Number Of Ideal Cardiovascular Health Metrics Research Articles

Ideal Cardiovascular Health and Cognitive Aging in the Northern Manhattan Study.

BackgroundThe American Heart Association defined target levels for 7 cardiovascular health (CVH) factors: smoking, body mass index, physical activity, diet, blood pressure, cholesterol, and glucose. We hypothesized that a greater number of American Heart Association ideal CVH metrics would be associated with less decline in cognitive performance in our multiethnic population.Methods and ResultsA subsample from the population‐based Northern Manhattan Study underwent repeated neuropsychological testing (mean interval 6±2 years). Domain‐specific Z scores were derived by using factor analysis for the domains of Episodic Memory, Semantic Memory, Executive Function, and Processing Speed, based on initial performance and decline over time. Linear regression models were constructed to examine the relationship between the number of ideal CVH metrics at enrollment with later cognitive performance and decline, adjusting for sociodemographics and magnetic resonance imaging brain markers. Among 1033 participants (mean age at initial cognitive assessment 72±8 years, 39% male, 19% black, 16% white, 65% Hispanic; n=722 with repeat testing), 3% had 0 ideal factors, 15% had 1 factor, 33% had 2 factors, 30% had 3 factors, 14% had 4 factors, 4% had 5 factors, 1% had 6 factors, and 0% had 7 factors. An increasing number of ideal CVH factors was associated with better processing speed at initial assessment and less decline. The association was driven by nonsmoking and glucose. Among those with better cognitive performance at initial assessment, positive associations were observed between the number of ideal CVH factors and less decline in the domains of Executive Function and Episodic Memory.ConclusionsThe number of ideal CVH metrics was associated with less decline in the domains of Processing Speed and, to a lesser extent, of Executive Function and Episodic Memory. Ideal CVH promotion benefits brain health and cognitive aging.

Ideal Cardiovascular Health Metrics Are Associated with Disability Independently of Vascular Conditions.

BackgroundVascular risk factors may be associated with disability independently of vascular events. We examined whether the American Heart Association’s 7 ideal cardiovascular health (CVH) metrics were independently associated with disability in a nationally representative cohort.MethodsAdults age ≥20 years from the National Health and Nutrition Examination Survey 2005–2012 were included. Ideal CVH was calculated as a composite of 7 measures, each scored 0–2. Primary predictors were number of ideal CVH metrics and score of CVH metrics. The outcome was a dichotomous score from 20 activities of daily living (ADL) and instrumental ADLs. Unadjusted and adjusted weighted logistic models estimated associations between ideal CVH and disability. The data were analyzed in 2015.ResultsAmong 22692 participants, mean age was 46.9 years. Cardiac disease and stroke were present in 6.6% and 2.8%; 90.3% had poor physical activity and 89.9% poor diet. Among 3975 individuals with full CVH data, in fully adjusted models, OR for disability was 0.90 (95% CI 0.83–0.98) per point increase in ideal CVH score, and 0.84 (0.73–0.97) per additional number of ideal CVH metrics.ConclusionsCVH metrics were strongly and significantly associated with reduced odds of disability independently of vascular and non-vascular conditions. Poorer CVH may cause subclinical vascular disease resulting in disability.

Modified Ideal Cardiovascular Health Status is Associated with Lower Prevalence of Stroke in Rural Northeast China.

Background: In 2010, the American Heart Association developed a new definition of ideal cardiovascular health (CVH) based on seven cardiovascular health metrics. This study aimed to investigate the relationship between modified ideal CVH metrics and the risk of stroke in the rural population of Northeast China. Methods: We included 11,417 adults from the rural population in Northeast China and collected all the information, including the baseline characteristics, history of stroke, and the seven ideal CVH metrics. Results: Our results showed that the presence of stroke was associated with high body mass index (BMI), poor diet score (salt intake), high total cholesterol (TC), high blood pressure (BP), and high fasting plasma glucose (FPG). The prevalence of stroke increased as the number of ideal CVH metrics decreased, and peaked to 13.1% among those with only one ideal CVH metric. Participants with only one ideal CVH had a 4.40-fold increased susceptibility of stroke than those with all seven ideal health metrics. Conclusion: This study revealed that people with a better CVH status had a lower prevalence of stroke and the susceptibility of stroke increased with the decreasing of the number of ideal CVH metrics.

