns with incident CVD. Results: There were 4,257 participants in YA (44% female, 48% Black) included. In the trajectory analysis, we identified four distinct CVH trajectory groups ( Figure 1A ): compared to the Persistently-High CVH group, the Moderate-Low-Declining and Moderate-Declining CVH trajectory groups had substantially higher hazards for incident CVD ( Figure 1B ). In the CVH status change analysis (N=2,884; Figure 1B ), compared to Stable High CVH in YA, Stable Low CVH had a 19-fold higher risk for incident CVD, and both increasing and decreasing CVH status in YA had greater risk for incident CVD as well. Conclusions: Trajectories of declining moderate and low CVH in YA had substantially higher risk for later-life incident CVD events. Those with decreasing CVH and those who started with lower CVH and improved it through YA, were also at higher risk. These data suggest that early life CVH and maintaining high CVH through YA are both important for prevention of later-life CVD.

Abstract P358: Association Between Psychological Distress and Cardiovascular Health Among Pregnant Individuals in the United States: Findings From Nationally Representative Data

Background: Psychological health has an impact on pregnancy outcomes. The impact of psychological health during pregnancy on maternal cardiovascular health (CVH) is not well understood. Methods: Data from the US National Health Interview Survey (2013-2018) were used. All participants aged ≥18 years were included, excluding those with missing data for any of the exposure, outcome, or covariates. Psychological health was measured by the six-item Kessler scale (K6), and severe psychological distress (SPD) was defined as K6 ≥13. CVH was quantified based on the American Heart Association’s Life’s Essential 8 ; as detailed dietary data were unavailable, a seven-item CVH score was used (higher score indicated worse CVH). Multivariable Poisson regression was used to test associations between SPD and CVH, adjusting for the presence of any known cardiac condition, family income, education level, race, sex, sexual orientation, insurance coverage, and age. Results: Altogether, 1,111 participants were analyzed representing a weighted population of 1,576,091 persons. Worse psychological distress was independently associated with suboptimal cardiovascular health in pregnant individuals (adjusted risk ratio (aRR) 1.03 [95% confidence interval: 1.02, 1.04], p&lt;0.001), with similar findings for SPD (aRR 1.34 [1.14, 1.58], p=0.001). These associations remained consistent regardless of age and race. Conclusions: Although SPD was relatively uncommon among pregnant individuals, it was strongly associated with worse maternal CVH. This underscores the critical need for a multidisciplinary approach that incorporates thorough psychological assessments in the care of pregnant individuals.