Favorable Cardiovascular Health Research Articles

Association of physical activity and screen time with cardiovascular disease risk in the Adolescent Brain Cognitive Development Study

BackgroundAccording to the Physical Activity Guidelines Advisory Committee Scientific Report, limited evidence is available on sedentary behaviors (screen time) and their joint associations with physical activity (steps) for cardiovascular health in adolescence. The objective of this study was to identify joint associations of screen time and physical activity categories with cardiovascular disease (CVD) risk factors (blood pressure, hemoglobin A1c, cholesterol) in adolescence.MethodsThis study analyzed data from the Adolescent Brain Cognitive Development (ABCD) Study, comprising a diverse sample of 4,718 U.S. adolescents aged 10–15 years between 2018 and 2021. Steps were measured by a Fitbit wearable device and levels were categorized as low (1,000–6,000), medium (> 6,000–12,000), and high (> 12,000) averaged daily step counts. Self-reported recreational screen time hours per day were classified as low (0–4), medium (> 4–8), and high (> 8) hours per day. CVD risk factors including blood pressure, hemoglobin A1c, and cholesterol (total and HDL) were measured.ResultsThe analytical sample averaged 6.6 h of screen time per day and 9,722 steps per day. In models including both screen time and steps, the high screen time category was associated with a 4.27 higher diastolic blood pressure percentile (95% CI 1.83–6.73) and lower HDL cholesterol (B= -2.85, 95% CI -4.77 to -0.94 mg/dL) compared to the low screen time category. Medium (B = 3.68, 95% CI 1.24–6.11) and low (B = 7.64, 95% CI 4.07–11.20) step categories were associated with higher diastolic blood pressure percentile compared to the high step category. The medium step category was associated with lower HDL cholesterol (B= -1.99, 95% CI -3.80 to -0.19 mg/dL) compared to the high step category. Findings were similar when screen time and step counts were analyzed as continuous variables; higher continuous step count was additionally associated with lower total cholesterol (mg/dL).ConclusionsCombinations of low screen time and high steps were generally associated with favorable cardiovascular health markers including lower diastolic blood pressure and higher HDL cholesterol, which can inform future adolescent health guidelines.

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 IA038: Neighborhood factors for adiposity change and cardiovascular health among Black breast cancer survivors

Abstract Maintaining a healthy weight and cardiovascular health (CVH) after a breast cancer (BC) diagnosis is gaining clinical attention because they are essential for reducing the burden of cardiovascular disease, achieving optimal cancer survivorship, and possibly reducing mortality after a BC diagnosis. Individual behaviors and choices are largely influenced by the surrounding social and built environment; however, the neighborhood risk factors influencing post-diagnosis weight change and CVH are unclear among Black women, who have higher rates of obesity, unfavorable CVH and mortality than any other racial/ethnic group. To address this knowledge gap, we conducted analyses based on the Women's Circle of Health Follow-Up Study (WCHFS), a population-based prospective cohort of Black BC survivors in New Jersey. In the first analysis, adiposity changes during the period ~10 months to 2 years after diagnosis were evaluated among 785 women enrolled in the WCHFS. We found that despite a high baseline prevalence of overweight or obesity, weight gain was common. Greater density of fast-food restaurants and lower walkability were identified as neighborhood-level risk factors for weight gain. We also showed that intentional weight loss was much less common than weight gain, and its neighborhood risk factors were considerably different from unintentional weight loss. In a subsequent analysis, we aimed to capture the complex interplay between neighborhood features through neighborhood archetype analysis based on 16 social and built environment features, and to estimate their associations with CVH around 2 years after diagnosis among Black women. The CVH index used American Heart Association definition and scoring criteria for BMI, diet, smoking, physical activity, blood pressure, cholesterol, glucose, and sleep. We found that Black BC survivors, on average, reached only half of the recommended optimal CVH score, and no participant met all ideal CVH metrics. Among the four neighborhood archetypes identified, we found that the archetype associated with the most favorable post-diagnostic CVH was characterized by diverse racial and ethnic populations, a higher neighborhood socioeconomic status, greater densities of restaurants, food stores, physical activity facilities, walkable destinations, and ambulatory care. However, only 16% of our participants lived in this type of neighborhood. In summary, our work revealed that residential environments may considerably impact adiposity change and CVH among Black BC survivors. Through these studies, we provided insights into the distinct neighborhood characteristics and archetypes that may influence BC survivorship for Black women. Recognizing that social determinants of health act at multiple levels, domains, and factors, it is crucial that future research comprehensively investigates neighborhood and other multilevel determinants to identify the specific social barriers that must be addressed to achieve the most measurable improvements in BC survivorship for Black women. Citation Format: Bo Qin, Carola T. Sánchez-Díaz, Hari S. Iyer, Noreen Goldman, Nur Zeinomar, Andrew G. Rundle, Christine B. Ambrosone, Kitaw Demissie, Chi-Chen Hong, Gina S. Lovasi, Elisa V. Bandera. Neighborhood factors for adiposity change and cardiovascular health among Black breast cancer survivors [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr IA038.

