Greater Cardiovascular Health Research Articles

Abstract 13855: Epigenetic Aging Markers Mediate the Association of Life’s Essential Eight With Cardiovascular Disease and All-Cause Mortality

Background: The American Heart Association recommended Life’s Essential 8 (LE8) as a simple cardiovascular health (CVH) metric. While optimal LE8 scores are associated with greater CVH and longevity, the mechanisms underlying these associations are unclear. Objective: To characterize the associations between LE8, epigenetic age scores, CVD, and all-cause mortality. Methods: LE8 scores were calculated for 5,669 participants in the Framingham Heart Study. Mixed proportional hazard models were used to evaluate the associations between LE8 score and CVD and all-cause mortality. We conducted mediation analyses to calculate the proportion of the association between LE8 score and CVD and all-cause mortality that is mediated by DNA methylation-based epigenetic age markers (GrimAge and PhenoAge). We performed stratified mediation analyses based on median-dichotomized polygenic risk score (PRS) of epigenetic age markers. Results: Higher LE8 scores, indicating better CVH, were associated with lower risk of CVD. One standard deviation (SD) increase in LE8 score was associated with a 35% decreased risk of CVD (95% CI: 27%, 41%, p =1.8E-15). One SD increase in LE8 was also associated with a 29% decreased risk of all-cause mortality (95% CI: 22%, 35%, p =7.0E-15). These associations were partly mediated by epigenetic age: the mean proportions of mediation by GrimAge and PhenoAge were 21% and 2% ( p =0.23) for CVD and 67% and 6% for all-cause mortality, respectively. In our stratified analysis, potential mediation effects of GrimAge and PhenoAge were more profound in participants with a higher PRS. For GrimAge, the proportion of mediation for the association between LE8 and CVD was 39% (95% CI: 14%, 80%, p =8.8E-04) for participants in the upper half of higher GrimAge PRS whereas there was no significant mediation for those with low GrimAge PRS values. For the association between LE8 and all-cause mortality, the proportion of mediation by GrimAge was 81% (95% CI: 48%, 100%, p <2.0E-16) in participants with the highest GrimAge PRS and not significant for those with the lowest GrimAge PRS. Conclusion: LE8 shows a strong association with CVD and all-cause mortality. Our observations suggest that these associations are mediated in part by DNA methylation-related mechanisms.

Abstract 16232: Life’s Essential 8 Cardiovascular Health Score and Cardiorespiratory Fitness in the Community

Background: Cardiorespiratory fitness (CRF) is a key indicator of cardiovascular health (CVH) and is inversely associated with cardiovascular disease (CVD) and mortality, but its relations with lifestyle behaviors and factors linked with CVH are incompletely elucidated. Hypothesis: Greater CVH, as assessed by a score comprising lifestyle and standard risk factors, is associated with greater CRF. Aim: To evaluate the cross-sectional relations of AHA’s Life’s Essential 8 (LE8) metrics with CRF in the community. Methods: Maximal cardiopulmonary exercise tests (CPET) were performed in the Framingham Heart Study (FHS). An LE8 score was constructed for each participant by averaging scores across all LE8 components (ranging 0-100). We related CRF and other CPET measures with total LE8 score, individual LE8 components as three-level variables (optimal/suboptimal/poor), and changes in LE8 score over an ≈8 year interval. Results: In 1838 FHS participants (age 54±9 years, 54% women, BMI 28±5 kg/m 2 ), mean LE8 score was 76±12. In age- and sex-adjusted models, a higher LE8 score was associated with higher peak VO 2 , better ventilatory efficiency, lower resting heart rate, and favorable blood pressure response to exercise (p<0.0001 for all). A clinically meaningful 5-point higher LE8 score was associated with a 6.0% greater peak VO 2 (≈1.4 ml/kg/min at the sample mean). There was no evidence of effect modification by age, sex, or CVD status. The eight LE8 score components were statistically significantly associated with peak VO 2 in models adjusted for age and sex, but blood lipids, diet, and sleep health were no longer statistically significant after adjustment for all other LE8 components ( Figure ). Over an ≈8-year interval, a 5-unit increase in LE8 score was associated with a 3.7% higher peak VO 2 (p<0.0001). Conclusion: Higher LE8 score is associated with greater CRF in the community, highlighting the importance of CVH as assessed by LE8 metrics in maintaining and promoting CRF.

