Prevalence Of Ideal Cardiovascular Health Research Articles

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 <25 kg/m2 , level of physical activity up to the achievement of the set goal, diet in accordance with national recommendations, blood pressure <120/80 mm Hg, total cholesterol <200 mg/dL and blood glucose level <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.

Abstract 16491: The Relationship Between Cardiovascular Health and 10-year Atherosclerotic Cardiovascular Risk in American Adults

Introduction: Life’s Essential 8 (LE8) is a metric of overall cardiovascular health (CVH) while 10-year atherosclerotic cardiovascular disease (ASCVD) risk is routinely used to guide primary prevention. Yet, the relationship between LE8 and 10-year ASCVD risk is unclear. Hypothesis: CVH has an inverse relationship with 10-year ASCVD risk in adults aged 40–75 years from the National Health and Nutrition Examination Survey 2017-2020 cycle. Methods: Adults with ASCVD and data missing to calculate 10-year ASCVD risk and LE8 scores were excluded. LE8 score was estimated from the mean of LE8 components (scored 0 to 100), with scores ≥80, 79–50, and <49 grouped into ideal, intermediate, and poor CVH, respectively. 10-year ASCVD risk was estimated using pooled cohort equation, with scores <5%, 5–19.9%, and ≥20% grouped as low, borderline/intermediate, and high risk, respectively. The survey weighted chi-square and ANOVA analysis was performed. Results: We included 1,550 adults representing nearly 45 million US adults with a mean age of 57.8 years, 35.3% women. Overall, 35.4%, 42.3%, and 22.3% had low, borderline/intermediate, and high 10-year ASCVD risk, respectively. Low, borderline/intermediate, and high-risk individuals had a mean LE8 score of 68.2, 61.8, and 62.6 (p-value: <0.001) while 18.1%, 7.4%, and 5.6% (p-value: 0.002) had ideal CVH, respectively. Diet, nicotine exposure, body mass index (BMI), and blood lipids metrics were very low across the risk groups (figure). Additionally, the mean blood pressure metric was 41.3 among high-risk and 61.1 among intermediate/borderline-risk individuals. Conclusions: The prevalence of ideal CVH is very low across all 10-year ASCVD risk groups primarily due to poor diet, nicotine exposure, high BMI, and high blood lipids. Since ASCVD risk is predominantly age-dependent and given comparable LE8 scores among borderline/intermediate and high-risk individuals, LE8 may denote an age-independent long-term/lifetime risk.

Vasomotor and other menopause symptoms and the prevalence of ideal cardiovascular health metrics among premenopausal stage women.

We examined the association between menopause symptoms and the prevalence of ideal cardiovascular health (CVH) metrics among premenopausal women. This cross-sectional study comprised 4,611 premenopausal women aged 42 to 52 years. Data for CVH metrics were collected during health screening examinations. Menopause symptoms were measured using the Korean version of the Menopause-Specific Quality of Life questionnaire. For vasomotor, psychosocial, physical, and sexual symptoms, participants were divided into absent or symptomatic groups, further divided into tertiles (range, 0-7; 7 being the most bothersome). Ideal CVH metrics were defined according to the American Heart Association Life Simple 7 metrics, except dietary component. Cardiovascular health metrics were scored from 0 (unhealthy) to 6 (healthy) and classified as poor (0-2), intermediate (3-4), and ideal (5-6). Multinomial logistic regression models were used to estimate the prevalence ratios for intermediate and poor CVH metrics using ideal CVH as the reference. The overall and 4 menopause-specific quality of life domain scores were significantly associated with poorer CVH metrics scores in a dose-response manner (P < 0.05). After adjusting for age, parity, education level, anti-Mullerian hormone levels, and alcohol intake, women with the most bothersome degree for vasomotor, psychosocial, physical, and sexual symptoms had significantly higher prevalence of poor CVH metrics, with corresponding prevalence ratios (95% confidence interval) of 2.90 (1.95-4.31), 2.07 (1.36-3.15), 3.01 (1.19-7.65), and 1.66 (1.15-2.39), respectively, compared with those without each vasomotor, psychosocial, physical, and sexual symptom. Premenopausal stage women with either vasomotor or nonvasomotor menopausal symptoms have significantly higher prevalence of poor CVH metrics, compared with those without any menopausal symptoms.

Prevalence of ideal cardiovascular health and its relationship with relative handgrip strength in rural northeast China.