Abstract 18948: Prospective Associations Between the Life's Essential 8 Cardiovascular Health Construct, Leptin, and Inflammatory Markers Among Women Across the Menopausal Transition: Findings From the AHA Research Goes Red Weight Study

Introduction: The menopausal transition is a key period of potential detrimental changes in adiposity. The hormone leptin may be relevant to obesity, inflammation, and cardiovascular health (CVH). Hypothesis: Among women across the menopausal transition, lower levels of circulating leptin, C-reactive protein (CRP) and interleukin 6 (IL-6) will be associated with better Life’s Essential 8 (LE8) CVH score. Methods: Participants were women ages 45-55y (N=291, mean age=50 ± 3.2yr, 74% with overweight/obesity, (n=98 pre-, n=94 peri-, n=99 post-menopausal) from the AHA Research Goes Red Weight Study, a 1-yr prospective observational study utilizing Verily’s online platform. At baseline and 1yr, women completed a 1-wk food record using the NIH ASA 24-Hour Dietary Assessment Tool and fasting blood samples were drawn. The LE8 CVH and component scores (range: 0-100, high: 80-100, moderate: 50-79, low: 0-49) were computed. Associations between leptin, inflammatory markers, and CVH scores were tested using multivariable linear regression models adjusted for age, race/ethnicity, education, employment, insurance, and menopausal status. Results: The mean (SD) overall LE8 CVH score at baseline was 68.0 (15.3) and did not vary by menopausal status. Individual LE8 scores were lowest for the diet metric [mean (SD)=40.2 (31.5)]. Pre-menopausal women had better scores on the blood glucose metric compared to post-menopausal [mean (SD)= 88.0 (24.4) vs. 76.2 (26.5), p=.02]. Compared to peri- and pre-menopausal women, leptin values were highest in post-menopausal women (55 ± 29.5 mg/mL vs. 41 ± 29.5 vs 39 ± 25.6, p=.047). In cross-sectional analyses, and after adjustment for confounders, higher overall LE8 CVH scores were associated with lower levels of leptin (B= -0.17, p<0.0001), CRP (B= -0.34, p=0.009), and IL-6 (B= -2.85; p=0.02). In multivariable prospective analyses, lower CRP at baseline predicted better LE8 CVH scores at 1 yr (B= -0.22; p=.02), with a similar trend for an association between lower baseline leptin and better LE8 CVH scores at 1 yr (B= 0.04; p=.066). Conclusions: In a national sample of women across the menopausal transition, those with lower leptin and inflammatory markers had more favorable CVH scores as measured by the recently updated LE8 construct.

Abstract 11548: An Examination of Differences in Ideal Cardiovascular Health Between Sexual Minority and Heterosexual Adults in the All of Us Research Program

