Ideal Cardiovascular Health Metrics Research Articles

Association between ideal cardiovascular health and abnormal glucose metabolism in the elderly: evidence based on real-world data

BackgroundLimited information is available on the effect of ideal cardiovascular health (CVH) and abnormal glucose metabolism in elderly people. We aimed to analyze the prevalence of CVH behaviors, abnormal glucose metabolism, and their correlation in 65 and older people.MethodsIn this study, randomized cluster sampling, multivariate logistic regression, and mediating effects analysis were used. Recruiting was carried out between January 2020 and December 2020, and 1984 participants aged 65 years or older completed the study.ResultsThe prevalence of abnormal glucose metabolism in this group was 26.7% (n = 529), among which the prevalence of impaired fasting glucose (IFG) was 9.5% (male vs. female: 8.7% vs 10.1%, P = 0.338), and the prevalence of type 2 diabetes mellitus (T2DM) was 19.0% (male vs. female: 17.8 vs. 19.8%, P = 0.256). The ideal CVH rate (number of ideal CVH metrics ≥ 5) was only 21.0%. The risk of IFG and T2DM decreased by 23% and 20% with each increase in one ideal CVH metrics, with OR (95%CI) of 0.77(0.65–0.92) and 0.80(0.71–0.90), respectively (P-trend < 0.001). TyG fully mediated the ideal CVH and the incidence of T2DM, and its mediating effect OR (95%CI) was 0.88(0.84–0.91).ConclusionsEach increase in an ideal CVH measure may effectively reduce the risk of abnormal glucose metabolism by more than 20%.

Trends in cardiovascular health metrics and associations with long-term mortality among US adults with coronary heart disease

Background and aimsOur study examined the trends of cardiovascular health metrics in individuals with coronary heart disease (CHD) and their associations with all-cause and cardiovascular disease mortality in the US. Methods and resultsThe cohort study was conducted based on the National Health and Nutrition Examination Survey 1999–2018 and their linked mortality files (through 2019). Baseline CHD was defined as a composite of self-reported doctor-diagnosed coronary heart disease, myocardial infarction, and angina pectoris. Cardiovascular health metrics were assessed according to the American Heart Association recommendations. Long-term all-cause and cardiovascular disease mortality were the primary outcomes. Survey-adjusted Cox regression models were used to estimate hazard ratios and corresponding 95% confidence intervals for the associations between cardiovascular health metrics and all-cause and cardiovascular disease mortality. The prevalence of one or fewer ideal cardiovascular health metrics increased from 14.15% to 22.79% (P < 0.001) and the prevalence of more than four ideal cardiovascular health metrics decreased from 21.65% to 15.70 % (P < 0.001) from 1999 to 2018, respectively. Compared with CHD participants with one or fewer ideal cardiovascular health metrics, those with four or more ideal cardiovascular health metrics had a 35% lower risk (hazard ratio, 0.65; 95% confidence interval: 0.51, 0.82) and a 45% lower risk (0.56; 0.38, 0.84) in all-cause and cardiovascular disease mortality, respectively. ConclusionSubstantial declines were noted in ideal cardiovascular health metrics in US adults with CHD. A higher number of cardiovascular health metrics was associated with lower all-cause and cardiovascular disease mortality in them.

Association of cardiovascular health and educational status in a screening cohort.

