Intermediate Cardiovascular Health Research Articles

Variations in health-related quality of life (EQ-5D) associated with cardiovascular health: a cross-sectional study of adults with diabetes in the Korean general population

ObjectivesPrevious studies on the differences in the mechanism and complications of diabetes between men and women have indicated potential sex differences in cardiovascular health, which affect health-related quality of life...

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

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

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

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

Association Between Cardiovascular Health Status and Healthcare Utilization in a Large Integrated Healthcare System

IntroductionThe American Heart Association (AHA) “Life's Simple 7” schema can be used to categorize patients’ cardiovascular health (CVH) status as Poor, Intermediate or Ideal based on smoking, body mass index (BMI), physical activity, dietary patterns, blood pressure, cholesterol, and fasting blood sugar. This study examined the association between CVH status and subsequent healthcare utilization. MethodsThis was an observational cohort study of adults from an integrated health care delivery system – Kaiser Permanente Northern California – that had outpatient care between 2013-2014. Patients were categorized by AHA CVH status: Poor, Intermediate or Ideal. Individual-level health care utilization and costs in 2015 were accumulated for each patient and compared across the 3 CVH categories and stratified by age groups. Results991,698 patients were included in the study. 194,003 (19.6%) were age 18-39, 554,129 (55.9%) age 40-64, and 243,566 (24.6%) age ≥65 years. 259,931 (26.2%) had Ideal CVH, 521,580 (52.6%) had Intermediate CVH, and 210,187 (21.2%) had Poor CVH. Healthcare utilization measured by average relative cost per patient increased monotonically across age categories (p<0.001). In addition, CVH category was inversely associated with lower cost in each age group (p<0.001). ConclusionAdults who were younger and had more ideal CVH had relatively lower health care costs across age groups. Interventions to promote better CVH may improve patient outcomes and reduce overall healthcare expenditures.

Ideal cardiovascular health and cardiovascular related events: a systematic review and meta-analysis.

The aim of this study was to systematically review and quantitatively summarise the evidence on the association between Life Simple's 7 (LS7) and multiple cardiovascular diseases (CVD) and cardiometabolic diseases (CMD). EMBASE and PubMed were searched from January 2010 to March 2022 for observational studies that investigated the association between ideal cardiovascular health (CVH) with CVD or CMD outcomes in an adult population. Two reviewers independently selected studies according to the eligibility criteria, extracted data, and evaluated risk of bias. Data were analysed with a random-effect meta-analysis. This meta-analysis included 59 studies (1,881,382 participants). Participants with ideal CVH had a considerably lower risk of a variety of CVDs and CMDs as compared to those with poor CVH, varying from 40% lower risk for atrial fibrillation (AF) (HR = 0.60 [95% CI 0.44-0.83]) to 82% lower risk for myocardial infarction (HR = 0.18 [95% CI 0.12-0.28]). Intermediate CVH was associated with 27%-57% lower risk in CVDs and CMDs compared to poor CVH, with the highest hazard for AF (HR = 0.73 [95% CI 0.59-0.91]), and the lowest hazard for peripheral arterial disease (HR = 0.43 [95% CI 0.30-0.60]). Ideal and moderate CVH were associated with a lower incidence of CVDs and CMDs than poor CVH. LS7 holds significant potential for promoting overall CVH and thereby contributing to the prevention of CVDs.

Abstract A139: Examining the association of cardiovascular health attainment with cancer screening adherence in community-dwelling Black women