Introduction: Although cardiovascular health (CVH) disparities have been documented among sexual minority (e.g., gay/lesbian, bisexual) adults, research has been limited by a focus on sexual identity differences in individual, rather than composite, measures of CVH. Composite measures of CVH provide more comprehensive assessments of future cardiovascular disease risk. Methods: We analyzed data from the All of Us Research Program to examine sexual identity differences in CVH using the American Heart Association’s Life's Essential 8 measure of ideal CVH. Participants received a score from 0-100 for each CVH metric. We calculated an unweighted average to determine cumulative ideal CVH (range 0-100). Higher scores indicated a more favorable CVH profile. We used sex-stratified multiple linear regression models to estimate differences in individual CVH metrics and cumulative ideal CVH between sexual minority and heterosexual adults. All models were adjusted for age, race, ethnicity, household income, education, and insurance status Results: The sample included 6,597 participants with a mean age of 63.3 years (±13.89) of which 57% were female and 79% were Non-Hispanic White. Lesbian women (B = -7.43, 95% CI = -13.20, -1.65), gay men (B = -6.39, 95% CI = -10.17, -2.61), and bisexual men (B = -7.41, 95% CI = -14.71, -0.10) had less favorable nicotine exposure scores than their heterosexual counterparts of the same sex. Gay (B = -9.65, 95% CI = -16.60, -2.71) and bisexual men (B = -14.12, 95% CI = -27.53, -0.72) had less favorable physical activity scores than heterosexual men. Bisexual men also had lower cumulative ideal CVH scores than heterosexual men (B = -5.22, 95% CI = -9.16, -1.29). In contrast, gay men had more favorable body mass index scores (B = 6.23, 95% CI = 2.24, 10.22) than heterosexual men. Conclusions: This is the first study to examine ideal CVH in sexual minority adults in the All of Us Research Program. Findings have important implications for the development of interventions to promote optimal CVH among middle-aged and older sexual minority adults. Interventions to reduce nicotine exposure are needed for lesbian women and sexual minority men. Efforts to improve the CVH of sexual minority men should also focus on increasing physical activity.

Abstract 12026: Life Essential 8 is Positively Associated With a Higher Executive Cognitive Function in US Children - ABCD Study

Background: While the association between cardiovascular health components has been linked to a higher risk of cognitive decline in adults, the relationship between cardiovascular health indicators and executive/cognitive function in US children remains poorly understood. Research Question: Are measures of cardiovascular health associated with executive, cognitive function and in US children? Aims: The purpose of this study was to determine cross-sectional associations of Life Essential 8 components with executive and cognitive function. Methods: This was a baseline analysis from a multicenter, prospective cohort study, known as the Adolescent Brain Cognitive Development (ABCD) study. Data were analyzed from the baseline ABCD data release 1.0. Participants were children aged 9 to 10 years old recruited in 21 US cities. Participants with incomplete questionnaire data for dietary intake, physical activity, nicotine exposure, or sleep health; health evaluation for body mass index, blood lipids, glycated hemoglobin, or blood pressure; or covariate data were excluded. Each cardiovascular health indicator ranges from 0 to 100 points, enabling the calculation of a composite cardiovascular health score as the unweighted average of all components, which also ranges from 0 to 100 points. The National Institutes of Health Toolbox neurocognitive battery assesses general cognitive ability, executive function, and learning/memory using raw scores and age-corrected measures. Results: A total of 978 individuals were analyzed. The mean (SD) age was 9.9 (0.2) years, 44.9% were girls, and 53.4% were White. Individuals with more favorable cardiovascular health behaviors showed better executive cognitive function (β = 0.170; CI 95%, 0.076 to 0.265; p = 0.001), and overall cardiovascular health was associated with higher executive cognitive function (β = 0.209; CI 95%, 0.067 to 0.351; p = 0.002). Conclusions: Cardiovascular health behaviors and overall cardiovascular health were directly linked to cognitive and executive function in 9-10-year-old US children, supporting public health recommendations to promote these behaviors for their potential benefits to cognitive function and brain development.