We aimed to investigate ideal cardiovascular health (CVH), its relationship with handgrip strength, and its components in rural China. We conducted a cross-sectional study of 3,203 rural Chinese individuals aged ≥35 years in Liaoning Province, China. Of these, 2,088 participants completed the follow-up survey. Handgrip strength was estimated using a handheld dynamometer and was normalized to body mass. Ideal CVH was assessed using seven health indicators (smoking, body mass index, physical activity, diet, cholesterol, blood pressure, and glucose). Binary logistic regression analyses were performed to assess the correlation between handgrip strength and ideal CVH. Women had a higher rate of ideal cardiovascular health (CVH) than men (15.7% vs. 6.8%, P < 0.001). Higher handgrip strength correlated with a higher proportion of ideal CVH (P for trend <0.001). After adjusting for confounding factors, the odds ratios (95% confidence interval) of ideal CVH across increasing handgrip strength tripartite were 1.00 (reference), 2.368 (1.773, 3.164), and 3.642 (2.605, 5.093) in the cross-sectional study and 1.00 (reference), 2.088 (1.074, 4.060), and 3.804 (1.829, 7.913) in the follow-up study (all P < 0.05). In rural China, the ideal CVH rate was low, and positively correlated with handgrip strength. Grip strength can be a rough predictor of ideal CVH and can be used to provide guidelines for improving CVH in rural China.

Assessing ideal cardiovascular health in medical students

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The ideal cardiovascular health concept was defined in preventive cardiology and measured mainly in older adults. However, data about the presence of cardiovascular risk factors in young adults is scarce, especially in our country. Purpose To assess the prevalence of cardiovascular risk factors amongst medical students and to estimate their cardiovascular health score. Methods In this cross-sectional study, 144 medical students from an East European medical university were enrolled. The inclusion criteria was having total cholesterol and fasting glucose level measured in the last six months. Individuals with chronic diseases were excluded. They filled an online anonymous survey. We applied the seven-metrics cardiovascular health scale developed by the American Heart Association. It defined the presence of four ideal behaviors: abstinence from smoking, normal body mass index, ideal physical activity, and dietary habits, and three ideal health factors: normal blood pressure, absence of hypercholesterolemia and diabetes mellitus. Each item was scored with 0, 1, and 2 corresponding to poor, intermediate or ideal health, consequently the maximal score was 14. We completed this battery with other three cardiovascular risk factors: stress, sleeping habits, and alcohol consumption. The same method was applied to calculate it, the maximal score was 20. We categorized in seven and ten metrics as ideal (10-14 and 16-20 points), intermediate (5-9 and 12-15 points), and poor (0-5 and 0-11 points) cardiovascular health. Age and sex were correlated with risk factors separately using IBM SPSS v.26 and GraphPad Prism 9.1.2. Results The mean age was 23.7 years (between 20 and 28 years) and 63.2% (n=91) of the participants were women. Ideal cardiovascular health with seven metrics compared to ten metrics was present in 61% vs. 31%, intermediate health in 30% vs. 57%, and poor health in 9% vs. 12%. Men presented significantly higher body mass index (p=0,0001), higher blood pressure (0,001) but without arterial hypertension, and males consumed more alcohol compared to women (p=0.011). Females experienced significantly more stress (p=0,001), were more frequently smokers (p=0,026) and followed special diets (p=0,013). The prevalence of ideal cardiovascular health was significantly higher in non-smokers. Conclusions Our study is the first in our country which evaluated cardiovascular health in medical students. In our sample, the most frequent risk factors were stress, inadequate diet, and alcohol consumption regardless of sex. One of five students had BMI&amp;gt;25 kg/m2, one of four hypercholesterolemia, and one of seven had higher fasting plasma glucose. The addition of stress, alcohol consumption, and sleeping behaviours to the basic evaluation, decreased the prevalence of ideal cardiovascular health almost by half. Based on our results we suggest the inclusion of stress and alcohol consumption in the evaluation of cardiovascular health.