Abstract Purpose of the study Cancer and cardiovascular disease are leading causes of death in the United States and share modifiable risk factors. Increasing ideal cardiovascular health indicated by the American Heart Association’s Life’s Simple 7 metrics (LS7: blood pressure, glucose, cholesterol, body mass index, physical activity, and smoking) and cancer screening adherence are both associated with reducing cancer-related mortality. However, there have been no studies to identify associations between LS7 and cancer screening adherence. It is well documented that people adopting positive health behaviors like physical activity and healthy eating have higher cancer screening adherence. Unfortunately, disparities by race exist in both engagement in health behaviors (key metrics of LS7) and cancer screening. Cancer screening disparities between Black and White women have narrowed over time; however, there are disparities in LS7 attainment by race. Here, we examined the association of LS7 attainment with screen detectable cancer (breast, cervical, and colorectal) adherence in Black women. Methods The Partnering in Negating Statistics (P.I.N.S.) for Black Women Initiative promotes health and wellness among Black women. Its community wellness events provide health education, screenings (e.g., breast, cervical, and cardiovascular health), and research participation opportunities. At P.I.N.S. events, LS7 metrics (score range 0-14) and self-reported cancer screening history were collected. The associations of LS7 with cancer screening adherence were examined using multinomial logistic regression adjusting for age, income, and education. Results In 2021 and 2022, 296 Black women participated in cardiovascular health screenings. They had a mean age of 50.1 years (SD 14.1); 66% employed; 88% insured; 69% with educational attainment ≥ college. The 166 participants with complete LS7 data had intermediate cardiovascular health with a median score of 8 [7-10]. In age adjusted models, a 1-unit increase in LS7 attainment was associated with a 45% higher odds of breast cancer screening adherence (OR 1.45, 95%CI: 1.03, 2.05; n=93), which was similar with full adjustment (OR 1.50, 95% CI: 0.95, 2.39; n=91). There was no association of LS7 attainment with cervical (OR 1.09, p=0.40; n=124) or colorectal cancer (OR 1.05, p=0.70; n=84) screening adherence. Conclusions In community-dwelling Black women, increasing LS7 attainment may increase odds of breast cancer screening adherence. Research with a larger sample is needed. Citation Format: Timiya S. Nolan, Songzhu Zhao, Amaris Williams, Guy Brock, Stephanie S. Ogonuwe, Faith Metlock, Alicia McKoy, Loletia Davis, Aldenise P. Ewing, Karen Patricia Williams, Electra D. Paskett, Joshua J. Joseph. Examining the association of cardiovascular health attainment with cancer screening adherence in community-dwelling Black women [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 A139.

Need for improvement of cardiovascular health: a clustering method to identify cardiovascular health profiles.

In France, the overall trend in the incidence of cardiovascular disease is unfavourable, especially in young subjects. This highlights the need to promote cardiovascular health by targeting the main risk factors. Social marketing campaigns to improve cardiovascular health should identify unhealthy behaviour and understand the target audience. The objective of this study was to identify poor cardiovascular health profiles in the French population using a clustering method. Subjects aged 18-74 years with no history of cardiovascular disease were included from the Esteban cross-sectional survey (2014-16). To evaluate cardiovascular health, seven items were considered as defined by the American Heart Association: blood glucose, blood cholesterol, blood pressure, body mass index, cigarette smoking, diet and physical activity. Cardiovascular health profiles were identified from these seven items by combining multiple correspondence analysis with hierarchical clustering and partitioning. A total of 1673 subjects were included in the main analysis. Five cardiovascular health profiles were identified: two profiles corresponded to subjects with poor cardiovascular health (mainly older men with a low socioeconomic status), two to subjects with intermediate cardiovascular health (one mainly comprised of young women with a low socioeconomic status and the other of young subjects with a high socioeconomic status) and one to subjects with good cardiovascular health (mainly older women). This description of cardiovascular health profiles, which led to the identification and characterization of target audiences for future population-based prevention campaigns, should be the starting point for improving cardiovascular health in the French population.

Abstract 39: Association of Cardiovascular Health With Time Lived Free of Coronary Artery Calcium

Introduction: Zero coronary artery calcium (CAC) is associated with lower risk of cardiovascular disease. More time lived without CAC may delay coronary artery disease morbidity, but prediction of when CAC will first develop is not well understood. To inform cardiovascular prevention, we evaluated how cardiovascular health (CVH) relates to time lived without CAC. Methods: In Multi-Ethnic Study of Atherosclerosis (MESA) participants with zero CAC at baseline followed up to 10 years, we used Kaplan-Meier curves to estimate restricted mean survival time since study entry lived with zero CAC, by baseline CVH per Life’s Simple 7 metrics categorized as high (score 12-14), moderate (8-11), and low (0-7), and stratified by sex and age (45-64, 65-84 years). Results: Among 3416 participants without CAC at baseline (63% female, mean age 58 [SD 9] years, mean CVH score 8.8 [2.1]), mean years lived with zero CAC was 4.9 (SD 3.5) years. Women with high CVH lived on average 6.6 (95% CI 6.4-6.8) years with zero CAC, with moderate CVH 6.2 (6.1-6.3) years with zero CAC, and with low CVH 5.6 (5.3-5.8) years with zero CAC. Men with high CVH lived on average 6.4 (5.9-6.9) years with zero CAC, with moderate CVH 6.1 (5.9-6.3) years with zero CAC, and with low CVH 5.5 (5.1-5.9) years with zero CAC (Figure A). Among participants aged 45-64 years, those with high CVH lived on average 7.4 (7.1-7.6) years with zero CAC, with moderate CVH 6.8 (6.6-6.9) years with zero CAC, and with low CVH 5.9 (5.7-6.2) years with zero CAC. Among participants aged 65-84 years, those with high CVH lived on average 5.1 (4.5-5.7) years with zero CAC, with moderate CVH 5.2 (5.0-5.4) years with zero CAC, and with low CVH 4.9 (4.6-5.2) years with zero CAC (Figure B). Conclusions: High CVH was associated with longer time lived with zero CAC in women and men. Adults aged 45-64 years with high or intermediate CVH at baseline had longer time lived with zero CAC compared with those with low CVH. Older adults had no difference in time lived with zero CAC based on CVH. Maintaining CVH in midlife may delay onset of CAC.