Time spent in a better cardiovascular health and risk of cardiovascular diseases and mortality: a prospective cohort study

BackgroundThe protective effect of a higher ideal cardiovascular health (CVH) score on cardiovascular diseases (CVDs) and mortality is well recognized. However, little is known regarding the length of favorable CVH status associated with CVDs and mortality. This study aimed to examined whether the duration of better (ideal or intermediate) CVH is associated with risk of developing CVDs and mortality.MethodsThis prospective cohort study used data from 83,536 individuals from 2006 to 2020 who were enrolled in the Kailuan Study. The CVH scores of individuals were assessed at visits 1, 2, 3, and 4, respectively. The years spent in better CVH were estimated for each individual as the number of examination cycles (0–4) in which the participant was in that CVH score ≥ 8 multiplied by 2 (the mean year interval of each visit). The primary outcomes are CVD events and all-cause mortality.ResultsAfter a median follow-up period of 7.48 years, 5486 (7.07%) cases of incident CVD events and 7669 (9.18%) deaths occurred. Compared with participants in “ ≤ 4 years” group, those who maintained for > 4 years had less likely to develop adverse outcomes (CVD events: hazard ratio (HR): 0.60, 95% confidence interval (CI 0.56–0.63; all-cause mortality: HR: 0.77, 95% CI 0.74–0.81). The number of years spent in better CVH was nonlinearly correlated with CVD events or mortality (all Ps for nonlinear < 0.05). The results indicated that maintaining more than 6 years in a better CVH status was associated with a decreased risk of CVD events or mortality.ConclusionOur study indicates that individuals maintaining more than 6 years in better CVH could increase cardiometabolic benefits and a lower risk of all-cause mortality.

CARDIORESPIRATORY FITNESS AND STROKE INCIDENCE IN HYPERTENSIVE PATIENTS

Objective: Stroke incidence is significantly higher in hypertensive patients compared to normotensive subjects. Cardiorespiratory fitness (CRF) is associated with a more favorable cardiovascular health. The CRF-stroke incidence association in hypertensive patients has not been fully explored. Thus, the objective of the current study was to evaluate the association between CRF assessed objectively by a standardized exercise test, and stroke incidence in hypertensive patients. Design and method: From 1999 to 2020, we identified 460,172 hypertensive patients (mean age: 63.1 ± 8.7 years) with a normal response to an exercise treadmill test (ETT) and no prior history of stroke. We established five CRF categories based on age-stratified quintiles of peak metabolic equivalents (MET) achieved: Least-Fit (4.5 ± 1.2 METs; n = 106,620); Low-Fit (6.9 ± 1.1; n = 120,327); Moderate-Fit (8.3 ± 1.2 METs; n = 89,748); Fit (10.3 ± 0.9 METs; n = 107,323); and High-Fit (13.1 ± 1.6 METs; n = 36,154). A multivariable Cox proportional hazards model was constructed to estimate hazard ratios (HR) and 95% confidence intervals [CI] for incidence of stroke across CRF categories. The model was adjusted for age, resting blood pressure, gender, race, coronary artery disease, smoking status, chronic kidney disease, atrial fibrillation, other cardiac risk factors, and medications. The Least-fit category was used as the reference group. Results: During follow-up (median = 10.6 years; 4,955,021 person-years), 11,868 individuals had a stroke (2.4 events per 1,000 person-years). The risk for stroke was 8% lower for each 1-MET increase in exercise capacity (HR = 0.92, CI: 0.91 - 0.93; p &lt; 0.001). The risk across fitness categories, declined progressively with increased CRF and was by 15% for the Least-Fit individuals (HR = 0.85; CI: 0.81 - 0.89), approximately 30% to 40% for Moderate-fit and Fit individuals, and 45% lower (HR = 0.55; CI: 0.50 - 0.60; p &lt; 0.001) for High-Fit individuals. Conclusions: Increased CRF was inversely related to stroke incidence in hypertensive patients. The association was independent and graded. These finding support the concept that health care professional should encourage patients to engage in habitual physical activity of moderate intensity and progressively aim to meet the physical activity guidelines proposed by authorities.

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.

Abstract P638: Sex Differences in Cardiovascular Health Among Young Adults in Puerto Rico