The global burden of chronic diseases, including cardiovascular disease, remains a significant public health challenge. The Life's Simple 7 (LS7) score was developed as a tool to evaluate cardiovascular health behaviours and habits and identify high-risk individuals. The present study aimed to assess the distribution of LS7 scores among educational strata. The study population consisted of 3,383 asymptomatic individuals screened for colorectal cancer at a single centre in Austria. We split patients into lower (n = 1,055), medium (n = 1,997), and higher (n = 331) education, based on the International Standard Classification of Education (ISCED). Cox regression models were utilized to determine the association between education and mortality over a median follow-up period of 7 years. Individuals with higher educational status had a significantly higher prevalence of ideal cardiovascular health metrics, as defined by the LS7 score, compared to those with medium and lower educational status: n = 94 (28%) vs. n = 347 (17%) and n = 84 (8%), respectively, (p < 0.001). In the Cox regression analysis, both medium (HR = 0.61, 95% CI: 0.43-0.84, p < 0.001) and higher educational status (HR = 0.44, 95% CI: 0.19-1.01, p = 0.06) were associated with all-cause mortality, as was the LS7. Our findings highlight a significant association between lower educational status and poorer cardiovascular health, as assessed by LS7, which persisted even after multivariable adjustment. Additionally, both educational status and LS7 were associated with increased mortality, underscoring the significance of our results. These findings have important implications for public health, as screening and prevention strategies may need to be tailored to meet the diverse educational backgrounds of individuals, given the higher prevalence of unhealthy lifestyle behaviours among those with lower educational status.

Association between the American Heart Association’s new “Life’s Essential 8” metrics and kidney stone

PurposeThe incidence of kidney stone disease has increased worldwide, resulting in high medical costs and social burden. Kidney stone disease shares some common features with the risk factors of cardiovascular diseases (CVDs). We investigated the association between cardiovascular health (CVH) based on the Life’s Essential 8 (LE8) score developed by the American Heart Association and the incidence of kidney stone disease.MethodsWe analyzed the data of 29,469 US adults aged 20 years or above from the National Health and Nutrition Examination Survey, 2007–2018. According to the LE8 score, CVH was divided into three categories: poor, intermediate, and ideal. Logistic regression was used to determine the association between CVH and the incidence of kidney stone disease by estimating odds ratios (ORs) and 95% confidence intervals (CIs).ResultsThe average age of the participants was 48.6 years, and 50% of the participants were women. The numbers of participants with poor, intermediate, and ideal CVH were 4149, 19,782, and 5538, respectively. After adjusting for related confounding factors, ideal CVH was associated with a reduction in the odds of kidney stone occurrence as compared to poor CVH (adjusted OR [aOR]: 0.45, 95% CI: 0.35–0.57, p < 0.001). Moreover, if the ideal CVH metrics was ≥ 6, the odds of kidney stone occurrence decreased by up to 61% (aOR: 0.39, 95% CI: 0.30–0.51).ConclusionsIn the present study, ideal CVH, a factor indicative of a healthy lifestyle, was associated with lower odds of kidney stone occurrence.

Birth weight, ideal cardiovascular health metrics in adulthood, and incident cardiovascular disease.

Prenatal and postnatal factors may have joint effects on cardiovascular health, and we aimed to assess the joint association of birth weight and ideal cardiovascular health metrics (ICVHMs) prospectively in adulthood with incident cardiovascular disease (CVD). In the UK Biobank, 227,833 participants with data on ICVHM components and birth weight and without CVD at baseline were included. The ICVHMs included smoking, body mass index, physical activity, diet information, total cholesterol, blood pressure, and hemoglobin A1c. The Cox proportional hazards model was used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) in men and women. Over a median follow-up period of 13.0years (2,831,236 person-years), we documented 17,477 patients with incident CVD. Compared with participants with birth weights of 2.5-4.0kg, the HRs [95% CIs] of CVD among those with low birth weights was 1.08 (1.00-1.16) in men and 1.23 (95% CI: 1.16-1.31) in women. The association between having a birth weight <2.5kg and CVD risk in men was more prominent for those aged <50years than for those of older age (P for interaction=0.026). Lower birth weight and non-ideal cardiovascular health metrics were jointly related to an increased risk of CVD. Participants with birth weights <2.5kg and ICVHMs score 0-1 had the highest risk of incident CVD (HR [95% CI]: 3.93 [3.01-5.13] in men; 4.24 [3.33-5.40] in women). The joint effect (HR [95% CI]: 1.36 [1.17-1.58]) could be decomposed into 24.7% (95% CI: 15.0-34.4%) for a lower birth weight, 64.7% (95% CI: 56.7-72.6%) for a lower ICVHM score, and 10.6% (95% CI: 2.7-18.6%) for their additive interaction in women. Birth weight and ICVHMs were jointly related to CVD risk. Attaining a normal birth weight and ideal ICVHMs may reduce the risk of CVD, and a simultaneous improvement of both prenatal and postnatal factors could further prevent additional cases in women.