Abstract 03: Partnering in Negating Statistics for Black Women: A Women's Community Wellness Initiative

Background: Black Americans have the highest rate of mortality from chronic diseases (e.g., cardiovascular disease, cancer, and diabetes) among all non-indigenous races and ethnicities. Higher attainment of ideal cardiovascular health (CVH), as indicated by AHA’s Life’s Simple 7 (LS7; glucose, cholesterol, blood pressure, body mass index, diet, physical activity, smoking), and Life’s Essential 8 metrics (LE8: LS7 + sleep duration) is associated with a lower risk of mortality from chronic disease among all races and ethnicities. About 70% of health outcomes are influenced by social determinants of health (SDoH) and lifestyle behaviors. Unfortunately, Black American women are more likely to be negatively impacted by SDoH and less likely to engage in healthy lifestyle behaviors than their White counterparts. The Partnering in Negating Statistics (P.I.N.S.) for Black Women Initiative began in 2021 to educate, provide access to resources, and partner in science toward promoting health and wellness among Black women. Herein described is the commencement of the P.I.N.S. Initiative through community-based wellness events and community-dwelling Black women’s attainment of LS7 and LE8. Methods: The P.I.N.S. Initiative capitalized on engagement of academic-community-government partnerships to plan and implement community-based wellness events for Black women. Large signature events boasted opportunities to participate in education, screenings (e.g., mammograms, pap smears, and LS7/LE8 screening), and research. In addition to capture of screening data, event feasibility was assessed via a program evaluation at signature events in August 2021 and 2022. Descriptive statistics (quantitative data) and thematic content analysis (qualitative data) were performed. Results: Community-based wellness events boasted high feasibility in the areas of demand and acceptability. Five hundred Black women attended the events, completing a total of 30 mammograms, 24 pap smears, and 418 biometric screenings. Of women with complete LS7 (N = 123) and LE8 (N = 63) data, the median [interquartile range] LS7 and LE8 scores were 8 [7-10] on a 0-14 scale and 63 [54, 73] on a 0-100 scale. From evaluations (N = 111), attendees (20-74 years old) were well educated (66% with a college degree) and mostly un-partnered (57%). Largely, women heard about our event through family, friends, and community partners. Women were very to extremely satisfied with wellness content (82%) and the program overall (85%). Respondents found value in community engagement and reported the need for an annual event. Conclusion: The P.I.N.S. Initiative is a feasible avenue to engage Black women with largely intermediate cardiovascular health in wellness-focused services. This initiative provides a modifiable framework for further research toward identifying interventions to promote ideal CVH and equitable cardiovascular outcomes.

Influence of the Social Environment on Ideal Cardiovascular Health.