Background: Emerging evidence supports significant variations in cardiovascular health (CVH), as defined by the American Heart Association (AHA) using “Life’s Simple 7” metrics, among Hispanics in the mainland US by sex and heritage group. Of these, Hispanic men and those of Puerto Rican background are less likely to meet favorable CVH criteria. Yet data on young men and women residing in Puerto Rico, an understudied population with a unique sociocultural context, are scarce. We assessed sex differences in CVH among young adults living in Puerto Rico. Measures: We used PR-OUTLOOK baseline data, collected between September 2020 and September 2022, for this analysis. Participants were between the ages of 18-29 years. CVH was measured using the AHA Life’s Essential 8 (LE8) score, a revised composite metric of physical activity, smoking, diet, sleep, body mass index (BMI), blood pressure, blood glucose, and non-HDL cholesterol. The total score ranges from 0-100, with higher scores indicating better CVH. For this analysis, the measure was modified to exclude diet given the lack of dietary data. Multivariable linear regression models were used to assess sex differences in the overall CVH score and its components. Analyses were adjusted for age, sex, marital status, and childhood material deprivation. Results: The sample included 964 adults - 619 women and 345 men. In adjusted analysis, women had a higher overall CVH score compared to men (β=2.77, 95% CI: 1.10, 4.44). Women also had higher scores for nicotine exposure (β=9.24, 95% CI: 5.18, 13.29), non-HDL cholesterol (β=4.31, 95% CI: 1.11, 7.51), and blood pressure (β=13.22, 95% CI: 10.39, 16.05) but lower for physical activity (β=-9.55, 95% CI: -15.18, -3.91). There were no significant sex differences in scores for sleep health, BMI, and blood glucose. Conclusion: There are sex differences in CVH among young adults in Puerto Rico, with women having overall better CVH. Interventions to improve nicotine exposure, non-HDL cholesterol, and blood pressure in men and participation in physical activity in women are needed to enhance and preserve overall CVH.

Differences in Ideal Cardiovascular Health Between Sexual Minority and Heterosexual Adults

Research on the cardiovascular health (CVH) of sexual minority adults has primarily examined differences in the prevalence of individual CVH metrics rather than comprehensive measures, which has limited development of behavioral interventions. To investigate sexual identity differences in CVH, measured using the American Heart Association's revised measure of ideal CVH, among adults in the US. This cross-sectional study analyzed population-based data from the National Health and Nutrition Examination Survey (NHANES; 2007-2016) in June 2022. Participants included noninstitutional adults aged 18 to 59 years. We excluded individuals who were pregnant at the time of their interview and those with a history of atherosclerotic cardiovascular disease or heart failure. Self-identified sexual identity categorized as heterosexual, gay/lesbian, bisexual, or something else. The main outcome was ideal CVH (assessed using questionnaire, dietary, and physical examination data). Participants received a score from 0 to 100 for each CVH metric, with higher scores indicating a more favorable CVH profile. An unweighted average was calculated to determine cumulative CVH (range, 0-100), which was recoded as low, moderate, or high. Sex-stratified regression models were performed to examine sexual identity differences in CVH metrics, disease awareness, and medication use. The sample included 12 180 participants (mean [SD] age, 39.6 [11.7] years; 6147 male individuals [50.5%]). Lesbian (B = -17.21; 95% CI, -31.98 to -2.44) and bisexual (B = -13.76; 95% CI, -20.54 to -6.99) female individuals had less favorable nicotine scores than heterosexual female individuals. Bisexual female individuals had less favorable body mass index scores (B = -7.47; 95% CI, -12.89 to -1.97) and lower cumulative ideal CVH scores (B = -2.59; 95% CI, -4.84 to -0.33) than heterosexual female individuals. Compared with heterosexual male individuals, gay male individuals had less favorable nicotine scores (B = -11.43; 95% CI, -21.87 to -0.99) but more favorable diet (B = 9.65; 95% CI, 2.38-16.92), body mass index (B = 9.75; 95% CI, 1.25-18.25), and glycemic status scores (B = 5.28; 95% CI, 0.59-9.97). Bisexual male individuals were twice as likely as heterosexual male individuals to report a diagnosis of hypertension (adjusted odds ratio [aOR], 1.98; 95% CI, 1.10-3.56) and use of antihypertensive medication (aOR, 2.20; 95% CI, 1.12-4.32). No differences in CVH were found between participants who reported their sexual identity as something else and heterosexual participants. Results of this cross-sectional study suggest that bisexual female individuals had worse cumulative CVH scores than heterosexual female individuals, whereas gay male individuals generally had better CVH than heterosexual male individuals. There is a need for tailored interventions to improve the CVH of sexual minority adults, particularly bisexual female individuals. Future longitudinal research is needed to examine factors that might contribute to CVH disparities among bisexual female individuals.