Association of the combination of obstructive sleep apnea risk and sleep duration with ideal cardiovascular health metrics in patients undergoing hemodialysis

BackgroundThe purpose of this study was to explore the separate and combined associations of obstructive sleep apnea (OSA) risk and sleep duration with ideal cardiovascular health metrics in hemodialysis (HD) patients.Methods470 HD participants (average: 59.48 ± 12.89 y, 281 men) were included in this study. Sleep duration was measured as self-reported average sleep time during the previous month. The OSA risk was assessed using the STOP-BANG questionnaire. Participants were divided into three groups based on the number of ideal cardiovascular health (CVH) metrics: 0–2,3–4, and 5–7. Ordinal logistic regression was conducted to model the associations of CVH metrics with sleep duration, OSA risk, and their combined effects by adjusting for specific covariates.ResultsAfter adjusting for covariates, short sleep duration (< 7 h) (OR = 0.53; 95% CI [ 0.30, 0.92]) and OSA risk (OR = 0.58; 95% CI [0.32, 0.83]) were negatively associated with better CVH (ideal vs. intermediate; intermediate vs. poor), respectively. For HD patients with both short sleep duration and OSA risk, the odds of ideal CVH metrics were reduced by 72% (odds ratio 0.28 [95% CI 0.13, 0.60]).ConclusionsShort sleep duration and OSA risk are separately and jointly associated with poor CVH in hemodialysis patients. Suitable interventions for sleep may minimize the risk of developing cardiovascular disease.

Microvascular Disease, Cardiovascular Health, and Risk of Coronary Heart Disease in Type 2 Diabetes: A UK Biobank Study.

The interplay between cardiovascular health metrics (CVHMs) and microvascular disease (MVD) in relation to the risk of incident coronary heart disease (CHD) among individuals with type 2 diabetes mellitus (T2DM) remains to be evaluated. To investigate the role of MVD and CVHMs in the development of CHD among T2DM. We included 19,664 participants with T2DM from the UK Biobank who had data on CVH metrics (CVHMs) and were free of CHD during recruitment. CVHMs were defined based on five behavioral (body mass index, diet, sleep duration, smoking, and regular exercise) and three biological factors (glycemic control, hyperlipidemia, and hypertension). MVD was defined as the presence of retinopathy, peripheral neuropathy, and chronic kidney disease. HR and 95% CI of CHD were estimated by multivariable Cox regression models. There were 3,252 incident cases of CHD recorded after a median follow-up of 12.3 years. After multivariable adjustment, each MVD was separately associated with risk of CHD, and those who had 1 or ≥2 MVD had a 27% and an 87% increased risk of developing CHD, respectively. Each of the unfavorable CVHMs was associated with a higher risk of CHD. As compared with MVD-free participants who had ideal CVHMs, those who had ≥2 MVD and had poor CVHMs were at particularly high risk of incident CHD (HR=4.58; 95% CI: 3.58, 5.86), similarly when considering behavioral CVH or biological CVH separately. On an additive scale, there was a positive statistically significant interaction between number of MVD and CVHMs. Coexistence of multiple MVDs was associated with a substantially higher risk of CHD among individuals with T2DM. Such an association may be amplified by unfavorable CVHMs.

Association between the trajectory of ideal cardiovascular health metrics and incident chronic kidney disease among 27,635 older adults in northern China–a prospective cohort study