Background The environment plays a large role in the health of individuals; however, more research is needed to better understand aspects of the environment that most influence health. Specifically, our study examines how the social environment influences cardiovascular health (CVH). Methods and Results The social environment was characterized using measures of belonging and life and work stress in individuals, as well as nationally derived measures of marginalization, deprivation, economic status, and community well-being in neighborhoods. CVH was defined by the American Heart Association's Cardiovascular Health Index-a summed score of 7 clinical and behavioral components known to have the greatest impact on CVH. Data were obtained from the Canadian Community Health Survey 2015 to 2016 and multiple national data sources. Multilevel regression models were used to analyze the associations between CVH and the social environment. Overall, 27% of Canadians reported ideal CVH (6-7 score points), 68% reported intermediate CVH (3-5 score points), and 5% reported poor CVH (0-2 score points). The neighborhood environment contributed up to 7% of the differences in CVH between individuals. Findings indicated that residing in a neighborhood with greater community well-being (odds ratio [OR], 1.33 [95% CI, 1.26-1.41]) was associated with achieving higher odds of ideal CVH, while weaker community belonging (OR, 0.67 [95% CI, 0.62-0.72]) and residing in a neighborhood with greater marginalization (OR, 0.87 [95% CI, 0.82-0.91]) and deprivation (OR, 0.67 [95% CI, 0.64-0.69]) were associated with achieving lower odds of ideal CVH. Conclusions Aspects of individual-level social environment and residing in a neighborhood with a more favorable social environment were both independently and significantly associated with achieving ideal CVH.

Less than ideal cardiovascular health among adults is associated with experiencing adverse childhood events: BRFSS 2019

Ideal cardiovascular health (CVH) is associated with a lower risk of heart disease and stroke while adverse childhood events (ACEs) are related to health behaviors (e.g., smoking, unhealthy diet) and conditions (e.g., hypertension, diabetes) associated with CVH. Data from the 2019 Behavioral Risk Factor Surveillance System was used to explore ACEs and CVH among 86,584 adults ≥18 years from 20 states. CVH was defined as poor (0–2), intermediate (3–5), and ideal (6–7) from summation of survey indicators (normal weight, healthy diet, adequate physical activity, not smoking, no hypertension, no high cholesterol, and no diabetes). ACEs was summed by number (0,1, 2, 3, and ≥4). A generalized logit model estimated associations between poor and intermediate CVH (ideal as referent) and ACEs accounting for age, race/ethnicity, sex, education, and health care coverage. Overall, 16.7% (95% Confidence Interval[CI]:16.3–17.1) had poor, 72.4% (95%CI:71.9–72.9) had intermediate, and 10.9% (95%CI:10.5–11.3) had ideal CVH. Zero ACEs were reported for 37.0% (95%CI:36.4–37.6), 22.5% (95%CI:22.0–23.0) reported 1, 12.7% (95%CI:12.3–13.1) reported 2, 8.5% (95%CI:8.2–8.9) reported 3, and 19.3% (95%CI:18.8–19.8) reported ≥4 ACEs. Those with 1 (Adjusted Odds Ratio [AOR] = 1.27;95%CI = 1.11–1.46), 2 (AOR = 1.63;95%CI:1.36–1.96), 3 (AOR = 2.01;95%CI:1.66–2.44), and ≥ 4 (AOR = 2.47;95%CI:2.11–2.89) ACEs were more likely to report poor (vs. ideal) CVH compared to those with 0 ACEs. Those who reported 2 (AOR = 1.28;95%CI = 1.08–1.51), 3 (AOR = 1.48;95%CI:1.25–1.75), and ≥ 4 (AOR = 1.59;95%CI:1.38–1.83) ACEs were more likely to report intermediate (vs. ideal) CVH compared to those with 0 ACEs. Preventing and mitigating the harms of ACEs and addressing barriers to ideal CVH, particularly social and structural determinants, may improve health.

Mobile-phone text messaging to promote ideal cardiovascular health in women

ObjectiveIdeal cardiovascular health (CVH) was developed to promote CVH as a key component of primordial prevention. Mobile short message service (SMS) is useful for improving health behaviours. We aim to...