Abstract WP189: Association Between Neighborhood Socioeconomic Characteristics, Cardiovascular Health, And Incidence Of Stroke

Introduction: Social and environment factors are associated with increased stroke risk. It is unclear if favorable cardiovascular health may attenuate this risk. We evaluated the impact of neighborhood socioeconomic characteristics on stroke incidence, and if levels of cardiovascular health modify this relationship. Methods: We conducted a longitudinal cohort study of Black and White participants using data from the Reasons for Geographic and Racial Differences in Stroke. We included all stroke-free participants and geocoded their home addresses to the census-tract level. Our primary exposure was neighborhood socioeconomic condition index (nSES; in quartiles) constructed using data from the U.S. Census on income, education, and occupation of residents by census tract. We evaluated cardiovascular health based on the American Heart Association’s Life Simple 7 (ideal, adequate, inadequate). We used a Cox proportional hazards model to regress nSES and its interaction with Life Simple 7 on stroke incidence, adjusting for individual demographics, socioeconomic status, and clinical characteristics. Results: We included 26,941 adults with a mean follow-up of 11.6 years (SD ± 5.2). During the study, 1,596 (5.9%) participants had a first incidence of stroke. Participants within the lowest nSES quartile, compared to those in the highest, were more likely to be Black, have lower household income, and an inadequate Life Simple 7 score. In multivariable models, there was a non-significant increased incidence of stroke (HR-1.13; 95% CI: 0.95-1.35) between the lowest and highest nSES quartiles. The interaction between nSES and Life Simple 7 was also non-significant for stroke incidence with worse cardiovascular health across all quartiles. Discussion: Among a national cohort of Black and White adults, we found a non-significant difference in stroke incidence between adults who live in worse neighborhood socioeconomic conditions and have inadequate cardiovascular health. Characterizing the potential contribution of social, environmental, and health behaviors could inform clinical and public health strategies to mitigate stroke risk.

Associations between life's simple 7 and incident depression among adults aged 50 years and older: A 15-year cohort study

This study aimed to examine association of Life's Simple 7 (LS7), an estimation of cardiovascular health status, with depression and the modification by genetic risk. Longitudinal analysis was conducted on participants aged 50 years and older in the English Longitudinal Study of Ageing (ELSA) (Waves 2 to 9). Cardiovascular health status was assessed by the LS7 which contains four health behaviors and three biological metrics. Depression was measured by the Center for Epidemiological Studies-Depression scale (CES-D). Associations of LS7 and its components with incident depression were estimated with Cox regression model adjusting for multiple covariates. Among 3231 participants, higher LS7 scores were associated with decreased risks of incident depression. Improvements in healthy behaviors (BMI, smoking, and physical activity) and blood glucose status presented inverse associations with depression. However, increased risk of depression was found among participants who had a better control of total cholesterol. In addition, the LS7-depression association was stronger among participants with high genetic risk compared to those with low genetic risk. Our findings indicated that favorable cardiovascular health, especially healthy behaviors, were associated with lower risk of depression. Higher LS7 scores were inversely associated with depression, especially among participants with high genetic risk.

Impact of cardiovascular health and genetic risk on coronary artery disease in Chinese adults

ObjectiveTo examine whether adherence to ideal cardiovascular health (CVH) can mitigate the genetic risk of coronary artery disease (CAD) in non-European populations.MethodsFine and Grey’s models were used to calculate HRs...

The optimal pulse pressures for healthy adults with different ages and sexes correlate with cardiovascular health metrics.