BackgroundThere is a lack of relevant studies evaluating the long-term impact of cardiovascular health factor (CVH) metrics on chronic kidney disease (CKD).ObjectiveThis study investigates the long-term change in CVH metrics in older people and explores the relationship between CVH metrics trajectory and CKD.MethodsIn total, 27,635 older people aged over 60 from the community-based Tianjin Chronic Kidney Disease Cohort study were enrolled. The participants completed five annual physical examinations between January 01, 2014, and December 31, 2018, and a subsequent follow-up between January 01, 2019, and December 31, 2021. CVH metrics trajectories were established by the group-based trajectory model to predict CKD risk. The relationships between baseline CVH, CVH change (ΔCVH), and CKD risk were also explored by logistic regression and restricted cubic spline regression model. In addition, likelihood ratio tests were used to compare the goodness of fit of the different models.ResultsSix distinct CVH metrics trajectories were identified among the participants: low-stable (11.19%), low-medium-stable (30.58%), medium-stable (30.54%), medium-high-decreased (5.46%), medium-high-stable (18.93%), and high-stable (3.25%). After adjustment for potential confounders, higher CVH metrics trajectory was associated with decreased risk of CKD (P for trend < 0.001). Comparing the high-stable with the low-stable group, the risk of CKD decreased by 46%. All sensitivity analyses, including adjusting for baseline CVH and removing each CVH component from the total CVH, produced consistent results. Furthermore, the likelihood ratio test revealed that the model established by the CVH trajectory fit better than the baseline CVH and Δ CVH.ConclusionThe higher CVH metrics trajectory and improvement of CVH metrics were associated with decreased risk of CKD. This study emphasized the importance of improving CVH to achieve primary prevention of CKD in older people.

Ideal cardiovascular health and risk of death in a large Swedish cohort

BackgroundIdeal cardiovascular health (CVH) can be assessed by 7 metrics: smoking, body mass index, physical activity, diet, hypertension, dyslipidemia and diabetes, proposed by the American Heart Association. We examined the association of ideal CVH metrics with risk of all-cause, CVD and non-CVD death in a large cohort.MethodsA total of 29,557 participants in the Swedish National March Cohort were included in this study. We ascertained 3,799 deaths during a median follow-up of 19 years. Cox regression models were used to estimate hazard ratios with 95% confidence intervals (95% CIs) of the association between CVH metrics with risk of death. Laplace regression was used to estimate 25th, 50th and 75th percentiles of age at death.ResultsCompared with those having 6–7 ideal CVH metrics, participants with 0–2 ideal metrics had 107% (95% CI = 46-192%) excess risk of all-cause, 224% (95% CI = 72-509%) excess risk of CVD and 108% (31-231%) excess risk of non-CVD death. The median age at death among those with 6–7 vs. 0–2 ideal metrics was extended by 4.2 years for all-causes, 5.8 years for CVD and 2.9 years for non-CVD, respectively. The observed associations were stronger among females than males.ConclusionsThe strong inverse association between number of ideal CVH metrics and risk of death supports the application of the proposed seven metrics for individual risk assessment and general health promotion.

Association of ideal cardiovascular health metrics with incident low estimated glomerular filtration rate: More than a decade follow-up in the Tehran Lipid and Glucose Study (TLGS).

To evaluate the association between ideal cardiovascular health metrics (ICVHM) and incident low estimated glomerular filtration rate (eGFR) among the Iranian population. The study population included 6927 Iranian adults aged 20-65 years (2942 male) without prevalent low eGFR [i.e., eGFR < 60 ml/min/1.73 m2] and free of cardiovascular disease. The ICVHM was defined according to the 2010 American Heart Association. The multivariable Cox proportional hazards regression analysis was used to calculate the hazard ratios (HRs) of ICVHM both as continuous and categorical variables. Over the median of 12.1 years of follow-up, we found 1259 incident cases of low eGFR among the study population. In this population, ideal and intermediate categories of body mass index (BMI) and blood pressure (BP) and only the ideal category of fasting plasma glucose (FPG) significantly decreased the risk of developing low eGFR; the corresponding HRs and (95% confidence intervals) were (0.87, 0.77-0.99), (0.84, 0.76-0.99), (0.79, 0.68-0.93), (0.70, 0.60-0.83) and (0.76, 0.64-0.91). Also, one additional ICVHM was associated with a reduced risk of low eGFR for the global (0.92, 0.88-0.97) and biological cardiovascular health (0.88, 0.82-0.93) in these participants. A sensitivity analysis using the interval-censoring approach demonstrated that our method is robust, and results remained essentially unchanged. In a subgroup population with dietary data (n = 2285), we did not find the beneficial impact of having intermediate/ideal categories of nutrition status compared to its poor one on incident low eGFR. We found a strong inverse association between having higher global ICVHM with incident low eGFR among the non-elderly Iranian population; the issue is mainly attributable to normal BP, BMI, and FPG levels.

