Fuster-BEWAT Score Research Articles

Abstract P280: Understanding the Association Between Resilience Factors and Lifestyle-Based CVD Prevention Among Young Adults in Puerto Rico

Background: Recent research has identified associations between optimism and cardiovascular disease endpoints. However, other resilience factors like shift-and-persist (SP; adapting the self to stress while finding purpose in tough times), spirituality, social support, and life satisfaction have been understudied. We assessed associations among these factors and a lifestyle-based CVD metric (the Fuster BEWAT score (FBS)) and identified the strongest predictor among young adults in Puerto Rico (PR), a population with a high burden of CVD risk factors. Methods: This cross-sectional analysis used data from young adults (18-29y) who underwent survey and clinical assessments (September 2020-September 2023 ) as part of the PR-OUTLOOK study. Those with complete data were included (n=1,721; 61% female). SP was measured with the Chen scale, optimism with the Life Orientation Test-Revised-6 items scale, spirituality with the Daily Spiritual Experiences Scales, social support (from friends, family, and partner) with the Whalen scale, and life satisfaction with one item from the International Social Survey Program. Higher scores in all scales represent greater resilience and all were converted to z-scores. The FBS included blood pressure, exercise, weight, diet, and tobacco. All metrics were dichotomized as ideal (1) or non-ideal (0) and a total FBS was calculated and categorized according to the number of ideal metrics: poor (0-1), intermediate (2-3), and ideal (≥4). The intermediate and ideal groups were grouped for analysis due to small cell size. Logistic regression models assessed the association between each resilience factor and intermediate/ideal FBS (vs. poor) adjusting for socio-demographics, health insurance, and depression symptoms (Model 1), and for all other resilience factors (Model 2). Results: In the sample, 46% had a poor FBS score, 53% had an intermediate score, and 1% achieved an ideal score. In Model 1, a one standard deviation increase in SP was associated with a 21% higher odds of intermediate/ideal FBS (OR=1.21; 95% CI=1.08-1.36), while optimism, life satisfaction, and social support were associated with 17% (OR=1.17; 95% CI=1.05-1.32), 15% (OR=1.15; 95% CI=1.03-1.29), and 12% (OR=1.12; 95% CI=1.01-1.25) higher odds, respectively. Upon adjusting for all resilience factors (Model 2), only SP remained significantly associated with intermediate/ideal FBS (OR=1.17, 95% CI=1.01-1.35). Conclusion: While optimism, life satisfaction, and social support demonstrated initial associations with better FBS scores, SP emerged as the most significant resilience factor predicting FBS. If confirmed with longitudinal studies, SP could be an important target for future studies of CVD prevention interventions.

Association of cardiovascular health and risk prediction algorithms with subclinical atherosclerosis identified by carotid ultrasound

The requirement for laboratory tests to assess conventional cardiovascular disease (CVD) risk may be a barrier to the early detection and management of atherosclerosis in some population groups. A simpler risk assessment could facilitate detection of CVD. The association of the Fuster-BEWAT Score (FBS), Framingham Risk Score (FRS), and Pooled Cohort Equation (PCE) with the presence of carotid plaque was investigated, with the intention of developing a stepped screening process for the primary prevention of CVD. Asymptomatic participants with a family history of premature CVD had an absolute cardiovascular disease risk (ACVDR) score calculated using the FBS, FRS, and PCE risk equations. This risk classification was compared with the presence or absence of carotid plaque on ultrasound. Prediction of carotid plaque presence by risk scores and risk factors was assessed by logistic regression and area under the curve (AUC) for discrimination and diagnostic performance. A classification and regression-tree (CART) model was obtained for stratification of risk assessment. Risk score calculation and ultrasound scanning were performed in 1031 participants, of whom 51 had carotid plaques. Participants with plaque and male sex showed higher risk (higher PCE and FRS and lower FBS, as higher scores of FBS indicate better cardiovascular health). Participants ≤50 years of age showed the FBS was a significant predictor; there was a reduced likelihood of plaque presence with a higher score (OR 0.54, 95% CI 0.39-0.75, P < .01). Higher ACVDR (evidenced by higher PCE and FRS scores and lower FBS score) was associated with an increased likelihood of carotid plaque; however, the FBS and the addition of risk factors not included in the equation showed the highest AUC (AUC = 0.76, P < .001). CART modeling showed that participants with FBS between 6 and 9 would be recommended for further risk stratification using the PCE, whereupon a PCE score ≥5% conferred an increased risk and greater possibility for plaque. Validation of the model using a different cohort showed similar risk stratification for plaque presence according to level of risk by CART analysis. FBS was able to identify the presence of carotid plaque in asymptomatic individuals. Its use for initial risk delineation might improve the selection of patients for more specific and complex assessment, reducing cost and time.