Blood pressure responses by fitness status following a physical activity intervention in sedentary adults

Background: Blood pressure and peak oxygen uptake (VO 2peak ) are strong independent predictors of all-cause and cardiovascular mortality. A VO 2peak of 8 METs or greater is associated with greater cardiovascular health and probability of survival, whereas individuals with a VO 2peak less than 8 METs are at greater risk for cardiovascular and all-cause mortality. Increasing physical activity in insufficiently active adults is associated with improvements in blood pressure (BP). Additionally, the relationship between an individual’s baseline VO 2peak and BP responses following a walking intervention are unknown. Therefore, we examined the change in BP in individuals stratified based on baseline VO 2peak (< 8 METs & ≥ 8 METs). We hypothesized that those with a VO 2peak < 8 METs would see greater blood pressure responses compared to those with a VO 2peak ≥ 8 METs. Methods: Cross-sectional, secondary analyses were carried out on data from a previously conducted clinical trial that included insufficiently active (as determined by accelerometry) individuals (N=518). Subjects underwent BP measurements, anthropometric testing, and a treadmill-based VO 2peak test with ventilatory gas exchange assessment to determine VO 2peak . Subjects with missing data were excluded from analyses. Additionally, only valid VO 2peak tests (≥90% age-predicted HR max , RER > 1.0) were included. Three hundred and sixty nine individuals had BP measured and met the criteria for a valid VO 2peak test. Subjects were then stratified based on baseline VO 2peak : low fit (<8 METS), and high fit (≥8 METS). Linear mixed model analyses were carried out to examine main effects (time and VO 2peak category) of the walking intervention on BP. The interaction of time and VO 2peak category was examined as well. Data are presented as means ± SD with α set at 0.05. Results: Eighty-one individuals had a VO 2peak greater than or equal to 8 METs (age = 41.9±10.0 years; BMI = 28.8±4.8; VO 2peak = 31.1±3.1 mL/kg/min; Males/Females = 55/26). Two-hundred and eighty-eight individuals had a VO2peak less than 8 METs (age = 45.9±8.6 years; BMI = 34.4±6.5; VO 2peak = 22.4±3.2 mL/kg/min; Males/Females = 75/213). There was a significant group by time interaction effect for changes in systolic BP (≥ 8 METs: Pre = 120.8±1.4, Post = 123.0±1.6 mmHg, < 8 METs: Pre = 122.1±0.7, Post = 120.4±1.0 mmHg) (p = 0.03). There was no significant effects found for DBP. Conclusions: These secondary analyses found that SBP significantly decreased following a 6-month walking intervention in individuals with low-fitness. These data suggest that those with lower baseline CRF are likely to have greater declines in SBP. Supported by NIH R01CA1989 This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

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

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

Association between Low Urban Neighborhood Greenness and Hypertensive Disorders of Pregnancy.

Urban neighborhood greenness is associated with greater cardiovascular health in the general population, and with better pregnancy and neonatal outcomes. Hypertension in pregnancy is a leading cause of maternal mortality and long-term cardiovascular morbidity and mortality in women. We sought to examine the association between greenness and hypertensive disorders of pregnancy. This study is a secondary analysis of a prospective cohort study of 1,943 women who received prenatal care from December 2013 to December 2016 at a single, urban, and tertiary academic medical center in Philadelphia, PA. Greenness measure was quantified via residential tree canopy cover within circumferential buffers of 100- and 500-meter radii around participants' homes. Associations between greenness and hypertensive disorders of pregnancy (defined as gestational hypertension or preeclampsia) were estimated by using multilevel logistic regression accounting for maternal sociodemographic information (race-ethnicity, insurance status, and age) medical history (diabetes, body mass index, smoking history, and parity), neighborhood deprivation index, and including 1,225 Philadelphia residents for whom key exposure and outcome data were available. At baseline, the participants' mean (SD) age was 27.5 (5.9) years, (range: 14-44 years). The majority of participants were non-Hispanic Black (857, 70.2%). Participants with less residential tree canopy cover were significantly more likely to have hypertensive disorders of pregnancy. The multivariable-adjusted odds ratio of hypertensive disorders of pregnancy among participants with less than 10% compared with those with greater than 30% tree canopy cover was 2.14 (95% confidence interval [CI]: 1.11-4.15) within 100-meter buffer. In our cohort, greenness was associated with lower hypertensive disorders of pregnancy odds. Our findings add to evidence that greenness may confer health benefits and warrant further investigations in identifying whether there is a causal pathway through which greenness may be protective against hypertensive disorders of pregnancy. · Low residential tree canopy is associated with increased risk of hypertensive disorders of pregnancy. · 100-meter buffers are most sensitive in identifying associations between tree canopy and HDP risk. · The role of greenness against hypertensive disorders of pregnancy should be further studied experimentally.