Abstract 13332: Ideal Cardiovascular Health Metrics Are Associated With Disability Independently of Vascular Conditions

Background: Individuals with disability comprise the largest health care consumer group in the US. Vascular and non-vascular conditions contribute independently to disability, but it is unclear whether vascular risk factors are associated with disability independently of vascular events. We examined whether the American Heart Association’s 7 ideal cardiovascular health (CVH) metrics were independently associated with disability in a nationally representative cohort. Methods: Adults age>=20 years from the National Health and Nutrition Examination Survey 2005-2012 were included. Ideal CVH was calculated as a composite of 7 measures, each scored from 0-2. Primary predictors were number of ideal CVH metrics and score of CVH metrics. The outcome was a dichotomous score from 20 activities of daily living (ADL) and instrumental ADLs. Unadjusted and adjusted weighted logistic models estimated associations between ideal CVH and disability. Secondarily, interactions were tested and each disability item was tested separately. Results: The total cohort included 22692 participants; mean age was 46.9 years. Cardiac disease and stroke were present in 6.6% and 2.8%; 90.3% had poor physical activity and 89.9% poor diet. Among 3975 individuals with full data on all 7 CVH metrics, the mean number of ideal CVH metrics was 3.12 (95% CI 3.05-3.20) and ideal CVH score was 7.6 (7.5-7.7). In fully adjusted models, the OR for disability was 0.90 (95% CI 0.83-0.98) per point increase in ideal CVH score, and 0.84 (0.73-0.97) per additional number of ideal CVH metrics. There were significant interactions with ideal CVH measures for cardiac disease (p =0.007 for ideal CVH score and 0.01 for number of ideal CVH indicators) and stroke (p= 0.12 and 0.11 respectively). Among those with cardiac disease and stroke, there was a paradoxical trend for increased odds of disability for increasing values of CVH. For the majority of disability items, there was an inverse relationship with ideal CVH metrics. Conclusions: Both ideal CVH score and number of ideal CVH metrics were strongly and significantly associated with reduced odds of disability independently of vascular and non-vascular conditions. Poorer CVH may cause subclinical vascular disease resulting in disability.

Optimizing Cardiovascular Health Across the Life Course.

Optimizing Cardiovascular Health Across the Life Course.

"Life's Simple 7" and Long-Term Mortality After Stroke.

BackgroundThe American Heart Association developed criteria dubbed “Life's Simple 7” defining ideal cardiovascular health: not smoking, regular physical activity, healthy diet, maintaining normal weight, and controlling cholesterol, blood pressure, and blood glucose levels. The impact of achieving these metrics on survival after stroke is unknown. We aimed to determine cardiovascular health scores among stroke survivors in the United States and to assess the link between cardiovascular health score and all‐cause mortality after stroke.Methods and ResultsWe assessed cardiovascular health metrics among a nationally representative sample of US adults with stroke (n=420) who participated in the National Health and Nutrition Examination Surveys in 1988–1994 (with mortality assessment through 2006). We determined cumulative all‐cause mortality by cardiovascular health score under the Cox proportional hazards model after adjusting for sociodemographic characteristics and comorbidities. No stroke survivors met all 7 ideal health metrics. Over a median duration of 98 months (range, 53–159), there was an inverse dose‐dependent relationship between number of ideal lifestyle metrics met and 10‐year adjusted mortality: 0 to 1: 57%; 2: 48%; 3: 43%; 4: 36%; and ≥5: 30%. Those who met ≥4 health metrics had lower all‐cause mortality than those who met 0 to 1 (hazard ratio, 0.51; 95% confidence interval, 0.28–0.92). After adjusting for sociodemographics, higher health score was associated with lower all‐cause mortality (trend P‐value, 0.022).ConclusionsAchieving a greater number of ideal cardiovascular health metrics is associated with lower long‐term risk of dying after stroke. Specifically targeting “Life's Simple 7” goals might have a profound impact, extending survival after stroke.