Effects of a school-based lifestyle intervention on ideal cardiovascular health in Chinese children and adolescents: a national, multicentre, cluster-randomised controlled trial

BackgroundThe prevalence of ideal cardiovascular health among Chinese children and adolescents is alarmingly low. We aimed to examine whether a school-based lifestyle intervention against obesity would improve ideal cardiovascular health. MethodsIn this cluster-randomised controlled trial, we included and randomly assigned schools from the seven regions of China to intervention or control (1:1), stratified by province and school grade (grades 1–11; ages 7–17 years). Randomisation was done by an independent statistician. The 9-month intervention consisted of school promotion for diet, exercise, and self-monitor of obesity-related behaviours and the control group was no promotion. The primary outcome, assessed at both baseline and 9 months, was ideal cardiovascular health (six or more ideal cardiovascular health behaviours [non-smoking, BMI, physical activity, and diet] and factors [total cholesterol, blood pressure, and fasting plasma glucose]). We did intention-to-treat analysis and multilevel modelling. This study was approved by the ethics committee of Peking University, Beijing, China (ClinicalTrials.gov, NCT02343588). Findings30 629 students in the intervention group and 26 581 students in the control group from 94 schools with any follow-up cardiovascular health measures were analysed. At follow-up, 22·0% (1139/5186) of the intervention group and 17·5% (601/3437) in the control group met ideal cardiovascular health. Overall, the intervention was associated with ideal cardiovascular health behaviours (three or more; odds ratio 1·15; 95% CI 1·02–1·29), but not other ideal cardiovascular health metrics after adjusting for covariates. The intervention had higher effects on ideal cardiovascular health behaviours in primary school students aged 7–12 years (1·19; 1·05–1·34) than secondary school students aged 13–17 years (p<0·0001), with no apparent sex difference (p=0·58). The intervention protected senior students aged 16–17 years from smoking (1·23; 1·10–1·37) and improved ideal physical activity in primary school students (1·14; 1·00–1·30) but was associated with lower odds of ideal total cholesterol in primary school boys (0·73; 0·57–0·94). InterpretationThis school-based intervention, focused on diet and exercise, was effective in improving ideal cardiovascular health behaviours in Chinese children and adolescents. Early intervention might benefit cardiovascular health over the life course. FundingThe Special Research Grant for Non-profit Public Service of the Ministry of Health of China (201202010) and Guangdong Provincial Natural Science Foundation (2021A1515010439).

Low prevalence of ideal cardiovascular health in the general Swedish population: Results from the Swedish CArdioPulmonary bioImage Study (SCAPIS).

The aim of the current study was to examine the prevalence of ideal cardiovascular health (iCVH) in the general Swedish middle-aged population. To address this aim, we utilised data from the Swedish CArdioPulmonary bioImage Study (SCAPIS) which is a large Swedish population-based study (N=30,154) that combined comprehensive state-of-the-art imaging technology with clinical examinations and included all iCVH components. A total iCVH score was calculated as the number of iCVH metrics at an ideal level for the seven components and classified as: ideal (⩾5 ideal components), intermediate (3-4 ideal components) and poor (⩽2 ideal components). Our results showed that only 18.2% of the population reached ideal status (i.e. ⩾5 components at the ideal level), whereas 51.9% were classified as intermediate status and 29.9% as poor status of iCVH. Women had a higher prevalence of iCVH status (23.9% vs. 12.0%) and a lower prevalence of poor iCVH status (23.5% vs. 36.8%). Our data may serve as benchmarks for future national and international comparisons and motivate efforts to promote cardiovascular health in the general population, given the strong link between iCVH with all-cause and cardiovascular disease mortality and morbidity.

Prevalence and Correlates of Cardiovascular Health Status among Adults in Afghanistan: Results of a National Survey in 2018.

The aim of the study was to assess the prevalence and correlates of cardiovascular health (CVH) status among adults in Afghanistan. In a national cross-sectional household survey 3,447 adults completed CVH measurements in Afghanistan. Criteria for ideal CVH (ICVH) were physical activity, healthy diet, non-smoking, fasting blood glucose (<100 mg/dL), body mass index (<25 kg/m2), total cholesterol (<200 mg/dL), and blood pressure (<120/<80 mmHg). More than one-third (34.3%) of participants had 5-7 ICVH, 45.7% 3-4 ICVH, and 20% had 0-2 ICVH. In adjusted logistic regression analysis, secondary or more education (AOR: 1.80, 95% CI: 1.22-2.66) was positively associated, and older age (45-69 years) (AOR: 0.33, 95% CI: 0.26-0.42), and urban residence (AOR: 0.67, 95% CI: 0.51-0.88) were inversely associated with 5-7 ICVH. The prevalence of ICVH was low in Afghan adults. Population measures may be used to improve CVH targeting identified associated factors.