Parent-Offspring Associations of Ideal Cardiovascular Health Metrics: Findings From the 2014 to 2021 Korea National Health and Nutrition Examination Survey.

Studies have reported the strength of cardiovascular health (CVH) metrics in parent-offspring relationships. This study aimed to describe the sex-specific associations between CVH in parents and adult offspring. This study was conducted on the Korea National Health and Nutrition Examination Survey data set, which analyzed trios of mother-father-child, with the child's age from 20 to 39 years. To use the nature of sampling design, survey weighting was applied to all our analyses. Ideal CVH was defined as a cluster of at least 5 ideal individual CVH metrics. We examined the association between parents and their adult offspring regarding clustering CVH and individual CVH metrics through odds ratios and 95% CIs using multiple logistic regression with standard errors adjusted for within-family clustering. The study included 1267 married couples comprising 748 sons and 819 daughters. After adjusting for household income and offspring's sex, age, education, and alcohol consumption, an offspring with either parent attaining a nonideal CVH was 3.52 times more likely to have nonideal CVH. Fathers' nonideal CVH was significantly positively associated with the daughters' nonideal CVH. Maternal nonideal CVH was significantly positively associated with the son's nonideal CVH. When analyzing individual CVH metrics, ideal status in fathers or mothers reduced the likelihood of their offspring having a nonideal status. This cross-sectional study showed positive and differential associations of CVH and its components between parents' and offsprings' nonideal status. Our hypothesis-generating results suggest the relevance of using CVH as a composite indicator in family-centered approaches and heart-health interventions.

Cardiovascular health, sleeping duration, and risk of mortality in current and former smokers

Background and aimsTo investigate the associations of ideal cardiovascular health metrics (ICVHMs) with all-cause mortality among former and current smokers compared with never smokers. Methods and resultsA total of 378,147 participants [mean age (SD) years: 56.3 (8.1); 47.2 % men] were included from the UK Biobank cohort. The ICVHMs were combined Life's simple 7 from the American Heart Association and sleep duration time. The association was explored using COX regression models. During a median follow-up of 13.3 years, we documented 24,594 deaths. Compared with never smokers, among former smokers, the multivariable-adjusted hazard ratio (HR) for all-cause mortality was 1.82 (95%CI 1.71–1.92) for participants who had ≤2 ICVHMs and 1.03 (0.97–1.10) for participants who had ≥6 ICVHMs; among current smokers, the HRs for mortality were 2.74 (2.60–2.89) and 2.18 (1.78–2.67). The phenomenon was more pronounced among participants younger than 60 years [HR (95%CI), 1.82 (1.71–1.95) for ≤2 ICVHMs vs 1.04 (0.96–1.12) for ≥6 ICVHMs with age ≥60 years and 1.83 (1.62–2.06) vs 0.98 (0.88–1.11) with age <60 years among former smokers; 2.66 (2.49–2.85) vs 2.44 (1.84–3.24) with age ≥60 years and 2.85 (2.62–3.10) vs 1.96 (1.47–2.61) with age <60 years among current smokers]. In addition, the HR for mortality of each 1-number increment in ICVHMs was 0.87 (0.86–0.89) among former smokers and 0.91 (0.89–0.94) among current smokers. ConclusionOur findings indicated the importance of adherence to have more ICVHMs in the mortality risk among former smokers, and priority of smoking cessation in current smokers. ImplicationsStudies have found that former smokers still have higher risks of lung cancer and all-cause mortality than never-smokers. The next question is whether the effects of previous or current smoking could be ameliorated by eight ideal cardiovascular health metrics (ICVHMs). We aim to explore whether ICVHMs may counteract the risk of all-cause mortality among former and current smokers. The results showed that only former smokers with ≥6 ICVHMs exhibited a comparable risk of all-cause mortality with never smokers. Furthermore, current smokers even having ≥6 ICVHMs still exhibited a higher risk of all-cause mortality compared with never smokers.