AHA Life's essential 8 and ideal cardiovascular health among young adults

ObjectiveThis study assessed cardiovascular health (CVH) in young adults using the 2022 AHA Life's Essential 8 (LE8) score and compared it with the Life's Simple 7 (LS7) score. MethodsIndividuals aged 18 to 44 years without a history of cardiovascular disease in the National Health and Nutrition Examination Survey (NHANES) cycles were included. Data from 2007-2008 to 2017-2018 were combined to create 3 groups (2007-2010, 2011-2014, and 2015-2018) for analysis. The LE8 score and its components were computed in the overall population and stratified by sex and race/ethnicity. Trends for the LE8 score were analyzed using adjusted linear regression models. ResultsAmong 12,197 young adults, representing an estimated 89.4 million individuals, from the NHANES 2007-2018, the CVH in the overall population and across all subgroups was stable (Ptrend >0.05). The blood lipid score improved across all subgroups (Ptrend:<0.05). The mean LE8 score was 69.2±0.3. Females (71.4±0.4) had better CVH compared with males (67.2±0.4). Non-Hispanic Black individuals (65.1± 0.3) had the lowest CVH compared with Non-Hispanic White individuals (69.9±0.5), Mexican American individuals (67.3±0.3), and other race individuals (71.2±0.4). Of the 46.1 million individuals categorized as intermediate CVH by the LS7 score, 8.1 million (17.6%) and 2.3 million (5.0%) were reclassified to poor and ideal CVH by the LE8 score, respectively. Of the 40.1 million individuals categorized as ideal CVH by the LS7 score, 18.9 million (47.1%) and 0.1 million (0.2%) were reclassified to poor CVH and intermediate CVH by the LE8 score, respectively. ConclusionAmong US young adults, there has been no improvement in CVH over the last decade with notable sex and race/ethnicity-associated differences in the LE8 score. Nearly 1 in 4 young adults had ideal CVH using the LE8 score compared with 1 in 2 individuals using the LS7 score.

The impact of cardiovascular health and frailty on mortality for males and females across the life course

BackgroundThe effect of frailty and poor cardiovascular health on mortality for males and females is not fully elucidated. We investigated whether the combined burden of frailty and poor cardiovascular health is associated with all-cause and cardiovascular disease (CVD) mortality by sex and age.MethodsWe analyzed data of 35,207 non-institutionalized US residents aged 20–85 years old (mean age [standard deviation]: 46.6 [16.7 years], 51.4% female, 70.8% White, 10.3% Black, 13.2% Hispanic) from the National Health and Nutrition Examination Survey (1999–2015). Cardiovascular health was measured with the American Heart Association’s Life’s Simple 7 score (LS7). A 33-item frailty index (FI) was constructed to exclude cardiovascular health deficits. We grouped the FI into 0.1 increments (non-frail: FI < 0.10, very mildly frail: 0.1 ≤ FI < 0.20, mildly frail: 0.20 ≤ FI < 0.30, and moderately/severely frail: FI ≥ 0.30) and LS7 into tertiles (T1[poor] = 0–7, T2[intermediate] = 8-9, T3[ideal] = 10–14). All-cause and CVD mortality data were analyzed up to 16 years. All regression models were stratified by sex.ResultsThe average FI was 0.09 (SD 0.10); 29.6% were at least very mildly frail, and the average LS7 was 7.9 (2.3). Mortality from all-causes and CVD were 8.5% (4228/35,207) and 6.1% (2917/35,207), respectively. The median length of follow-up was 8.1 years. The combined burden of frailty and poor cardiovascular health on mortality risk varied according to age in males (FI*age interaction p = 0.01; LS7*age interaction p < 0.001) but not in females. In females, poor FI and LS7 combined to predict all-cause and CVD mortality in a dose-response manner. All-cause and CVD mortality risk was greater for older males (60 and 70 years old) who were at least mildly frail and had intermediate cardiovascular health or worse (hazard ratio [lower/higher confidence interval ranges] range: all-cause mortality = 2.02–5.30 [1.20–4.04, 3.15–6.94]; CVD-related mortality = 2.22–7.16 [1.03–4.46, 4.49–11.50]) but not for younger males (30, 40, and 50 years old).ConclusionsThe combined burden of frailty and LS7 on mortality is similar across all ages in females. In males, this burden is greater among older people. Adding frailty to assessments of overall cardiovascular health may identify more individuals at risk for mortality and better inform decisions to implement preventative or treatment approaches.

No Mediation Effect of Telomere Length or Mitochondrial DNA Copy Number on the Association Between Adverse Childhood Experiences (ACEs) and Central Arterial Stiffness.