Prevalência de saúde cardiovascular ideal na população adulta brasileira - Pesquisa Nacional de Saúde 2019

to analyze the prevalence of ideal cardiovascular health (CVH) in the Brazilian adult population based on the 2019 National Health Survey. this was a population-based cross-sectional study (n = 77,494); prevalence and respective 95% confidence intervals (95%CI) of ideal CVH (seven metrics achieved simultaneously) and by individual metrics (four behavioral and three biological metrics), as defined by the American Heart Association, were estimated. only 0.5% (95%CI 0.4;0.6) of the study population presented ideal CVH, with higher prevalence among those with higher level of education (1.3%; 95%CI 0.9;1.6) and residents in urban areas (0.6%; 95%CI 0.5;0.7); the prevalence of behavioral and biological metrics was 0.7% (95%CI 0.6;0.8) and 63.3% (95%CI 62.7;63.9) respectively. the prevalence of ideal CVH was very low, highlighting the need for public policies aimed at promotion, surveillance and CVH care in the Brazilian adult population.

Changes in ideal cardiovascular health among Malawian adults from 2009 to 2017

Ideal Cardiovascular Health (CVH) is a concept defined by the American Heart Association (AHA) as part of its 2020 Impact Goals. Until now, changes in ideal CVH have been poorly evaluated in Sub-Saharan African populations. We aimed to investigate changes in the prevalence of ideal CVH and its components in a population of Malawian adults. Secondary analysis was done on cross-sectional data from 2009 to 2017, obtained from the Malawi STEPS surveys which included 5730 participants aged 25–64 years. CVH metrics categorized into “ideal (6–7 ideal metrics)”, “intermediate (3–5 ideal metrics)” and “poor (0–2 ideal metrics)” were computed using blood pressure, body mass index (BMI), fasting glycaemia, fruit and vegetable intake, physical activity, smoking, and total cholesterol. Sampling weights were used to account for the sampling design, and all estimates were standardised by age and sex using the direct method. The mean participant age across both periods was 40.1 ± 12.4 years. The prevalence of meeting ≥ 6 ideal CVH metrics increased substantially from 9.4% in 2009 to 33.3% in 2017, whereas having ≤ 2 ideal CVH metrics decreased from 7.6% to 0.5% over this time. For the individual metrics, desirable levels of smoking, fruit and vegetable intake, physical activity, blood pressure (BP), total cholesterol and fasting glucose all increased during the study period whilst achievable levels of BMI (< 25 kg/m2) declined. From 2009 to 2017, the mean number of ideal CVH metrics was higher in women compared to men (from 2.1% to 5.1% vs 2.0% to 5.0%). However, poor levels of smoking and fruit and vegetable intake were higher in men compared to women (from 27.9% to 23.6% vs. 7.4%% to 1.9% , and from 33.7% to 42.9% vs 30.8% to 34.6%, respectively). Also, whilst achievable levels of BMI rose in men (from 84.4% to 86.2%) the proportion reduced in women (from 72.1% to 67.5% ). Overall, CVH improved in Malawian adults from 2009 to 2017 and was highest in women. However, the prevalence of poor fruit and vegetable intake, and poor smoking remained high in men whilst optimal levels of BMI was declined in women. To improve this situation, individual and population-based strategies that address body mass, smoking and fruit and vegetable intake are warranted for maximal health gains in stemming the development of cardiovascular events.

Association of ideal cardiovascular health with carotid intima-media thickness (cIMT) in a young adult population

Ideal cardiovascular health (CVH) is associated with a lower risk of developing cardiovascular diseases. This study aims to investigate the association of CVH metrics with carotid intima-media thickness (cIMT) as a marker of subclinical atherosclerosis in young adults. A cross-sectional study was performed on 1295 adults, average age of 29.7 ± 4.0 years, selected from the participants of the Tehran Lipid and Glucose Study. The participants were divided into three groups based on the overall CVH score: ideal, intermediate, and poor CVH. Multivariate-adjusted linear regression was used to determine the association of the CVH score with cIMT. Multivariate-adjusted odds ratios (ORs) were calculated for high cIMT (≥ 95% percentile). Also, the independent effects of each ideal CVH metric on cIMT were analyzed. The prevalence of ideal CVH was 6.4% in men and 12.4% in women, and mean cIMT was obtained 0.53 ± 0.09 mm in men and 0.57 ± 0.08 mm in women. A 1-point increase of the CVH score in men and women was associated with a cIMT decrease of 0.009 and 0.011 mm (men: Beta [SE] = − 0.009 [0.003]; women: − 0.011 [0.007], p < 0.001), rendering the ORs of 0.66 and 0.70 for having a high cIMT (≥ 95% percentile), respectively. Ideal blood pressure in both sexes and body mass index in women had significant inverse association with cIMT. There was an inverse graded association between the CVH score and cIMT among young adults, indicating that ideal CVH metrics were associated with better vascular health in this population.