Ideal cardiovascular health metrics have better identification of arthritis

BackgroundThis study aimed to explore the association between ideal cardiovascular health metrics (ICVHM) and arthritis (AR), as well as the interactions of various indicators in ICVHM on AR in US adults.MethodsWe involved 17,041 participants who were interviewed by NHANES from 2011 to 2018. AR included osteoarthritis or degenerative arthritis (OA), rheumatoid arthritis (RA), and psoriatic arthritis and other arthritis (Other AR). Logistic regression was applied to analyze the association between AR and ICVHM. Mixed graphical model (MGM) was used to explore the interaction between variables in ICVHM.ResultsHigher ICVHM scores had a protective effect on AR. Compared to “≤1” score, the ORs of AR in participants with 2, 3, 4, and ≥5 were 0.586, 0.472, 0.259, and 0.130, respectively. Similar results were also found in different types of AR. ICVHM has a maximum area under the curve value of 0.765 and the interaction between blood pressure and total cholesterol was 0.43.ConclusionsICVHM correlates significantly with AR and is better at identifying AR than individual indicators. ICVHM can be better improved by controlling the indicators with stronger interactions. Our findings provide guidance for promoting health factors, which have important implications for identification and prevention of AR.

Koncept i značaj idealnog kardiovaskularnog zdravlja

Cardiovascular diseases (CVD) are the leading cause of death worldwide. In 2019, 17.9 million people died from CVD which accounts for 32% of all deaths globally. The burden of CVD in a given population is related to the cardiovascular health (CVH) of that particular population. In 2010, The American Heart Association initiated a new concept of ideal CVH focused on two groups, health behavior components (smoking, body mass index, physical activity, and diet) and health components (total cholesterol, blood glucose, and blood pressure). Ideal CVH is defined as the simultaneous presence of seven ideal CVH components or "Life's Simple 7" (non-smoking, body mass index &lt;25 kg/m2 , level of physical activity up to the achievement of the set goal, diet in accordance with national recommendations, blood pressure &lt;120/80 mm Hg, total cholesterol &lt;200 mg/dL and blood glucose level &lt;100 mg/dL) in the absence of clinically manifested CVD. The prevalence of ideal CVH is low worldwide and is less than 1% in the USA, China and Spain, and the lowest values (0.02% and 0,1%) were recorded in the Republic of Srpska, Bosnia and Herzegovina and Serbia, respectively. The ideal CVH is inversely related to the incidence and mortality rates of CVD, as well as the overall mortality rates. People with a greater number of ideal CVH metrics (5, 6, and 7) are significantly less likely to suffer from CVD, ischemic heart disease and stroke, and have lower mortality from CVD, as well as lower total mortality compared to people without any or with only one ideal component of CVH. The status of CVH in the population is essential for predicting the risk of morbidity and mortality from CVD, which can be reduced by improving both health/biological and behavioral components of CVH.

The association of ideal cardiovascular health metrics and incident hypertension among an urban population of Iran: a decade follow-up in Tehran Lipid and Glucose Study.

We aimed to determine the association between ideal cardiovascular health metrics (ICVHM) and the incidence of hypertension among Iranian adults. The study population included 5409Iranian adults aged ≥20 years (2088 men) without hypertension (applying the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline) at baseline. The ICVHM was defined according to the AHA's 2020 impact goals, excluding total cholesterol was replaced by non-HDL cholesterol (non-HDL-C). Multivariable Cox proportional hazards regression analysis was done to estimate the hazard ratios (HRs) for ICVHM both as continuous and categorical variables. During a median 8.5-year follow-up, 2972 new cases of hypertension were identified (men: 1,287). Non-HDL-C < 130 mg/dL in men [HR (95% CI): 0.75(0.65-0.86)] and fasting plasma glucose(FPG) < 100 mg/dL in women[HR (95% CI): 0.79(0.64-0.97)], and among both genders, being normal/overweigth status (compared to obese) and blood pressure <120/80 mmHg were associated with a lower risk for hypertension. Additionally, in both gender, a 1-point increase in the number of global ICVHM decreased the risk of hypertension by more than 10%, and having ≥5 vs. <2 ICVHM, were associated with a lower risk of hypertension by 30% (all p values < 0.05). Applying the JNC 7 guideline, the association between ICVHM, with incident hypertension, were generally similar. Having a higher number of ICVHM was associated with a lower risk of incident hypertension, using both 2017 ACC/AHA and JNC 7 guidelines, mostly attributable to keeping the ideal status of body mass index, non-HDL-C, and FPG.