Use of clinical scores in young Australian adults for prediction of atherosclerosis in middle age

We sought to apply a simple cardiovascular health tool not requiring laboratory tests (the Fuster-BEWAT score, FBS) to predict subclinical atherosclerosis. This study included 2657 young adults (< 40 years of age). In the prognostic group (n = 894, followed for 13 years until aged 40–50 years at follow-up), the primary outcome was presence of carotid plaque measured by carotid ultrasound at follow-up. Of these 894 participants, 86 (9.6%) had unilateral, and 23 participants (2.6%) had bilateral, carotid plaques at follow-up. The baseline FBS was predictive of carotid plaque at follow-up [odds ratio OR = 0.86 (95% CI 0.77–0.96) per 1-SD increase in FBS], similar to prediction from Pooled Cohort Equation [PCE, OR = 0.72 (0.61–0.85) per 1-SD decrease in PCE]. Risk scores at baseline predicted outcomes more strongly than those at follow-up, and did so independently of any changes over 13 years of follow-up. Similar discrimination for predicting carotid plaque after 13 years was found for both baseline FBS [C-statistic = 0.68 (95% CI 0.62–0.74)] and PCE [C-statistic = 0.69 (95% CI 0.63–0.75)]. Application of this FBS prognostic information to a contemporary cohort of 1763 young adults anticipates the future development of plaque in 305 (17.3%), especially in the 1494 participants (85%) with ≤ 2 metrics of ideal health. In conclusions, FBS measured in young adulthood predicted atherosclerosis 13 years later in middle age, independent of score changes over the follow-up period, emphasizing the importance of early damage to vascular health. FBS may be a simple and feasible risk score for engaging low-risk young people with reduction of future cardiovascular risk.

Effects of a comprehensive lifestyle intervention on cardiovascular health: the TANSNIP-PESA trial.

AimsTo investigate the effectiveness of a 3-year worksite lifestyle intervention on cardiovascular metrics and to study whether outcomes are influenced by baseline subclinical atherosclerosis (SA) by non-invasive imaging.Methods and resultsA randomized controlled trial was performed to compare a lifestyle intervention with standard of care in asymptomatic middle-aged subjects, stratified by SA. The intervention consisted of nine motivational interviews during the first year, followed by three further sessions between Years 1 and 3. The primary outcome was the change in a pre-specified adaptation of the Fuster-BEWAT score (Blood pressure, Exercise, Weight, Alimentation, and Tobacco) between baseline and follow-up Years 1–3. A total of 1020 participants (mean age 50 ± 4 years) were enrolled, of whom 510 were randomly assigned to the intervention and 510 to the control group. The baseline adapted Fuster-BEWAT score was 16.2 ± 3.7 points in the intervention group and 16.5 ± 3.5 points in the control group. At Year 1, the score improved significantly in intervention participants compared with controls [estimate 0.83 (95% CI 0.52–1.15) points]. However, intervention effectiveness decreased to non-significant levels at Year 3 [0.24 (95% CI –0.10 to 0.59) points]. Over the 3-year period, the intervention was effective in participants having low baseline SA [0.61 (95% CI 0.30–0.93) points] but not in those with high baseline SA [0.19 (95% CI –0.26 to 0.64) points].ConclusionIn middle-aged asymptomatic adults, a lifestyle intervention was associated with a significant improvement in cardiovascular health and behavioural metrics. The effect attenuated after 1 year as the intensity of the intervention was reduced.Trial registrationClinicalTrials.gov (NCT02561065).

Burnout and Cardiovascular Risk in Healthcare Professionals During the COVID-19 Pandemic.

IntroductionThe objective of this study was to investigate the psychosocial and cardiovascular markers in healthcare professionals during the COVID-19 pandemic.MethodsThis was a STROBE compliant, blended exploratory study. Residents, staff physicians, nurses, and auxiliary healthcare professionals from both inpatient and outpatient medicine services were recruited using a planned random probability sample. The Maslach Burnout Inventory (MBI), Fuster-BEWAT score (FBS), and socio-demographic factors, as well as sleep quality, were studied. The correlations between burnout severity and cardiovascular risk were examined using multivariable linear regression models adjusted for confounding variables, such as sociodemographic and anthropometric characteristics.ResultsThe regression analysis with FBS as the outcome showed a negative association between cardiovascular health and emotional exhaustion [Coef.(95%CI): −0.029 (−0.048, −0.01), p = 0.002]. The higher the emotional exhaustion the lower the cardiovascular health. Further, the model showed a positive association between personal accomplishment and cardiovascular health [Coef.(95%CI): 0.045 (0.007, 0.082), p = 0.02]. Emotional exhaustion was significantly positive correlated with REM sleep and light average (Spearman’s rank correlation: 0.37 and 0.35, respectively, with P < 0.05).ConclusionThe data from this study show that healthcare practitioners who are with burnout and emotional exhaustion have an elevated cardiovascular risk, however, causality cannot be determined. As an adaptive response to stressful situations, REM sleep increases. The findings of this study may be relevant in creating preventive strategies for burnout and cardiovascular risk reduction or prevention.Clinical Trial Registration[www.ClinicalTrials.gov], identifier [NCT04422418].