Abstract 31: Cardiovascular Health at Young and Middle Ages and Dementia in Older Age - The Chicago Heart Association Detection Project in Industry Study

Background: Data are sparse regarding the association of cardiovascular health (CVH) in younger/middle age with the diagnosis of dementia later in life. Methods: We used linked data from the Chicago Heart Association Detection Project in Industry Study assessed in 1967-73 with fee-for-service Medicare claims and National Death Index data from 1991-2010. Participants were ≤65 years old in 1991 and Medicare eligible during 1991-2010. Baseline CVD risk factors included blood pressure, cholesterol, BMI, smoking, and diabetes. Participants were classified into four strata: favorable levels of all factors, 0 factors high but 1+ elevated, 1 high, and ≥2 high risk factors. ICD-9 codes were used to identify date of first dementia diagnosis. We used competing Cox models to estimate hazards for dementia in Medicare data after age 65 with competing event of all-cause mortality prior to dementia diagnosis. Covariates included baseline age, race, sex, and education attainment. Results: This study included 4,273 females and 8,381 males, 10.3% Black, baseline ages 18-48. Dementia was diagnosed in 5.1% of study participants. The prevalence of dementia diagnosis increased with increasing CVH burden from 3.4% to 6.4%. During 1991-2010 in Medicare, the average time from age 65 to the first dementia diagnosis was 7.7 years. Greater CVH in younger age was associated with a reduced risk of being diagnosed with dementia in later life. Hazards ratios of experiencing dementia in those with baseline favorable levels, 0 RF high, and 1 only high RF were lower by 36%, 29%, and 28% respectively as compared to those with 2+ high-risk factors (see Table - Model 1). Similar trends were observed when deaths were treated as competing events although the association was attenuated (Model 2). Patterns were similar when stratified by sex or race. Conclusions: Having a favorable CVH profile at younger age is associated with lower risk of dementia in older age. Improvements in CVH in younger age may translate to increased independence and quality of life later in life.

Abstract P155: Cardiovascular Health at Young and Middle Ages and Medical Care Costs at Old Age

Introduction: We investigate the association between cardiovascular health at young and middle age and medical care costs and utilization in old age. Methods: We linked Chicago Heart Association (CHA) study participants’ baseline cardiovascular health (CVH) (18-59 yrs) to their Medicare claims (1991-2010) for all Part A and Part B services, including inpatient and skilled nursing facility, outpatient, home health, durable medical equipment, and hospice care. Baseline CVH is a composite measure of BP, cholesterol, diabetes, BMI, and smoking and is divided into four strata representing increasing burden. Medical care utilization (e.g., admissions and visits) and costs (in 2010 dollars) were calculated from the claims. We analyzed both the overall costs and the composition of costs among various medical care services and by CVD (non-CVD) morbidity and sex. Conditional quantile regressions were used to estimate the association between increased CVH and costs and negative binomial regressions were used for the number of inpatient admissions and outpatient visits, and the length of inpatient or hospice stay. Results: Among the 22,236 participants (222,816 person-years) 41.7% are female, 5.7% had favorable levels of all factors, 19.6% had 1+ risk factors at elevated levels, 40.9% had 1 high risk factor, and 33.7% had 2+ high risk factors. The median (mean) health care costs over the sample is $12,477 ($189,598) per person year in 2010 dollars, poorer CVH was associated with higher total medical care costs and a greater proportion of spending on home health visits (Figure). A greater CVH burden was associated with greater utilization and length of stay. Individuals with 2+ high risk factors on average have 0.22 more inpatient admissions per year and their inpatient stay is almost 2.91 days longer per year than individuals with favorable CVH. Conclusion: Unfavorable CVH early in life is associated with higher medical care cost burden in old age. Future interventions to improve CVH may result in reduced healthcare costs and utilization.