Prevalence of ideal cardiovascular health and its correlates in patients with inflammatory bowel disease, psoriasis and spondyloarthropathy.

Prevalence of ideal cardiovascular health and its correlates in patients with inflammatory bowel disease, psoriasis and spondyloarthropathy.

Community-based, cluster-randomized pilot trial of a cardiovascular mHealth intervention: Rationale, design, and baseline findings of the FAITH! Trial

Compared to whites, African-Americans have lower prevalence of ideal cardiovascular health (CVH) based on the American Heart Association Life's Simple 7 (LS7). These CVH inequities have worsened during the COVID-19 pandemic. Ideal LS7 health-promoting behaviors and biological risk factors (eg, diet, blood pressure) are associated with improved CVH outcomes. The FAITH! (Fostering African-American Improvement in Total Health) App, a community-informed, mobile health (mHealth) intervention, previously demonstrated significant improvements in LS7 components among African-Americans, suggesting that mHealth interventions may be effective in improving CVH. This paper presents the FAITH! Trial design, baseline findings, and pandemic-related lessons learned. Utilizing a community-based participatory research approach, this study assessed the feasibility/preliminary efficacy of a refined FAITH! App for promoting LS7 among African-Americans in faith communities using a cluster, randomized controlled trial. Participants received the FAITH! App (immediate intervention) or were assigned to a delayed intervention comparator group. Baseline data were collected via electronic surveys and health assessments. Primary outcomes are change in LS7 score from baseline to 6-months post-intervention and app engagement/usability. Of 85 enrolled individuals, 76 completed baseline surveys/health assessments, for a participation rate of 89% (N=34 randomized to the immediate intervention, N=42 to delayed intervention). At baseline, participants were predominantly female (54/76, 71%), employed (56/76, 78%) and of high cardiometabolic risk (72/76, 95% with hypertension and/or overweight/obesity) with mean LS7 scores in the poor range (6.8, SD=1.9). The FAITH! Trial recruitment was feasible, and its results may inform the use of mHealth tools to increase ideal CVH among African-Americans.

Abstract 11389: Prevalence and Trends of Ideal Cardiovascular Health in 18 Countries: A Pooled Analysis of 68 Nationally Representative Surveys

Introduction: Increasing the prevalence of the ideal cardiovascular health (CVH) phenotype over the coming decades would likely result in dramatic improvements in healthy longevity and reductions in healthcare costs. Therefore, it is of paramount importance to understand the global prevalence and trends of the ideal CVH behaviors and factors for monitoring progress and providing evidence to support policy efforts. Hypothesis: We aim to describe the prevalence of CVH for the AHA defined metrics of tobacco use, body mass index, total cholesterol, blood pressure and glucose levels, and estimate its trends worldwide. Methods: We used data from people aged &gt; 20 years who participated in 68 national health examination surveys from 1983 to 2017 in 18 countries: Australia, Czech Republic, Denmark, Germany, Greece, Ireland, Italy, Malaysia, Mexico, Poland, Seychelles, Slovakia, South Korea, Spain, Sweden, Turkey, the UK, and the USA. We calculated age-standardized prevalence of ideal CVH (no current smoking, BMI &lt; 25 kg/m2, untreated TC &lt; 200 mg/dL, untreated BP &lt; 120 / &lt; 80 mmHg, and absence of diabetes mellitus). Additionally, we examined the trends of the ideal CVH for countries that had at least two individual-level national surveys in two different decades (2000-2009 vs 2010-2019). Results: With the exception of Australia and South Korea, age-standardized prevalence of idea CVH was lower than 10% in women and lower than 5% in men across all countries. Older individuals had a lower prevalence of Ideal CVH than younger ones. Those over 65 years of age had a prevalence almost equal to zero. In ages 35-64 years, ideal CVH prevalence ranged from 3.6% to 25.4% among women, and from 0.6% to 7.1% among men. For the 10 countries where trends were estimated by age-sex groups, ideal CVH prevalence did not change or declined in the selected middle-income countries and increased in the selected high-income countries except for South Korea, where it plateaued for men and declined for women. Conclusions: Prevalence of ideal CVH worldwide is low and is declining for adults in middle-income countries in recent decades.