Prediction of future atherosclerosis in 13 years from young asymptomatic adults

Abstract Aim To compare the Pooled Cohort Equation (PCE) and Ideal Cardiovascular Health Score (ICHS) with a simpler cardiovascular risk score not requiring laboratory tests (the Fuster-BEWAT score, FBS) in predicting the presence and extent of subclinical atherosclerosis 13 years later. Methods Data included 894 adults (48% male) who were aged 26–36 years at baseline and 40–50 years at follow-up. The primary outcome was the presence of carotid plaque measured by ultrasound at follow-up. Secondary outcomes were number of arteries affected, plaque thickness and plaque area. All three scores were calculated at both baseline and follow-up. Results At follow-up, 86 participants (9.6%) had unilateral carotid plaques and 23 participants (2.6%) had bilateral carotid plaques. At baseline, all three scores were predictive of the presence of carotid plaque at follow-up (PCE odds ratio (OR) = 1.42 [95% CI: 1.19–1.70], ICHS OR=0.87 [0.77–0.99], FBS OR=0.86 [95% CI: 0.77–0.96]) and all secondary outcomes. All baseline scores predicted outcomes more strongly than those at follow-up, and did so independent of any changes over 13 years of follow-up. Similar levels of discriminatory power were found for all three baseline scores in predicting the presence of carotid plaque after 13 years (PCE C-statistic = 0.69 [95% CI: 0.63–0.75], ICHS C-statistic = 0.67 [95% CI: 0.61–0.74] and FBS C-statistic = 0.68 [95% CI: 0.62–0.74]) Conclusions All baseline scores predicted subclinical atherosclerosis 13 years later. The similar discrimination of the scores highlights the benefit of using FBS as a simpler and more feasible risk score for predicting future cardiovascular risk in low-risk young people. Funding Acknowledgement Type of funding sources: None.

The challenge of sustainability: Long-term results from the Fifty-Fifty peer group-based intervention in cardiovascular risk factors

The Fifty-Fifty trial demonstrated that a peer-group-based intervention was able to improve healthy behaviors in individuals with cardiovascular (CV) risk factors immediately post-intervention. To determine the long-term sustainability of a one-year peer-group-based intervention focused on CV health and behavior. A total of 543 adults aged 25 to 50 years with at least 1 CV risk factor were screened and recruited, received initial training through workshops, and were then randomized 1:1 to a peer-group-based intervention group (IG) or a self-management control group (CG) for 12 months. At a median of 52 months from baseline, 321 participants were re-assessed (~60% retention). The primary outcome was the mean change in a composite health score related to blood pressure, exercise, weight, alimentation, and tobacco use (Fuster-BEWAT score [FBS], range 0-15). Intervention effects were assessed using linear-mixed effects models. The mean age of retained participants was 48.0 years (SD: 5.4), and 73% were female. Consistent with previous results, the change of overall FBS was significantly greater in the IG than in the CG at 12-month follow-up (between-group difference, 0.60 points; 95% CI, 0.08-1.12; P=.025). Assessment of long-term sustainability (52-month follow-up) showed that there were no between-group differences in the mean overall FBS (IG mean score, 8.52; 95% CI, 7.97-9.07 vs CG mean score, 8.51; 95% CI, 7.93-9.10; P=.972) or in the change of overall FBS from screening (IG mean change, 0.64; 95% CI, 0.00-1.28; CG mean change, 0.46; 95% CI, -0.20-1.12; P=.497). A one-year peer-group-based intervention showed favorable results at immediate post-intervention but did not demonstrate significant differences between the IG and CG at 52 months. Combination of an initial training period (workshops) with the maintenance of peer-support groups or other re-intervention strategies may be required to achieve sustained effects on healthy behaviors. ClinicalTrials.gov identifier NCT02367963. Registered (https://clinicaltrials.gov/show/NCT02367963).

Association of a favorable cardiovascular health profile (Life"s Simple 7 and Fuster-BEWAT scores) with the presence of a newly proposed 4-tiered left ventricular hypertrophy