Abstract P194: Association of First Birth with Long-term Trajectories of Cardiovascular Health: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Background: Pregnancy is the first major physiologic stress women will experience that may exacerbate cardiovascular risk factors. Little is known about how pregnancy impacts cardiovascular health (CVH), as defined by the AHA. We examined the effects of a first birth on trajectories of CVH in a community-based sample of biracial women. Methods: CARDIA is a longitudinal study of 5,115 black and white adults aged 18-30 years at enrollment (1985-86). CVH was defined as poor, intermediate and ideal levels of 6 of 7 available AHA factors (BMI, physical activity, smoking, blood pressure, glucose, and cholesterol) assigned scores of 0, 1, and 2, respectively. A modified CVH score (CVHS) was calculated as the sum of scores from individual health factors (range 0-14; higher score=greater CVH). We employed latent-class modeling to identify distinct trajectories in CVHS over 25 years of follow up after first birth. Results: Among 1,775 baseline nulliparas (59.1% white), 888 first live births occurred. In women with ≥1 birth (Figure 1a) and with no births (Figure 1b) there were 6 distinct CVHS trajectories and most tracked over time. Trajectory patterns were similar between women with and without a birth, and select groups experienced a rapid decline in CVHS (Figure 1a: groups 1,2,5; 1b: groups 1,2,3). There is no statistically significant difference in likelihood of group membership based on number of births or exam year of first birth (1a). Conclusion: Contrary to expectation, CVHS trajectories through adulthood do not differ markedly between women with and without live births. Future analyses among subgroups at risk for longer adverse effects are being evaluated.

Abstract P198: Association Between Parity and Inflammation Varies by Acculturation Level Among Mexican American Women of Childbearing Age

Introduction: Parity is an independent risk factor for cardiovascular health. Its association with cardiovascular disease risk among Mexican American women is less established, even though this population currently has the highest fertility rate in the U.S. We examined the association of parity with a cardiovascular risk biomarker, C-reactive protein (CRP), among Mexican American women of childbearing age. Methods: Participants (N=1,346) were currently non-pregnant women of Mexican background, aged 16-49 years, in the National Health and Nutrition Examination Survey (NHANES) 1999-2006. The association between parity status [classified as live birth ≤ one year ago, live birth > one year ago, or nulliparous (reference group)] and elevated CRP (>3.0 mg/L) was examined using binary logistic regression. Since greater acculturation is associated with greater cardiovascular health risk among Mexican American women, an interaction between parity and acculturation was considered. Acculturation (scores 0 to 5) was defined based on nativity status, duration of residence in the U.S. (0-Mexico-born, U.S. resident < 10 years, 1-Mexico-born, U.S. resident 10-19 years, 2-Mexico-born, U.S. resident ≥20 years, 3- U.S. born), and language use at home (0-Spanish, 1-bilingual, 2-English). Scores 0-1, 2-3, 4-5 represented low, moderate, and high acculturation level, respectively. Results: The association of parity status with elevated CRP varied by acculturation level ( P for interaction = 0.01). In stratified analyses, live birth ≤ one year ago and live birth > one year ago, compared to nulliparity, was associated with higher odds of elevated CRP among women with low acculturation but not among women with moderate or high acculturation level. Additional adjustment for access to health care and lifestyle factors did not change results. Conclusions: In this cross-sectional study, parity is associated with a higher likelihood of elevated CRP in women with low acculturation.

The association between cardiovascular health and health-related quality of life and health status measures among U.S. adults: a cross-sectional study of the National Health and Nutrition Examination Surveys, 2001-2010.

BackgroundThis study was conducted to examine the association between ideal cardiovascular health (CVH) and health-related quality of life and health status indicators.MethodsThis cross-sectional study included adult NHANES participants from 2001 to 2010 without CVD (N = 7115). CVH was defined according to AHA definitions with poor, intermediate and ideal levels of the seven factors (diet, BMI, physical activity, smoking, blood pressure, glucose, and cholesterol) assigned scores of 0, 1, and 2, respectively. A CVH score (CVHS) was calculated as the sum of the scores from each individual health factor (range 0–14; higher score indicating greater CVH). CVHS was categorized as poor (0–7), intermediate (8–10), and ideal (11–14). Linear regression models examined the association between CVHS category with health status and number of unhealthy days per month, adjusted for socio-demographic characteristics and disability.ResultsAmong US adults 20–79 years, 14, 46 and 40 % had ideal, intermediate and poor CVHS, respectively. Compared to those with poor CVH, individuals in intermediate and ideal CVH were 44 and 71 % less likely to report being in fair/poor health. Participants with ideal CVH scores reported a mean of 2.4 fewer unhealthy days over the past month, including one less day in which their physical health was not good and two fewer days in which their mental health was not good.ConclusionsIdeal CVH is associated with greater overall health status and fewer physically and mentally unhealthy days.Electronic supplementary materialThe online version of this article (doi:10.1186/s12955-015-0352-z) contains supplementary material, which is available to authorized users.