Pulse pressure (PP) may play a role in the development of cardiovascular disease, and the optimal PP for different ages and sexes is unknown. In a prospective cohort, we studied subjects with favorable cardiovascular health (CVH), proposed the mean PP as the optimal PP values, and demonstrated its relationship with healthy lifestyles. Between 1996 and 2016, a total of 162,636 participants (aged 20 years or above; mean age 34.9 years; 26.4% male subjects; meeting criteria for favorable health) were recruited for a medical examination program. PP in male subjects was 45.6 ± 9.4 mmHg and increased after the age of 50 years. PP in female subjects was 41.8 ± 9.5 mmHg and increased after the age of 40 years, exceeding that of male subjects after the age of 50 years. Except for female subjects with a PP of 40-70 mmHg, PP increase correlates with both systolic blood pressure (BP) increase and diastolic BP decrease. Individuals with mean PP values are more likely to meet health metrics, including body mass index (BMI) <25 kg/m2 (chi-squared = 9.35, p<0.01 in male subjects; chi-squared = 208.79, p < 0.001 in female subjects) and BP <120/80 mmHg (chi-squared =1,300, p < 0.001 in male subjects; chi-squared =11,000, p < 0.001 in female subjects). We propose a health score (Hscore) based on the sum of five metrics (BP, BMI, being physically active, non-smoking, and healthy diet), which significantly correlates with the optimal PP. The mean PP (within ±1 standard deviation) could be proposed as the optimal PP in the adult population with favorable CVH. The relationship between health metrics and the optimal PP based on age and sex was further demonstrated to validate the Hscore.

Abstract 10014: Work-Related Stress and Ideal Cardiovascular Health: The Multi-Ethnic Study of Atherosclerosis

Background: Work-related stress is a psychosocial risk factor linked to a higher risk of adverse health outcomes, especially cardiovascular disease (CVD). However, the association between work-related stress and ideal cardiovascular health (CVH) is not well established. We examined whether work-related stress was negatively associated with favorable CVH in a multi-ethnic population of adults free of CVD at baseline. Methods: We analyzed cross-sectional data of 6,486 men and women aged 45-84 years. Work-related stress was assessed by the presence or absence of ongoing job difficulty and ongoing job difficulty for &gt;6 months. CVH was measured by a scoring system that assigned points to 7 metrics (smoking, physical activity, body mass index, diet, total cholesterol, blood pressure and blood glucose). Each metric had 3 categories: poor (0 points), intermediate (1 point) and ideal (2 points). The total score attainable was 14 points, categorized as inadequate (0-8 points), average (9-10 points) and optimal (11-14 points). We used polytomous logistic regression to examine the association of work-related stress with the CVH score and number of ideal metrics, adjusted for sociodemographic factors. Results: The mean age (SD) was 62 (10) years and 53% were women. Ongoing job difficulty was reported by 14% of participants while 13% reported ongoing job difficulty for &gt;6 months. Participants who reported ongoing job difficulty had 21% and 24% lower odds of having average and optimal CVH scores, respectively (Table). Additionally, the presence of ongoing job difficulty for &gt;6 months was associated with 23% and 24% lower odds of having average and optimal CVH scores, respectively. A similar trend was observed for the association of work-related stress with the number of ideal metrics. Conclusion: Work-related stress was negatively associated with favorable CVH. Stress reduction and CVH promotion programs in the workplace may decrease the incidence of CVD.

Abstract 15307: Change in Cardiovascular Health, Cardiovascular Disease, and Mortality in Patients With Diabetes

Aim: To describe patterns of change in cardiovascular health (CVH) measured by the Life’s Simple 7 (LS7) over 6 years in participants with diabetes, and assess the association of these patterns of change with subsequent CVD and all-cause mortality. Methods: We conducted a long-term prospective cohort analysis (median follow-up 19 years) using the ARIC study, a community-based, biracial cohort with participants aged 45-64 years at baseline in 1987-1989. Seven markers of LS7 were collected at baseline and 6 years later: smoking, body mass index, physical activity, diet, total cholesterol, blood glucose, and blood pressure. At both time points, participants were classified as low, moderate, and favorable CVH, corresponding to presenting 0-2, 3-4, and 5-7 metrics at ideal levels. Results: The majority (62.2%) of participants with diabetes at baseline had a stable low CVH at both visits, whereas 12.1% had stable moderate and 0.4% stable favorable, 14.9% improved, and 10.5% worsened. Compared to those with stable low LS7, CVD and mortality risk was lower for those who showed improvement 6 years later, or started moderate and remained so, or even who deteriorated to low CVH. This was driven by favorable changes in blood pressure, cholesterol, physical activity and smoking. Compared to participants free of diabetes with a stable favorable CVH trajectory, participants with diabetes had a higher CVD and mortality risk regardless of their CVH trajectory. However, those with a favorable LS7 trajectory displayed the same excess risk as participants without diabetes with constantly low CVH. Conclusions: Among individuals with diabetes, maintaining or reaching ideal levels of LS7 metrics can help reduce the excess CVD incidence and mortality. A favorable CVH trajectory in people with diabetes carried approximately the same excess CVD and mortality risk than an unfavorable CVH trajectory in people free of diabetes.