Abstract Funding Acknowledgements Type of funding sources: None. Background AHA"s Life"s Simple 7 cardiovascular health score is recommended for use in primary prevention. Simpler tools not requiring laboratory tests, such as the Fuster-BEWAT score (FBS) (blood pressure [B], exercise [E], weight [W], alimentation [A], and tobacco [T]), are also available. Purpose This study sought to compare the effectiveness of Life"s Simple 7 and FBS in predicting the newly proposed 4-tiered left ventricular hypertrophy (LVH) classification based on LV dilatation (high LV end-diastolic volume [EDV] index) and concentricity (mass/end-diastolic volume [M/EDV]0.67) in the general Chinese population. Methods Participants from Northeast China Rural Cardiovascular Health study who underwent cardiac echocardiography (n = 11,261) were enrolled. Patients with LVH were divided into 4 groups—eccentric nondilated (normal M/EDV and EDV), eccentric dilated (increased EDV, normal M/EDV), concentric nondilated (increased M/EDV, normal EDV), and concentric dilated (increased M/EDV and EDV)—and compared with patients with normal LVM. Results With poor Life"s Simple 7 and FBS as references, individuals with ideal Life"s Simple 7 and FBS showed lower adjusted odds of having eccentric nondilated (Life"s Simple 7, odds ratio [OR]: 0.26; 95% confidence interval [CI]: 0.20 to 0.34 vs. FBS, OR: 0.28; 95% CI: 0.20 to 0.38), eccentric dilated (OR: 0.73 [0.57-0.94] vs. OR: 0.57 [0.43-0.76]), concentric nondilated (OR: 0.12 [0.04-0.38] vs. OR: 0.19 [0.07-0.52]), and concentric dilated LVH (OR: 0.12 [0.03-0.37] vs. OR: 0.26 [0.10-0.72]). Taken together, the odds for these 4 LV geometric phenotypes decreased in a graded manner in subjects with intermediate and ideal ICHS and FBS compared with subjects with poor ICHS and FBS (p for trend &amp;lt;0.01). For the total ICHS and FBS on a continuous scale from 0 (all 7 poor) to 7 (all 7 ideal), risk reductions of the 4 distinct LVH patterns were of comparable magnitude for each 1-point increment of ICHS and FBS. Similar levels of significantly discriminating accuracy were found for Life"s Simple 7 and FBS with respect to the eccentric nondilated (C-statistic: 0.737; 95% CI: 0.725 to 0.750 vs. 0.731; 95% CI: 0.718 to 0.744, respectively), eccentric dilated (0.684 [0.670-0.699] vs. 0.686 [0.671-0.701]), concentric nondilated (0.658 [0.624-0.692] vs. 0.650 [0.615-0.684]), and concentric dilated LVH (0.711 [0.678-0.744] vs. 0.698 [0.663-0.733]). Conclusions Our findings demonstrate that the FBS appears capable of performing just as well as does the Life"s Simple 7 in predicting the novel 4-group classification of LVH, making the FBS particularly suited as a reliable low-cost indicator of CV health in settings where access to laboratory analysis is limited and health care resources are constrained. Abstract Figure.

FUSTER-BEWAT SCORE VERSUS IDEAL CARDIOVASCULAR HEALTH SCORE TO PREDICT LEFT VENTRICULAR HYPERTROPHY: DATA FROM CHINA PEACE MILLIONS PERSONS PROJECT

Abstract Objective: The Fuster-BEWAT Score (FBS) has been recently developed for use in lifestyle-based cardiovascular disease prevention, presenting similar accuracy in predicting subclinical atherosclerosis with ideal cardiovascular health score (ICHS), but it is unclear whether these scores exhibit comparable predictive values for detection of left ventricular hypertrophy (LVH). We evaluated the effectiveness of ICHS and FBS in assessing the presence of LVH among Chinese population. Design and method: A total of 3,521 participants aged 35 to 75 years with echocardiography screening in Guangdong were enrolled in the China PEACE (Patient centered Evaluative Assessment of Cardiac Events) Millions Persons Project. Subjects were grouped into three categories according to the number of favorable ICHS or FBS: ideal, intermediate, and poor. Left ventricular mass index (LVMI) was assessed by left ventricular mass divided by body surface area. LVH was defined as LVMI &gt; = 115 g/m2 in male and LVMI &gt; = 95 g/m2 in female. Results: In this study, poor ICHS accounts for 14.3% of all participants, intermediate ICHS 78.2%, and ideal ICHS 7.6%; poor FBS accounts for 4.4% of all participants, intermediate FBS 65.4%, and ideal FBS 30.2%. With poor ICHS as references, those with intermediate and ideal ICHS showed substantially lower adjusted odds of having LVH (odds ratio (OR) [95% confidence interval (CI)]: 0.643 [0.417, 0.991] and 0.346 [0.219, 0.547], respectively, with a p-value for trend &lt; 0.001). Compared with participants with poor FBS, intermediate and ideal FBS were negatively associated with the likelihood of LVH (OR [95%CI]: 0.638 [0.512, 0.796] and 0.316 [0.211, 0.473], respectively, with a p-value for trend &lt; 0.001). The Receiver Operating Characteristic Curve (ROC) indicated identical discriminating accuracy of ICHS (Area Under Curve (AUC): 0.696) and FBS (AUC: 0.702) with DeLong's test p-value 0.172 in identifying LVH. Conclusions: Both ICHS and FBS predict the presence and extent of subclinical atherosclerosis with similar accuracy, highlighting the value of the FBS as a simpler and more affordable score for evaluating the risk of LVH.

Prediction of Future Atherosclerosis From Young Adulthood

To compare the Pooled Cohort Equation (PCE) and Ideal Cardiovascular Health Score (ICHS) with a simpler cardiovascular risk score not requiring laboratory tests (the Fuster-BEWAT score, FBS) in predicting the presence and extent of subclinical atherosclerosis 13 years later.