Prevalence of ideal cardiovascular health in southeast Chinese adults

There are currently approximately 290 million people with cardiovascular disease (CVD) [1], which means that the prevention and control for CVD in China is facing more severe challenges. The American Heart Association (AHA) recently developed definitions of ideal cardiovascular health (CVH) based on 7 health metrics [2]. A strong graded relationship exists between the number of ideal CVH metrics and CVD risks [3]. The distribution of CVH varies across countries or regions. However, the prevalence of ideal CVH metrics by the AHA definition has not been reported in Southeast Chinese adults.

Abstract T MP47: Ideal Cardiovascular Health Predicts Functional Status: The Northern Manhattan Study

Background: The American Heart Association’s metric of ideal cardiovascular health (CVH) has been previously associated with vascular events, mortality, and subclinical atherosclerotic disease, but its association with functional impairment independent of cardiovascular disease and stroke has not been explored. We hypothesized that ideal CVH predicts improved long-term functional status after adjusting for incident stroke and myocardial infarction. Methods: In the prospective, multiethnic Northern Manhattan Study, stroke-free individuals in northern Manhattan aged >=40 years had annual assessments of disability with the Barthel index (BI), for a median of 13 years. Baseline demographics, medical risk factors, and laboratory studies were collected. Ideal CVH was calculated as a composite of 7 measures, each scored on a scale of 0-2: smoking, body mass index, physical activity, diet, total cholesterol, blood pressure, and fasting plasma glucose. This analysis was based on: 1) number of ideal CVH metrics, and 2) total score of all CVH metrics. Results: Of 3219 participants, mean age was 69 years (SD 10), 63% were female, 21% non-Hispanic White, 25% non-Hispanic black, and 54% Hispanic. Twenty percent had 0-1 ideal CVH metrics, 32% had 2, 30% had 3, 14% had 4, and 4% had 5-7. Both the number of ideal CVH categories and higher total CVH metric scores were associated with higher mean BI scores at 5 and 10 years. These gradients persisted when results were adjusted for incident stroke and MI, when mobility and non-mobility domains of the BI were analyzed separately, and when the BI was analyzed dichotomously. At 10 years, in a fully adjusted model, differences in mean BI score were lower for poor versus ideal physical activity (3.48 points, p<0.0001) and fasting glucose (4.58 points, p<0.0001). Conclusions: Ideal CVH predicts functional impairment, even after accounting for incident vascular events. Vascular functional impairment is an important outcome, and further research is needed to determine whether it may be improved by optimizing vascular health. Achieving the AHA 2020 goal will not only have favorable effects on stroke and MI, but also likely reduce functional impairment.

Association of ideal cardiovascular health and calcified atherosclerotic plaque in the coronary arteries: The National Heart, Lung, and Blood Institute Family Heart Study

The American Heart Association (AHA) established recommendations based on 7 ideal health behaviors and factors with the goal of improving cardiovascular health (CVH) and reducing both morbidity and mortality from cardiovascular disease by 20% by 2020. Few studies have investigated their association with subclinical coronary heart disease. We sought to examine whether the 7 AHA CVH metrics were associated with calcified atherosclerotic plaque in the coronary arteries. In a cross-sectional design, we studied 1,731 predominantly white men and women from the National Heart, Lung, and Blood Institute Family Heart Study without prevalent coronary heart disease. Diet was assessed by a semiquantitative food frequency questionnaire. Coronary artery calcium (CAC) was measured by cardiac computed tomography. We defined prevalent CAC using an Agatston score of 100+ and fitted generalized estimating equations to calculate prevalence odds ratios of CAC. Mean age was 56.8 years, and 41% were male. The median number of ideal CVH metrics was 3, and no participant met all 7. There was a strong inverse relationship between number of ideal CVH metrics and prevalent CAC. Odds ratios (95% CI) for CAC of 100+ were 1.0 (reference), 0.37 (0.29-0.45), 0.35 (0.26-0.44), and 0.27 (0.20-0.36) among subjects with 0 to 1, 2, 3, and 4+ ideal CVH metrics, respectively (P = .0001), adjusting for sex, age, field center, alcohol, income, education, and energy consumption. These data demonstrate a strong and graded inverse relationship between AHA ideal CVH metrics and prevalent CAC in adult men and women.