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.

Role of ideal cardiovascular health metrics in reducing risk of incident arrhythmias.

Cardiovascular health (CVH) has been proven to reduce cardiovascular disease burden and mortality, but data are lacking regarding cardiac arrhythmias. The aim of this study was to assess the association between CVH metrics and atrial fibrillation/flutter (AF), ventricular arrhythmias, and bradyarrhythmias. This study analysed data from the Atherosclerosis Risk in Communities (ARIC) cohort, with participants recruited from four different communities across the United States. Cardiovascular health metrics were scored at baseline (1987-89) following the American Heart Association's recommendations and categorized as poor, intermediate, or ideal. Arrhythmia episodes were diagnosed by International Classification of Diseases (ICD)-9 code. Adjusted associations were estimated using Cox models and event rates and population attributable fractions were calculated by CVH metrics category. The study population consisted of 13 078 participants, with 2548 AF, 1363 ventricular arrhythmias, and 706 bradyarrhythmias occurred. The adjusted hazard ratios (HRs) for ideal (vs. poor) CVH metrics were 0.59 [95% confidence interval (CI): 0.50-0.69] for AF, 0.38 (95% CI: 0.28-0.51) for ventricular arrhythmias, and 0.70 (95% CI: 0.51-0.97) for bradyarrhythmia. The risk of incident arrhythmias decreased steadily as the CVH metrics improved from 0 to 14 scores. The adjusted population attributable fractions were calculated to be 29.9% for AF, 54.4% for ventricular arrhythmias, and 21.9% for bradyarrhythmia, respectively. The association between CVH metrics and incident arrhythmias was also seen in people who remained free of coronary heart disease over the follow-up. Achieving ideal CVH metrics recommendations by AHA in midlife was associated with a lower risk of incident arrhythmias later in life.

Ideal cardiovascular health metrics and cardiovascular mortality in patients with renal insufficiency

Abstract Background With high cardiovascular mortality, the benefits of cardiovascular health (CVH) metrics to renal insufficiency populations remain unclear. Objectives To investigate ideal cardiovascular health metrics (ICVHMs) associations with cardiovascular mortality in a renal insufficiency population compared to normal individuals. Methods We analyzed data from the National Health and Nutrition Examination (NHANES) 2007–2018 Survey, with mortality follow-up through December 31st, 2019. We divided 29,682 participants into three groups based on the estimated glomerular filtration rate. CVH was updated in the latest 2022 American Heart Association recommendations. Cox regression analyses based on NHANES data were used to determine associations between ICVHMs and cardiovascular mortality in patients with renal insufficiency. Results In 29,682 participants, the mean (standard error) age ranged from 40.2 (0.2) to 71.6 (0.4) years. When compared with participants with normal renal function, participants with mild renal insufficiency who had ideal CVH reduced their risk of cardiovascular mortality (Hazard Ratio (HR) = 0.34; 95% confidence interval (CI): 0.14–0.81), while the HR for cardiovascular mortality gradually decreased from 1.47 (95% CI: 0.85–2.52) in participants who had ≤ 1 ICVHMs, to 0.30 (95% CI: 0.12–0.77) in those who had ≥ 6 ICVHMs. In participants with renal insufficiency, for each ICVHMs increment, a 25% reduction in cardiovascular mortality risk was observed (95% CI: 0.69–0.82). Conclusions More ICVHMs counteracted renal impairment harm when compared with populations with normal functions, and cardiovascular benefits increased with ICVHMs in patients with renal insufficiency.