Impact of COVID-19 Pandemic Burnout on Cardiovascular Risk in Healthcare Professionals Study Protocol: A Multicenter Exploratory Longitudinal Study.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has created new and unpredictable challenges for healthcare systems. Healthcare professionals are heavily affected by this rapidly changing situation, especially frontline healthcare professionals who are directly engaged in the diagnosis, treatment, and care of patients with COVID-19 and may experience psychological burdens. The objective of this study is to explore the evolution of psychosocial, cardiovascular, and immune markers in healthcare professionals with different levels of exposure to the COVID-19 pandemic.Methods and Analysis: This is a STROBE compliant, blended, exploratory study involving online and onsite approaches that use wearable monitoring. A planned random probability sample of residents, staff physicians, nurses, and auxiliary healthcare professionals will be recruited. The study sample will be stratified by exposure to the COVID-19 pandemic. As a first step, recruitment will be conducted online, with e-consent and using e-surveys with Maslach Burnout Inventory, Fuster-BEWAT score, and sociodemographic characteristics. Onsite visits will be planned for the second step where participants will receive a wearable setup that will measure heart rate, actimetry, and sleep quality monitoring, which will be used together with blood sampling for immune biomarkers. Steps 1 and 2 will then be repeated at 2–3 months, and 6 months. Power BI and Tableau will be used for data visualization, while front-end data capture will be used for data collection using specific survey/questionnaires, which will enable data linkage between e-surveys, internet of things wearable devices, and clinical laboratory data.Clinical Trial Registration: ClinicalTrials.gov; Identifier: NCT04422418

Fuster-BEWAT score versus cardiovascular health score to predict subclinical target organ damage: Insights from a large-scale Asian population.

Fuster-BEWAT score versus cardiovascular health score to predict subclinical target organ damage: Insights from a large-scale Asian population.

Fuster-BEWAT score versus American Heart Association's Life's Simple 7 To predict subclinical target organ damage: findings from a large-scale Asian population

Abstract Background The AHA's Life's Simple 7 score is recommended for use in primordial prevention. Simpler tools not requiring laboratory tests, such as the Fuster-BEWAT score (FBS) (blood pressure [B], exercise [E], weight [W], alimentation [A], and tobacco [T]), are also available. We aimed to investigate the relationships of FBS and Life's Simple 7 with several subclinical markers of target organ damage (TOD) representing myocardial structure and function (i.e., ECG-LVH and LV diastolic dysfunction), carotid structure (i.e., carotid intima-media thickness), and vascular function (i.e., arterial stiffness) in the framework of general Chinese population. Methods The study population consisted of 11,163 community-based adults (mean age 53.9 years; 54% female) who were recruited in the NCRCH (Northeast China Rural Cardiovascular Health) study between January 2013 and August 2013. A SD + SV4 ≥2.3 mV for female subjects and ≥2.8 mV for male subjects were considered positive for LVH according to Peguero–Lo Presti criteria. Participants with LV diastolic dysfunction was defined as septal e' velocity &amp;lt;7 cm/s, average E/e' ratio&amp;gt;14, or left atrial volume index&amp;gt;34 mL/m2. Carotid intima-media thickness &amp;gt;0.9mm was assessed for the detection of carotid wall thickness. The highest tertile of pulse pressure/stroke volume indexed to height2.04 (&amp;gt;2.76 mm Hg/ml) was chosen to reflect increased arterial stiffness. Results With poor Life's Simple 7 and FBS as references, subjects with ideal Life's Simple 7 and FBS presented substantially lower adjusted odds of having ECG-LVH (OR, 0.57; 95% CI, 0.49–0.66 vs. OR, 0.54; 95% CI, 0.46–0.64), LV diastolic dysfunction (OR, 0.34 [0.26–0.45] vs. OR, 0.43 [0.33–0.57]), carotid wall thickness (OR, 0.66 [0.51–0.87] vs. OR, 0.68 [0.50–0.93]), and arterial stiffness (OR, 0.22 [0.19–0.26] vs. OR, 0.21 [0.18–0.25]). In a similar model, per each additional metric at recommended optimal level of Life's Simple 7 (0–7) and FBS (0–5) was predictive to a similar degree of reduced odds of all subclinical TOD. Similar levels of significantly discriminating accuracy were found for Life's Simple 7 and FBS with respect to ECG-LVH (Life's Simple 7: C-statistic of 0.623; FBS: C-statistic of 0.625), LV diastolic dysfunction (FBS C-statistic of 0.729; CVHS C-statistic of 0.721), carotid wall thickness (FBS: C-statistic of 0.720; Life's Simple 7: C-statistic of 0.721) and arterial stiffness (FBS: C-statistic of 0.701; Life's Simple 7: C-statistic of 0.704). Conclusions Both scores exhibited comparable discriminatory values for detection of subclinical TOD in a large sample of middle-aged adults, highlighting the potential usefulness and clinical relevance of FBS as an easy, practical, and affordable option for elucidating the impact of CV risk behaviors and factors on subclinical CVD in settings where limited access to laboratory analysis and resource-constrained health-care areas hinder the possibility of estimating CV risk. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Natural Science Foundation of China