Association of a favorable cardiovascular health profile with the presence of coronary artery calcification.

To examine the association between the American Heart Association's 7 metrics of ideal cardiovascular health (ICH) and the presence of subclinical coronary atherosclerosis as assessed by coronary artery calcification (CAC) using electron-beam computed tomography. This study is a cross-sectional analysis of data obtained on 3121 male and female patients evaluated at the Cooper Clinic in Dallas, Texas, between 1997 and 2007. We included men aged ≥45 and women aged ≥55 without known cardiovascular disease and for whom information on all ICH metrics and a CAC score were available. Patients were grouped into 3 categories according to their number of ICH metrics: favorable (4-7 ICH metrics), intermediate (3 metrics), and unfavorable (0-2 metrics). Patients with favorable ICH profiles had a lower prevalence and severity of subclinical atherosclerosis than those with unfavorable or intermediate ICH profiles as estimated by CAC. This inverse association of CAC with ICH metrics was evident whether the presence of coronary calcium was defined as CAC score>0, CAC score>100, or CAC score>400. Patients with favorable ICH profiles had odds of coronary calcium (CAC>0) less than half of those for patients with unfavorable profiles (odds ratio 0.41; 95% confidence interval, 0.34-0.50) and patients with intermediate ICH profiles had odds of detectable CAC 32% lower (odds ratio 0.68; 95% confidence interval, 0.57-0.82). A statistically significant association was found between a favorable level of ICH metrics and less or absent subclinical atherosclerosis as measured by CAC underscoring the importance of primordial prevention.

Abstract T P345: Cardiovascular Health Metrics and All-cause and Cardiovascular Disease Mortality among Middle Aged Men in Korea: The Seoul Male Cohort Study

Background: In Korea, Cerebrovascular and cardiovascular diseases (CVD) were the second leading cause of deaths in 2011. In 2010, the American Heart Association (AHA) published cardiovascular health metrics (CVHM) aimed at reducing deaths from all CVDs and stroke, and improving the cardiovascular health of the population as a whole. Despite their implications, the AHA’s metrics have not been broadly studied or previously applied to an Asian population. Objectives: This study estimated the combined association of cardiovascular health behaviors on the risk of all-cause and CVD mortality in middle-aged men in Korea. Methods: In total, 14,533 men aged 40-59 years were enrolled in 1993 and followed-up through 2011. CVHM defined the following lifestyles proposed by the AHA: smoking, physical activity, BMI, healthy diet score, total cholesterol, blood pressure, and fasting blood glucose. The CVHMs score was calculated as a single categorical variable, by assigning 1 point to each ideal healthy behavior vs. 0 points otherwise. All subjects were classified as meeting 0-7 CVHM. The principal outcome variables were all-cause and CVD mortality. The Cox proportional hazard regression model was used to estimate the hazard ratio (HR) of cardiovascular health behavior, and CVHMs score. PARs were calculated from significant CVHMs. Results: During 266,482.8 person-years of follow-up, there were 1,314 deaths in total. Current smoking, blood pressure, and fasting blood glucose were significantly associated with all-cause and CVD mortality. The adjusted PARs for the 3 significant metrics combined were 81% (95% CI, 50-94%) and 96% (66-99%) for all-cause and CVD mortality, respectively. More ideal CVHM was significantly associated with lower risks of all-cause and CVD mortality ( p-trend<.0001 ). The adjusted HRs of the groups with 6-7 vs. 0-2 ideal CVHM were 0.49 (0.35-0.70) and 0.23 (0.10-0.57) for all-cause and CVD mortality, respectively. Conclusions: Among ideal cardiovascular health behaviors, non-smoking, normal blood pressure, and recommended fasting blood glucose levels associated with reduced risks of all-cause and total CVD mortality. There was a strong trend towards decreased all-cause and CVD mortality risk with increasing the number of ideal CVHMs.