Prevalence of ideal cardiovascular health in a community-based population – results from the Swiss Longitudinal Cohort Study (SWICOS)

The American Heart Association (AHA) developed a concept to measure cardiovascular health in populations. We aimed to analyse participants in the Swiss Longitudinal Cohort Study (SWICOS) according to the AHA concept. We analysed cardiovascular health according to the AHA concept in all 474 participants of the prospective, population-based SWICOS study who were 18 years or older. The AHA concept uses seven health metrics of known cardiovascular risk factors (blood pressure, total cholesterol, blood glucose, smoking, body weight, physical activity and diet), and classifies each health metric according to three levels (ideal, intermediate and poor) using pre-defined cut-offs. Ideal cardiovascular health for three or more of the seven health metrics was found in 259 participants (54.9%; 95% confidence interval [CI] 50.1-59.4%), but a relevant number of participants (n = 213, 45.1%, 95% CI 40.6-49.7%) showed ideal cardiovascular health for only two or fewer of the seven health metrics. Poor cardiovascular health for three or more of the seven health metrics was found in 40 participants (8.5%; 95% CI 6.1-11.4%); a majority of 432 participants (91.5%; 95% CI 88.6-93.9%) showed a poor level for only two or fewer of the seven health metrics. Overall, we found favourable results for cardiovascular health in the population-based SWICOS cohort. Nevertheless, we see the need for further health prevention campaigns given the fact that a relevant proportion of the participants could optimise their cardiovascular health.

Prevalence and differences of ideal cardiovascular health in urban and rural adolescents in the Region of Tyrol: results from the EVA Tyrol study

PurposeEarly adoption of a healthy lifestyle has positive effects on cardiovascular health (CVH) in adulthood. In this study, we aimed to assess CVH metrics in a cohort of healthy teenagers with focus on differences between rural and urban areas.MethodsThe Early Vascular Aging (EVA) Tyrol study is a population-based non-randomized controlled trial, which prospectively enrolled 14- to 19-year-old adolescents in North Tyrol, Austria and South Tyrol, Italy between 2015 and 2018. Data from the baseline and control group (prior to health intervention) are included in the current analysis. CVH determinants (smoking, body mass index, physical activity, dietary patterns, systolic and diastolic blood pressure, total cholesterol and fasting blood glucose) were assessed and analyzed for urban and rural subgroups separately by univariate testing. Significant variables were added in a generalized linear model adjusted for living in urban or rural area with age and sex as covariates. Ideal CVH is defined according to the guidelines of the American Heart Association.Results2031 healthy adolescents were enrolled in the present study (56.2% female, mean age 16.5 years). 792 adolescents (39.0%) were from urban and 1239 (61.0%) from rural areas. In 1.3% of adolescents living in urban vs. 1.7% living in rural areas all CVH determinants were in an ideal range. Compared to the rural group, urban adolescents reported significantly longer periods of moderate to vigorous-intensive activity (median 50.0 min/day (interquartile range 30–80) vs. median 40.0 min/day (interquartile range 25–60), p < 0.01). This observation remained significant in a generalized linear model (p < 0.01). There were no significant differences between the study groups regarding all other CVH metrics.ConclusionThe low prevalence of ideal CVH for adolescents living in urban as well as rural areas highlights the need for early health intervention. Geographic differences must be taken into account when defining targeted subgroups for health intervention programs.

Influential Periods in Longitudinal Clinical Cardiovascular Health Scores.