Life's simple 7 cardiovascular health metrics versus Fuster-BEWAT score to predict the new 4-tiered left ventricular hypertrophy classification: insight from a large Asian population

Abstract Background AHA's Life's Simple 7 cardiovascular health score is recommended for use in primary prevention. Simpler tools not requiring laboratory tests, such as the Fuster-BEWAT score (FBS) (blood pressure [B], exercise [E], weight [W], alimentation [A], and tobacco [T]), are also available. This study sought to compare the effectiveness of Life's Simple 7 and FBS in predicting the newly proposed 4-tiered LVH classification based on LV dilatation (high LV end-diastolic volume [EDV] index) and concentricity (mass/end-diastolic volume [M/EDV]0.67) in the general Chinese population. Methods Participants from Northeast China Rural Cardiovascular Health study who underwent cardiac echocardiography (n=11,261) were enrolled. Patients with LVH were divided into 4 groups–eccentric nondilated (normal M/EDV and EDV), eccentric dilated (increased EDV, normal M/EDV), concentric nondilated (increased M/EDV, normal EDV), and concentric dilated (increased M/EDV and EDV)–and compared with patients with normal LVM. LVH was classified as increased LV mass when indexed to height2.7 using thresholds of≥48 g/m2.7 for men and ≥39 g/m2.7 for women. Previously defined thresholds for elevated EDV indexed to BSA (≥74 ml/m2 for men and ≥68 ml/m2 for women) and M/EDV0.67 (≥9.1 g/ml0.67 for men and ≥8.1 g/ml0.67 for women) were used. Results With poor Life's Simple 7 and FBS as references, individuals with ideal Life's Simple 7 and FBS showed lower adjusted odds of having eccentric nondilated (Life's Simple 7, odds ratio [OR]: 0.26; 95% confidence interval [CI]: 0.20 to 0.34 vs. FBS, OR: 0.28; 95% CI: 0.20 to 0.38), eccentric dilated (OR: 0.73 [0.57–0.94] vs. OR: 0.57 [0.43–0.76]), concentric nondilated (OR: 0.12 [0.04–0.38] vs. OR: 0.19 [0.07–0.52]), and concentric dilated LVH (OR: 0.12 [0.03–0.37] vs. OR: 0.26 [0.10–0.72]). For the total ICHS and FBS on a continuous scale from 0 (all 7 poor) to 7 (all 7 ideal), risk reductions of the four distinct LVH patterns were of comparable magnitude for each 1-point increment of ICHS and FBS. Similar levels of significantly discriminating accuracy were found for Life's Simple 7 and FBS with respect to the eccentric nondilated (C-statistic: 0.737; 95% CI: 0.725 to 0.750 vs. 0.731; 95% CI: 0.718 to 0.744, respectively), eccentric dilated (0.684 [0.670–0.699] vs. 0.686 [0.671–0.701]), concentric nondilated (0.658 [0.624–0.692] vs. 0.650 [0.615–0.684]), and concentric dilated LVH (0.711 [0.678–0.744] vs. 0.698 [0.663–0.733]). Conclusions Our findings demonstrate that the FBS appears capable of performing just as well as does the Life's Simple 7 in predicting the novel 4-group classification of LVH, making the FBS particularly suited as a reliable low-cost indicator of CV health in settings where access to laboratory analysis is limited and health care resources are constrained. Therefore, it may be considered the first option in settings where access to laboratory analysis is limited. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): National Natural Science Foundation of China

Abstract 277: Fuster-BEWAT Score versus American Heart Association’s Life’s Simple 7 to Predict Subclinical Target Organ Damage: Findings From a Large-scale Asian Population

Background: The AHA’s Life’s Simple 7 score is recommended for use in primordial prevention. Simpler tools not requiring laboratory tests, such as the Fuster-BEWAT score (FBS) (blood pressure [B], exercise [E], weight [W], alimentation [A], and tobacco [T]), are also available. We aimed to investigate the relationships of FBS and Life’s Simple 7 with several subclinical markers of target organ damage (TOD) representing myocardial structure and function, carotid structure, and vascular function in the framework of general Chinese population. Methods: The study population consisted of 11,163 community-based adults (mean age 53.9 years; 54% female) who were recruited in the NCRCH (Northeast China Rural Cardiovascular Health) study between January 2013 and August 2013. Results: With poor Life’s Simple 7 and FBS as references, subjects with ideal Life’s Simple 7 and FBS presented substantially lower adjusted odds of having ECG-LVH (OR, 0.57; 95% CI, 0.49-0.66 vs. OR, 0.54; 95% CI, 0.46-0.64), LV diastolic dysfunction (OR, 0.34 [0.26-0.45] vs. OR, 0.43 [0.33-0.57]), carotid wall thickness (OR, 0.66 [0.51-0.87] vs. OR, 0.68 [0.50-0.93]), and arterial stiffness (OR, 0.22 [0.19-0.26] vs. OR, 0.21 [0.18-0.25]). In a similar model, per each additional metric at recommended optimal level of Life’s Simple 7 (0-7) and FBS (0-5) was predictive to a similar degree of reduced odds of all subclinical TOD. Similar levels of significantly discriminating accuracy were found for Life’s Simple 7 and FBS with respect to ECG-LVH (Life’s Simple 7: C-statistic of 0.623; FBS: C-statistic of 0.625), LV diastolic dysfunction (FBS C-statistic of 0.729; CVHS C-statistic of 0.721), carotid wall thickness (FBS: C-statistic of 0.720; Life’s Simple 7: C-statistic of 0.721) and arterial stiffness (FBS: C-statistic of 0.701; Life’s Simple 7: C-statistic of 0.704). Conclusions: Both scores exhibited comparable discriminatory values for detection of subclinical TOD in a large sample of middle-aged adults, highlighting the potential usefulness and clinical relevance of FBS as an easy, practical, and affordable option for elucidating the impact of CV risk behaviors and factors on subclinical CVD in settings where limited access to laboratory analysis and resource-constrained health-care areas hinder the possibility of estimating CV risk.