Background Adverse childhood experiences (ACEs) have been linked to increased cardiovascular disease (CVD) risk. Previous reports have suggested that accelerated biological aging-indexed by telomere length (TL) and mitochondrial DNA copy number (mtDNAcn)-may contribute to associations between ACEs and cardiovascular health outcomes. Here, we examine the potential mediating effects of TL and mtDNAcn on the association between ACEs and central arterial stiffness-an intermediate cardiovascular health outcome-as a novel pathway linking ACEs to CVD risk among young adults. Methods and Results One hundred and eighty-five (n=102 women; mean age, 22.5±1.5 years) individuals provided information on ACEs. TL (kb per diploid cell) and mtDNAcn (copies per diploid cell) were quantified using quantitative polymerase chain reaction techniques. Central arterial stiffness was measured as carotid-femoral pulse wave velocity (cfPWV; m/s). Multiple linear regression analyses were used to examine the associations between ACEs, TL, mtDNAcn, and cfPWV. ACEs were positively associated with cfPWV (β=0.147, P=0.035). TL (β=-0.170, P=0.011) and mtDNAcn (β=-0.159, P=0.019) were inversely associated with cfPWV. Neither TL (β=-0.027, P=0.726) nor mtDNAcn (β=0.038, P=0.620) was associated with ACEs. Neither marker mediated the association between ACEs and cfPWV. Conclusions An increasing number of ACEs were associated with a faster cfPWV and thus, a greater degree of central arterial stiffness. ACEs were not associated with either TL or mtDNAcn, suggesting that these markers do not represent a mediating pathway linking ACEs to central arterial stiffness.

Ideal cardiovascular health and women's health characteristics in middle aged women free of diagnosed cardiovascular disease. The Polish Norwegian study

Abstract Background Women's reproductive history has been recognized as a cardiovascular risk factor and risk enhancer. Purpose To compare ideal cardiovascular health (CVH) metrics across multiple women's health conditions: parity, breastfeeding, hormonal contraceptive use and menopause status. Methods Cross-sectional data were collected from 7034 women, age 45 to 64 years, free of CVD. Using the 7 American Heart Association criteria, we defined CVH as ideal, intermediate or poor if 6–7, 3–5 or 0–2 ideal metrics were met, respectively. We calculated the CVH score, ranging from 7 (all metrics poor) to 21 (all metrics ideal). Reproductive history was self-reported. We categorized parity in four categories (0, 1–2, 3–4 and 5 or more births). We used general linear models and proportional odds regression models to adjust for covariates and to assess mediation by age, education, income and urban/rural residence. Results Women had a mean age of 55.1 years (SD 5.3). The prevalence of nulliparity was 8.4%, menopause 75.49% and ever use of oral contraceptives, 12.8%. Among non-nulliparous, 88.9% breastfed for a median cumulative duration of 10 months. The prevalence of traditional CVD risk factors was high (obesity 27.6%, uncontrolled blood pressure 39.8%, poor diet 38%). The prevalence of ideal, intermediate and poor CVH was 0.1%, 41.7% and 58.2% respectively. None of the participants had all 7 cardiovascular health metrics at ideal level. Average CVH score was 14.1 (SD 1.9). The prevalence of intermediate CVH scores was highest among nulliparous (27.6%) and decreased with parity (26.72%, 19.87% and 11.42%). There was a statistically significant gradient in mean age-adjusted CVH score across the four parity categories, increasing from multiparous of 5 or more births (13.36, 95% CI 13.13–13.60) to nulliparous (14.24, 95% CI 14.08–14.39). Nulliparous women had 2.9 times greater odds (95% CI 1.91–4.54) of higher CVH scores than multiparous of 5 or more births, after adjusting for age, menopause and use of hormonal contraceptives. Similarly, for women who gave birth 1–2 times and 3–4 times, the adjusted relative odds were 2.65 (95% CI 1.78–3.94) and 1.80 (95% CI 1.2–2.71), respectively. Further adjustment for education, rural residence, personal and/or household finance status attenuated these relations, suggesting a mediating effect. Among non-nulliparous, neither ever breastfeeding or cumulative duration of breastfeeding were associated with CVH scores. Premenopausal women had 1.56 (95% CI 1.33–1.84) times higher odds of higher CVH scores then postmenopausal ones, after full adjustment. Conclusion Women's reproductive history, particularly parity is associated with middle-age cardiovascular health, and part of the association is explained by socio-economic status. These findings suggest the need for early screening and intensification of preventive cardiology interventions in women, especially among vulnerable subgroups. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): The Polish-Norwegian Research Fund (PNRF-228-AI-1/07)

Cardiovascular health trajectories among adolescents enrolled in the SI Program in Spain: a longitudinal study