Cardiovascular health in adolescents with type 1 diabetes: The SEARCH CVD Study

In their Strategic Impact Goal Statement, the American Heart Association focused on primordial prevention of cardiovascular risk factors by defining metrics for ideal cardiovascular health (ICH). The prevalence of ICH among youth with type 1 diabetes is unknown. Youth with type 1 diabetes face an increased risk of cardiovascular disease (CVD) as they age. The purpose of this report was to examine the prevalence of ICH in a population of youth with type 1 diabetes and to examine the association of ICH with measures of cardiovascular structure and function. This report is based on SEARCH CVD an ancillary study to the SEARCH for Diabetes in Youth. A total of 190 adolescents with type 1 diabetes had complete data on all of the ICH metrics at baseline and had measures of arterial stiffness [pulse wave velocity (PWV), brachial distensibility (BrachD), and augmentation index (AIx)] and carotid intima-media thickness completed at a follow-up visit [on average 5 yr after baseline (interquartile range 4-5)]. No subjects met the ICH criteria for all 7 metrics. Meeting an increasing number of ICH metrics was significantly associated with lower arterial stiffness [lower PWV of the trunk (β = -0.02 ±0.01; p = 0.004) and AIx (β = -2.2 ±0.66; p = 0.001), and increased BrachD (β = 0.14 ±0.07; p = 0.04)]. Increasing number of ICH metrics was significantly associated with decreased arterial stiffness, but prevalence of ICH in this population was low. Youth with type 1 diabetes could benefit from improvements in their cardiovascular health.

Ideal Cardiovascular Health Metrics and the Risks of Ischemic and Intracerebral Hemorrhagic Stroke

Previous studies showed an inverse association between ideal cardiovascular health (CVH) metrics and the total risk of cardiovascular diseases and stroke. This study aimed to investigate the relationship between ideal CVH metrics and the risks of ischemic and hemorrhagic stroke, respectively. We collected information on the 7 ideal CVH metrics (including smoking status, body mass index, dietary intake, physical activity, blood pressure, total cholesterol, and fasting blood glucose) among 91 698 participants from the Kailuan study, China (72 826 men and 18 872 women between the ages of 18 and 98 years), free of myocardial infarction and stroke at baseline (2006-2007). Cox proportional hazards models were used to estimate stroke risk. During the 4-year follow-up, we identified 1486 incident stroke events (1057 ischemic, 386 intracerebral hemorrhagic, and 43 subarachnoid hemorrhagic). The hazard ratios (95% confidence interval) for total stroke with adherence to 0 (reference), 1, 2, 3, 4, 5, and 6/7 ideal CVH metrics were: 1, 0.92 (0.69-1.23), 0.69 (0.52-0.92), 0.52 (0.39-0.68), 0.38 (0.28-0.51), 0.27 (0.18-0.40), and 0.24 (0.11-0.54), respectively (P trend <0.01), after adjusting for age, sex, education, income, and hospital. Similar inverse associations were observed for both ischemic and intracerebral hemorrhagic stroke (both P trend <0.01). We observed a clear inverse gradient relationship between the number of ideal CVH metrics and the risk of stroke in a Chinese population, supporting the importance of ideal health behaviors and factors in stroke prevention.

Ideal Cardiovascular Health Metrics on the Prevalence of Asymptomatic Intracranial Artery Stenosis: A Cross-Sectional Study

Background and PurposeIntracranial Artery Stenosis (ICAS) is one of the most common causes of ischemic stroke in Asia. Previous studies have shown the number of ideal cardiovascular health (CVH) metrics was associated with lower risk of stroke. This study aimed to investigate the relationship between ideal CVH metrics and prevalence of ICAS.MethodsA random sample of 5,412 participants (selected from Kailuan Study as a reference population) aged 40 years or older (40.10% women), free of stroke, transient ischemic attack, and coronary disease, were enrolled in the Asymptomatic Polyvascular Abnormalities Community study from 2010 to 2011. We collected information on the seven CVH metrics (including smoking, body mass index, dietary intake, physical activity, blood pressure, total cholesterol and fasting blood glucose); and assessed ICAS by transcranial Doppler. The relationship between the ideal CVH metrics and prevalence of ICAS was analyzed using the multivariate logistic regression.ResultsAfter adjusting for age, sex, and other potential confounders, the adjusted odds ratios(95% confidence interval) for ICAS were 0.76(0.58–0.99), 0.55(0.43–0.72), 0.49(0.37–0.65), 0.43(0.31–0.61), and 0.36(0.22–0.62), respectively, for those having 2, 3, 4, 5, and 6–7 ideal CVH metrics compared with those having 0–1 ideal metric(p-trend<0.0001). Similar inverse associations were observed in different age and gender groups (all p-trends<0.05).ConclusionWe found a clear gradient relationship between the number of ideal CVH metrics and lower prevalence of ICAS in a Chinese population, which supports the importance of ideal health behaviors and factors in the prevention of ICAS.