Abstract 381: Life’s Simple 7 Cardiovascular Health Metrics versus Fuster-BEWAT Score to Predict the New 4-tiered Left Ventricular Hypertrophy Classification: Insight From a Large Asian-population

Background: AHA's Life's Simple 7 cardiovascular health score is recommended for use in primary prevention. Simpler tools not requiring laboratory tests, such as the Fuster-BEWAT score (FBS) (blood pressure [B], exercise [E], weight [W], alimentation [A], and tobacco [T]), are also available. This study sought to compare the effectiveness of Life's Simple 7 and FBS in predicting the newly proposed 4-tiered LVH classification based on LV dilatation (high LV end-diastolic volume [EDV] index) and concentricity (mass/end-diastolic volume [M/EDV] 0.67 ) in the general Chinese population. Methods: Participants from Northeast China Rural Cardiovascular Health study who underwent cardiac echocardiography (n=11,261) were enrolled. Patients with LVH were divided into 4 groups—eccentric nondilated (normal M/EDV and EDV), eccentric dilated (increased EDV, normal M/EDV), concentric nondilated (increased M/EDV, normal EDV), and concentric dilated (increased M/EDV and EDV)—and compared with patients with normal LVM. Results: With poor Life's Simple 7 and FBS as references, individuals with ideal Life's Simple 7 and FBS showed lower adjusted odds of having eccentric nondilated (Life's Simple 7, odds ratio [OR]: 0.26; 95% confidence interval [CI]: 0.20 to 0.34 vs. FBS, OR: 0.28; 95% CI: 0.20 to 0.38), eccentric dilated (OR: 0.73 [0.57-0.94] vs. OR: 0.57 [0.43-0.76]), concentric nondilated (OR: 0.12 [0.04-0.38] vs. OR: 0.19 [0.07-0.52]), and concentric dilated LVH (OR: 0.12 [0.03-0.37] vs. OR: 0.26 [0.10-0.72]). Similar levels of significantly discriminating accuracy were found for Life's Simple 7 and FBS with respect to the eccentric nondilated (C-statistic: 0.737; 95% CI: 0.725 to 0.750 vs. 0.731; 95% CI: 0.718 to 0.744, respectively), eccentric dilated (0.684 [0.670-0.699] vs. 0.686 [0.671-0.701]), concentric nondilated (0.658 [0.624-0.692] vs. 0.650 [0.615-0.684]), and concentric dilated LVH (0.711 [0.678-0.744] vs. 0.698 [0.663-0.733]). Conclusions: Our findings demonstrate that the FBS appears capable of performing just as well as does the Life's Simple 7 in predicting the novel 4-group classification of LVH, making the FBS particularly suited as a reliable low-cost indicator of CV health in settings where access to laboratory analysis is limited and health care resources are constrained.

Different Lifestyle Interventions in Adults From Underserved Communities: The FAMILIA Trial