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): 1. Fondo de Investigación Sanitaria- Instituto de Salud Carlos III2. SHE Foundation and “la Caixa” Foundation. Background There is a paucity of data on adolescents’ cardiovascular health (CVH) profiles and longitudinal trajectories. Purpose To identify CVH trajectories in a large cohort of Spanish adolescents aged 12 to 16 years and their relationship with sociodemographic variables. Methods This study collected data at approximately 12, 14 and 16 years of age from 1078 adolescents attending 24 secondary schools enrolled in the SI! Program for Secondary Schools trial in Spain [1]. The status (non-ideal = 0 points; ideal = 1 point) of each CVH individual metric (smoking status, body mass index, physical activity, dietary habits, blood pressure, total cholesterol, and blood glucose) was determined following the criteria established by the American Heart Association [2]. An overall CVH score was constructed summing the number of ideal CVH metrics (ranged thus from 0 to 7 points), and poor, intermediate, or ideal overall CVH score was defined as ≤3, 4-5, or 6-7 ideal metrics, respectively [3]. CVH trajectories were identified using latent class trajectory modeling with the Stata command traj [4]. Next, individuals were assigned to the trajectory group they were most likely to belong based on the posterior predictive probabilities of group membership. Results Among 1078 adolescents with a baseline mean (SD) age of 12.5 (0.4) years, 48.5% girls, four distinct CVH trajectory groups were identified: low-stable (56 adolescents [5.0%]), low-rise (232 [21.3%]), intermediate-decline (136 [18.2%]) and intermediate-stable (654 [55.5%]) (Figure 1). Adolescents belonging to the intermediate-stable and the low-stable trajectories showed the highest and lowest overall CVH mean (SD) scores at baseline [4.8 (0.8) and 2.6 (0.9), respectively] (Figure 2). Similar differences were observed for the analysis of overall CVH score as a categorical variable (poor, intermediate, ideal). Sociodemographic differences between CVH trajectories were identified, with the highest proportion of girls, high-income and non-migrant families within the intermediate-stable trajectory. Conclusions In a large cohort of adolescents, ~55% of adolescents showed an intermediate CVH score at baseline and did not decline over time. The characterization of distinct CVH trajectories and sociodemographic differences between them may help tailoring health promotion programs for adolescents.

Abstract P153: Racial/ethnic- And Education-level Differences In Poor, Intermediate, And Ideal Cardiovascular Health Among Women Of Reproductive Age: Behavioral Risk Factor Surveillance System, 2019

Introduction: The American Heart Association (AHA) promotes ideal cardiovascular health (CVH) to reduce the risk of heart disease and stroke by achieving seven metrics (normal weight, not smoking, ≥5 fruits and vegetables daily, physical activity ≥150 minutes per week, no diabetes, no high blood pressure, and no high cholesterol). Overall, about 5% of the adult population report ideal CVH. Characterizing CVH among women of reproductive age (WRA; 18-44 years of age) offers opportunities to promote overall cardiovascular and preventive health along the life course. Methods: Data from the 2019 Behavioral Risk Factor Surveillance System was used to estimate define CVH categories (poor, intermediate, ideal) among 38,012 WRA from 49 states (New Jersey didn’t meet standards for weighting), District of Columbia, Guam, and Puerto Rico. Per commonly used standards, having &gt; 6 metrics defined ideal CVH, 3-5 metrics defined intermediate, and 0-2 metrics defined poor CVH. A generalized logit model was used to estimate the associations between race/ethnicity and education with CVH (poor vs intermediate CVH, and ideal vs. intermediate CVH), accounting for age and insurance status. Results: Overall, 8.6% (95%CI:8.2-9.1%) of WRA reported poor CVH, 85.4% (95%CI: 84.8-86.1) reported intermediate CVH, and 6.0% (95%CI:5.5-6.5) reported ideal CVH. Non-Hispanic Black (NHB) WRA had higher odds of reporting poor vs. intermediate CVH (AOR=1.34; 95%CI:1.14-1.58) and lower odds of reporting ideal vs. intermediate CVH (AOR=0.47; 95%CI:0.33-0.68) compared to non-Hispanic White WRA. College graduates also had lower odd of reporting poor vs. intermediate CVH (AOR=0.21; 95%CI:0.17-0.27) and higher odds of reporting ideal vs. intermediate CVH (AOR=2.59; 95%CI:1.52-4.43) compared to those with less than a high school education. Conclusion: Most WRA have intermediate CVH, nearly 1 in 10 have poor CVH, and only about 1 in 16 have ideal CVH. The CVH metric used in this study provides evidence of the disproportionate burden of poor CVH among NHB WRA and women with less than a college degree. Understanding the barriers to ideal CVH for WRA, particularly social and structural determinants, may improve cardiovascular health and reduce disparities across the life course.