Early adulthood weight change, midlife “Life’s essential 8” health status and risk of cardiometabolic diseases: a chinese nationwide cohort study

BackgroundThe association between weight change during early adulthood and cardiometabolic diseases remains uncertain in Chinese population. Whether the association varies with comprehensive cardiovascular health (CVH) in midlife assessed by “Life’s Essential 8” has not been characterized. We aim to examine the associations of early adulthood weight change and midlife “Life’s Essential 8” CVH status with cardiometabolic outcomes in a Chinese cohort.MethodsThe study participants were from the China Cardiometabolic Disease and Cancer Cohort (4 C) Study. This analysis included 72,610 middle-aged and older participants followed for a median of 3.6 years. At baseline, the participants recalled body weight at age 20 and 40 years, and we calculated change in weight and BMI between 20 and 40 years of age. Health behaviors information in “Life’s Essential 8” was collected by questionnaire, and health factors were measured in the study center. During follow-up, we ascertained incident cardiovascular events based on medical records, and diagnosed incident diabetes according to the American Diabetes Association 2010 criteria.Results72,610 study participants were included with a mean age of 56.0 ± 8.8 years and 29% of them were males. Weight gain of more than 10 kg between 20 and 40 years of age was associated with 22% increased risk of incident cardiovascular events (HR: 1.22; 95%CI: 1.04–1.43) and 38% increased risk of diabetes (HR: 1.38; 95%CI: 1.25–1.53) compared to stable weight. Besides, the association of weight gain more than 10 kg in early adulthood with cardiometabolic risk was even stronger in those with low CVH score in midlife (HR: 2.44; 95%CI: 2.01–2.97 for incident cardiovascular events; HR: 2.20; 95%CI: 1.90–2.55 for incident diabetes) or with few ideal cardiovascular health metrics in midlife.ConclusionsOur study indicated that weight gain in early adulthood was associated with significantly increased risk of cardiometabolic diseases. And the association could be stronger in those with poor CVH profiles in midlife. These findings confirmed the significance of weight management during early adulthood and suggested that individuals who experienced substantial weight gain in early life should be encouraged to maintain good CVH status in Chinese population.

Association of visceral fat area or BMI with arterial stiffness in ideal cardiovascular health metrics among T2DM patients.

"Obesity paradox" occurs in type 2 diabetes mellitus (T2DM) patients when body mass index (BMI) is applied to define obesity. We examined the association of visceral fat area (VFA) as an obesity measurement with arterial stiffness in seven ideal cardiovascular health metrics (ICVHMs). A total of 29 048 patients were included in the analysis from June 2017 to April 2021 in 10 sites of National Metabolic Management Centers. ICVHMs were modified from the recommendations of the American Heart Association. Brachial-ankle pulse wave velocity (BaPWV) ≥ 1400 cm/s was employed to evaluate increased arterial stiffness. Multivariate regression models were used to compare the different effects of BMI and VFA on arterial stiffness. Lower VFA was more strongly associated with low BaPWV than lower BMI when other ICVHMs were included (adjusted odds ratio [OR], 0.85 [95% confidence interval [CI], 0.80-0.90] vs OR 1.08 [95% CI, 1.00-1.17]). Multivariable-adjusted ORs for arterial stiffness were highest in patients with the VAT area VFA in the range of 150-200 cm2 (adjusted OR, 1.26 [95% CI 1.12-1.41]). Compared with participants with VAT VFA < 100 cm2 , among participants with higher VAT VFA, the OR for arterial stiffness decreased gradually from 1.89 (95% CI, 1.73-2.07) in patients who had ≤1 ICVHM to 0.39 (95% CI, 0.25-0.62) in patients who had ≥5 ICVHMs. In patients with T2DM, using VAT for anthropometric measures of obesity, VFA was more relevant to cardiovascular risk than BMI in the seven ICVHMs. For anthropometric measures of obesity in the ICVHMs to describe cardiovascular risk VFA would be more optimal than BMI.