Ideal Cardiovascular Health Predicts Lower Risks of Myocardial Infarction, Stroke, and Vascular Death Across Whites, Blacks, and Hispanics

Background— Evidence of the relationship of cardiovascular health (CVH), defined by the American Heart Association, and specific cardiovascular outcomes is lacking, particularly among Hispanics. This study sought to evaluate the relationship between the number of ideal CVH metrics and cardiovascular risk, overall and by event subtype, in a multiethnic community-based prospective cohort. Methods and Results— A total of 2981 subjects (mean age, 69±10 years; 54% Caribbean Hispanic, 25% black, 21% white) free of myocardial infarction and stroke at baseline in the Northern Manhattan Study were prospectively followed up (median follow-up, 11 years). The relationship between the number of ideal CVH metrics and the risk of cardiovascular disease, including myocardial infarction, stroke, and vascular death, was investigated. Overall, a strong gradient relationship was observed between the adjusted hazard ratios for cardiovascular disease and the number of ideal CVH metrics: 0.73 (95% confidence interval, 0.60–0.89), 0.61 (95% confidence interval, 0.50–0.76), 0.49 (95% confidence interval, 0.38–0.63), and 0.41 (95% confidence interval, 0.26–0.63) for those having 2, 3, 4, and 5 to 6 ideal CVH metrics, respectively, compared with those having 0 to 1 ideal CVH metrics ( P for trend &lt;0.0001). Similar graded relationships were found between the number of ideal CVH metrics and the adjusted incidence rate for each specific outcome and among whites, blacks, and Caribbean Hispanics. Conclusions— Our findings demonstrated a steep gradient relationship between ideal CVH and individual cardiovascular disease end points, including stroke, that was similar for whites, blacks, and Caribbean Hispanics. This evidence supports the application of the AHA ideal cardiovascular health metrics for cardiovascular disease risk assessment and health promotion for all Americans regardless of race-ethnic background.

Disparities in Ideal Cardiovascular Health

In 2010, the American Heart Association (AHA) declared 2020 health strategy goals to reduce deaths from cardiovascular disease and stroke by 20% and to improve the cardiovascular health (CVH) of all Americans by 20%.1 The latter goal is aimed at helping everyone living in the United States to achieve, or at least move toward, ideal CVH by focusing on 7 key health behaviors and risk factors—smoking, body mass-index, diet (based on the healthy diet score), participation in physical activity, and levels of blood pressure (<120/80 mm Hg), blood glucose (<100 mg/dL), and total cholesterol (<200 mg/dL).2 What must not be forgotten is that this 2020 AHA strategy was instituted against the background of health disparities identified by the Institute of Medicine3 in 2003 that are still present in our society today. In this issue of Circulation , Dong et al4 describe a strong graded relationship between the number of ideal CVH metrics and cardiovascular disease (CVD) risk (stroke, myocardial infarction, and vascular death) among whites, blacks, and Hispanics living in the same community. Furthermore, the authors assessed stroke as a separate outcome event whereas previous studies5–8 on ideal CVH either did not include stroke or treated stroke only as a component of a composite outcome. Article see p 2975 There are several other key observations reported by Dong et al.4 First, the study highlights the observation that ideal CVH is rare. A glaring finding of the study is the dismally low prevalence of ideal CVH in the urban setting, in which no participants had all 7 ideal CVH metrics (0%) and few participants had 5 to 6 metrics (4.4%). Thus, considerable work needs to be done to achieve ideal CVH for all Americans, and these findings point to a particular …