Relationship of American Heart Association's Life Simple 7, Ectopic Fat, and Insulin Resistance in 5 Racial/Ethnic Groups.

The inverse association between ideal cardiovascular health (CVH) as measured by the American Heart Association's Life Simple 7 (LS7) and cardiovascular disease (CVD) incidence is well documented. However, research exploring the association between CVH and specific risk factors for cardiometabolic disease is sparse in diverse cohorts. This study included 7717 participants from the Mediators of Atherosclerosis in South Asians Living in America and the Multi-Ethnic Study of Atherosclerosis cohorts. We assigned each LS7 component a 0, 1, and 2 and summed these scores to derive an overall CVH score. Visceral, subcutaneous, and intermuscular fat area, pericardial fat volume, and hepatic fat attenuation were measured using noncontrast computed tomography. Multivariable linear regression was used to examine associations between CVH categories and each log-transformed ectopic fat depot, as well as the homeostatic assessment for insulin resistance (HOMA-IR). In adjusted analysis, compared to those with ideal CVH, participants with poor CVH demonstrated 63.4% (95% CI, 54.3-73.0) higher visceral fat area, 84.0% (95% CI, 76.5-92.1) higher pericardial fat volume, 61.6% (95% CI, 50.7-73.2) higher subcutaneous fat area, and 40.6% (95% CI, 30.2-52.0) higher intermuscular fat area, and 15.1% (95% CI, 13.1-17.2) higher hepatic fat (all Ps < 0.001). Also, poor CVH was associated with 148.2% (95% CI, 131.1-166.7) higher HOMA-IR. We also found significant heterogeneity in the strengths of association by race/ethnicity for each ectopic fat depot. Poor and intermediate CVH, as defined by LS7 metrics, were associated with significantly higher measures of ectopic fat and insulin resistance among individuals from 5 racial/ethnic groups.

Examining Optimism, Psychosocial Risks, and Cardiovascular Health Using Life's Simple 7 Metrics in the Multi-Ethnic Study of Atherosclerosis and the Jackson Heart Study.

Background: Optimism has been shown to be positively associated with better cardiovascular health (CVH). However, there is a dearth of prospective studies showing the benefits of optimism on CVH, especially in the presence of adversities, i.e., psychosocial risks. This study examines the prospective relationship between optimism and CVH outcomes based on the Life's Simple 7 (LS7) metrics and whether multilevel psychosocial risks modify the aforementioned relationship.Methods: We examined self-reported optimism and CVH using harmonized data from two U.S. cohorts: Multi-Ethnic Study of Atherosclerosis (MESA) and Jackson Heart Study (JHS). Modified Poisson regression models were used to estimate the relationship between optimism and CVH using LS7 among MESA participants (N = 3,520) and to examine the relationship of interest based on four biological LS7 metrics (body mass index, blood pressure, cholesterol, and blood glucose) among JHS and MESA participants (N = 5,541). For all CVH outcomes, we assessed for effect measure modification by psychosocial risk.Results: Among MESA participants, the adjusted risk ratio (aRR) for ideal or intermediate CVH using LS7 comparing participants who reported high or medium optimism to those with the lowest level of optimism was 1.10 [95% Confidence Interval (CI): 1.04–1.16] and 1.05 (95% CI: 0.99–1.11), respectively. Among MESA and JHS participants, the corresponding aRRs for having all ideal or intermediate (vs. no poor) metrics based on the four biological LS7 metrics were 1.05 (0.98–1.12) and 1.04 (0.97–1.11), respectively. The corresponding aRRs for having lower cardiovascular risk (0–1 poor metrics) based on the four biological LS7 metrics were 1.01 (0.98–1.03) and 1.01 (0.98–1.03), respectively. There was some evidence of effect modification by neighborhood deprivation for the LS7 outcome and by chronic stress for the ideal or intermediate (no poor) metrics outcome based on the four biological LS7 metrics.Conclusion: Our findings suggest that greater optimism is positively associated with better CVH based on certain LS7 outcomes among a racially/ethnically diverse study population. This relationship may be effect measure modified by specific psychosocial risks. Optimism shows further promise as a potential area for intervention on CVH. However, additional prospective and intervention studies are needed.