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.

Association of cardiovascular health with diabetic complications, all-cause mortality, and life expectancy among people with type 2 diabetes

BackgroundWe aimed to assess the impact of healthy cardiovascular health (CVH) on diabetic complications, mortality, and life expectancy among people with type 2 diabetes and to explore whether inflammation marker mediate these associations.MethodsThis prospective cohort study included 33,236 participants (aged 40–72) with type 2 diabetes from the UK Biobank with annual follow-up from 2006 to 2010 to 2020. Type 2 diabetes was ascertained from self-report, glycated hemoglobin ≥ 6.5%, hospital inpatient registry, or glucose-lowering medication use. Information on mortality was derived from the national death registry. Favorable CVH metrics consisted of non-smoker, regular physical activity, a healthy diet, non-overweight, untreated resting blood pressure < 120/<80 mm Hg, and untreated total cholesterol < 200 mg/dL. Participants were categorized into three groups according to the number of favorable CVH metrics: unfavorable (0 or 1); intermediate (any 2 or 3); and favorable (4 or more). Inflammation marker, as measured by C-reactive protein (CRP), was assessed at baseline and categorized as low (≤ 3 mg/L) and high (> 3 mg/L). Data were analyzed using Cox regression models, flexible parametric survival models, and mediation models.ResultsDuring the follow-up (median: 11.7 years), 3133 (9.4%) cases of diabetes complications and 4701 (14.1%) deaths occurred. Compared to unfavorable CVH, favorable CVH was associated with a reduced risk of diabetes complications (HR, 0.35; 95% CI, 0.26–0.47) and all-cause mortality (HR, 0.53; 95% CI, 0.43–0.65). In participants with unfavorable CVH, life expectancy at age 45 had a significantly reduction of 7.20 (95% CI, 5.48–8.92) years compared to those with a favorable CVH. Among people with type 2 diabetes, the proportions of diabetes complications and all-cause mortality that would be reduced by promoting the favorable CVH was 61.5% and 39.1%, respectively. CRP level mediated 14.3% and 29.7% of the associations between CVH and diabetic complication and all-cause mortality, respectively.ConclusionA favorable CVH was associated with lower risk of diabetes complications and mortality risk, and was associated with a longer life expectancy among people with type 2 diabetes. This association may be in part accounted for by inflammatory processes. Our findings highlight the importance of favorable CVH for the prevention of diabetic complications and all-cause mortality among people with type 2 diabetes, and underscores the need to monitor inflammation among people with unfavorable CVH.

Effect of Social Environments on Cardiovascular Disease in the United States.

Background This study aims to examine the effect of time-variant perceived neighborhood social cohesion, perceived neighborhood physical disorder, and local crime on cardiovascular disease (CVD) incidence from 2006 through 2016. Methods and Results We obtained data from the Health & Retirement Study. Respondents aged ≥50 years and with no recorded history of CVD until 2006 (N=8826) were included and followed for 10years. Cox proportional hazards models were estimated with CVD incidence as an outcome variable and time-variant social environment factors (perceived neighborhood social cohesion, perceived neighborhood physical disorder, and local crime) as exposures, after controlling for sociodemographic factors and CVD-related risk/protective factors. Our results showed that perceived neighborhood social cohesion was associated with CVD among Black respondents, but not Hispanic and White respondents. Perceived neighborhood physical disorder and local crime rates were not associated with CVD incidence across all racial and ethnic groups. Conclusions The results demonstrate that perceptions of favorable social environments need to be considered to reduce CVD risk among Black adults. Further research is needed to identify different pathways through which living in favorable social environments benefits cardiovascular health by racial and ethnic groups.