BackgroundThe current trends of unhealthy lifestyle behaviors in underserved communities are disturbing. Thus, effective health promotion strategies constitute an unmet need. ObjectivesThe purpose of this study was to assess the impact of 2 different lifestyle interventions on parents/caregivers of children attending preschools in a socioeconomically disadvantaged community. MethodsThe FAMILIA (Family-Based Approach in a Minority Community Integrating Systems-Biology for Promotion of Health) study is a cluster-randomized trial involving 15 Head Start preschools in Harlem, New York. Schools, and their children’s parents/caregivers, were randomized to receive either an “individual-focused” or “peer-to-peer–based” lifestyle intervention program for 12 months or control. The primary outcome was the change from baseline to 12 months in a composite health score related to blood pressure, exercise, weight, alimentation, and tobacco (Fuster-BEWAT Score [FBS]), ranging from 0 to 15 (ideal health = 15). To assess the sustainability of the intervention, this study evaluated the change of FBS at 24 months. Main pre-specified secondary outcomes included changes in FBS subcomponents and the effect of the knowledge of presence of atherosclerosis as assessed by bilateral carotid/femoral vascular ultrasound. Mixed-effects models were used to test for intervention effects. ResultsA total of 635 parents/caregivers were enrolled: mean age 38 ± 11 years, 83% women, 57% Hispanic/Latino, 31% African American, and a baseline FBS of 9.3 ± 2.4 points. The mean within-group change in FBS from baseline to 12 months was ∼0.20 points in all groups, with no overall between-group differences. However, high-adherence participants to the intervention exhibited a greater change in FBS than their low-adherence counterparts: 0.30 points (95% confidence interval: 0.03 to 0.57; p = 0.027) versus 0.00 points (95% confidence interval: −0.43 to 0.43; p = 1.0), respectively. Furthermore, the knowledge by the participant of the presence of atherosclerosis significantly boosted the intervention effects. Similar results were sustained at 24 months. ConclusionsAlthough overall significant differences were not observed between intervention and control groups, the FAMILIA trial highlights that high adherence rates to lifestyle interventions may improve health outcomes. It also suggests a potential contributory role of the presentation of atherosclerosis pictures, providing helpful information to improve future lifestyle interventions in adults.

Grenada Heart Project–Community Health ActioN to EncouraGe healthy BEhaviors (GHP-CHANGE): A randomized control peer group–based lifestyle intervention

The incidence of cardiovascular (CV) risk factors is increasing globally, with a disproportionate burden in the low and low-middle income countries (L/LMICs). Peer support, as a low-cost lifestyle intervention, has succeeded in managing chronic illness. For global CV risk reduction, limited data exists in LMICs. The GHP-CHANGE was designed as a community-based randomized trial to test the effectiveness of peer support strategy for CV risk reduction in the island of Grenada, a LMIC. We recruited 402 adults from the Grenada Heart Project (GHP) Cohort Study of 2827 subjects with at least two CV risk factors. Subjects were randomized in a 1:1 fashion to a peer-group based intervention group (n = 206) or a self-management control group (n = 196) for 12 months. The primary outcome was the change from baseline in a composite score related to Blood pressure, Exercise, Weight, Alimentation and Tobacco (FBS, Fuster-BEWAT Score), ranging from 0 to 15 (ideal health = 15). Linear mixed-effects models were used to test for intervention effects. Participants mean age was 51.4 years (SD 14.5) years, two-thirds were female, and baseline mean FBS was 8.9 (SD 2.6) and 8.5 (SD 2.6) in the intervention and control group, respectively (P = .152). At post intervention, the mean FBS was higher in the intervention group compared to the control group [9.1 (SD 2.7) vs 8.5 (SD 2.6), P = .028]. When balancing baseline health profile, the between-group difference (intervention vs. control) in the change of FBS was 0.31 points (95% CI: -0.12 to 0.75; P = .154). The GHP-CHANGE trial showed that a peer-support lifestyle intervention program was feasible; however, it did not demonstrate a significant improvement in the FBS as compared to the control group. Further studies should assess the effects of low-cost lifestyle interventions in LMICs.

FUSTER-BEWAT SCORE VERSUS IDEAL CARDIOVASCULAR HEALTH SCORE TO PREDICT ARTERIAL STIFFNESS: IMPLICATIONS IN RURAL COMMUNITIES

The Fuster-BEWAT Score (FBS) has been recently developed for use in lifestyle-based cardiovascular disease (CVD) prevention, presenting similar accuracy in predicting subclinical atherosclerosis with ideal cardiovascular health score (ICHS), but it is unclear whether both scores exhibit comparable

Health Factors Associated with Cardiovascular Wellness

In this review, we discuss a new paradigm for atherosclerotic cardiovascular disease (ASCVD) prevention that is focused on cultivating cardiovascular wellness through the promotion of "health factors." Cardiovascular prevention efforts have contributed to falling rates of ASCVD over the past five decades. However, contemporary increases in obesity and diabetes have led to a recent slowing in the annual decline of ASCVD death rates. This slowing represents an opportunity for new thinking to change the current ASCVD prevention paradigm, i.e., the identification and treatment or control of risk factors for disease. Indeed, a new paradigm focusing on cultivating cardiovascular wellness in addition to preventing disease is gaining increased traction. With this approach, the goal of ASCVD prevention is shifting to include consideration of both treating "risk factors" and cultivating health factors. Importantly, cardiovascular wellness is more than just the absence of disease and, therefore, risk factors and health factors are not always mere opposites. We review healthy lifestyle tools such as the American Heart Association Life's simple 7 and Fuster-BEWAT score. We summarize landmark studies of interventions aimed at improving adherence to health factors. We highlight the inherent limitations of current studies to adequately examine cardiovascular wellness. We propose new study designs that are required to identify novel health factors and measures of wellness. We conclude with recommendations regarding the utility of health factors and cardiovascular wellness in current practice.