The prevalence of ideal cardiovascular health (CVH) among adults in the United States is low and decreases with age. Our objective was to identify specific age windows when the loss of CVH accelerates, to ascertain preventive opportunities for intervention. Data were pooled from 5 longitudinal cohorts (Project Heartbeat!, Cardiovascular Risk in Young Finns Study, The Bogalusa Heart Study, Coronary Artery Risk Development in Young Adults, Special Turku Coronary Risk Factor Intervention Project) from the United States and Finland from 1973 to 2012. Individuals with clinical CVH factors (i.e., body mass index, blood pressure, cholesterol, blood glucose) measured from ages 8 to 55 years were included. These factors were categorized and summed into a clinical CVH score ranging from 0 (worst) to 8 (best). Adjusted, segmented, linear mixed models were used to estimate the change in CVH over time. Among the 18,343 participants, 9,461 (52%) were female and 12,346 (67%) were White. The baseline mean (standard deviation) clinical CVH score was 6.9 (1.2) at an average age of 17.6 (8.1) years. Two inflection points were estimated: at 16.9 years (95% confidence interval: 16.4, 17.4) and at 37.2 years (95% confidence interval: 32.4, 41.9). Late adolescence and early middle age appear to be influential periods during which the loss of CVH accelerates.

Geographic Variation in Cardiovascular Health Among American Adults

ObjectiveTo evaluate the contemporary geographic trends in cardiovascular health in the United States and its relationship with geographic distribution of cardiovascular mortality. MethodsBy use of a retrospective cross-sectional design, the 2011-2017 Behavioral Risk Factor Surveillance System (BRFSS) was queried to determine the age-adjusted prevalence of cardiovascular health index (CVHI) metrics (sum of ideal blood pressure, blood glucose concentration, lipid levels, body mass index, smoking, physical activity, and diet). Cardiovascular health was estimated as both continuous (0 to 7 points) and categorical (ideal, intermediate, poor) variables from the BRFSS. Age-adjusted cardiovascular mortality for 2017 was obtained from the Centers for Disease Control and Prevention WONDER database. ResultsAmong 1,362,529 American adult participants of the BRFSS 2011-2017 and all American residents in 2017, the CVHI score increased from 3.89±0.004 in 2011 to 3.96±0.005 in 2017 (Ptrend<.001) nationally, with modest improvement across all regions (Ptrend<.05 for all). Ideal cardiovascular health prevalence improved in the northeastern (Ptrend=.03) and southern regions (Ptrend=.002). In 2017, the prevalence of coronary heart disease (6.8%; 95% CI, 6.5% to 7.1%) and stroke (3.7%; 95% CI, 3.4% to 3.9%) was highest in the southern region. The CVHI score (3.81±0.01) and the prevalence of ideal cardiovascular health (12.2%; 95% CI, 11.7% to 12.7%) were lowest in the southern United States. This corresponded to the higher cardiovascular mortality in the southern region (233.0 [95% CI, 232.2- to 33.8] per 100,000 persons). ConclusionDespite a modest improvement in CVHI, only 1 in 6 Americans has ideal cardiovascular health with significant geographic differences. These differences correlate with the geographic distribution of cardiovascular mortality. An urgent unmet need exists to mitigate the geographic disparities in cardiovascular morbidity and mortality.

Pre- and Perinatal Correlates of Ideal Cardiovascular Health during Early Childhood: A Prospective Analysis in the Healthy Start Study

To characterize prevalence of ideal cardiovascular health (ICVH) during early childhood (4-7years of age), and to identify pre- and perinatal biological, sociodemographic, metabolic, and behavioral correlates of ICVH. Among 350 mother-child pairs in the Healthy Start Study, we defined ICVH as no exposure to second hand smoke; ≥1hour/day of moderate-to-vigorous physical activity; body mass index ≤85th percentile; systolic and diastolic blood pressure <90th percentile; cholesterol <170mg/dL, fasting glucose <100mg/dL; and healthy diet, per the American Heart Association. Pre- and perinatal characteristics were obtained from questionnaires, medical records, and in-person visits. Because of low prevalence of ICVH, we focused on prevalence of meeting ≥6 metrics in the analysis. We examined bivariate associations of each characteristic with % meeting ≥6 metrics and included those that were significant (P<.05) in a multivariable logistic regression model. ICVH prevalence at mean±SD age 4.7±0.6years was 6.9%; boys had twice the prevalence as girls (9% vs 4.4%). Most (>85%) children met criteria for second hand smoke, body mass index, blood pressure, cholesterol, and glucose, and only one-third met criteria for physical activity (31.4%) and diet (35.1%). In multivariable analyses, key correlates of ICVH were maternal weight status (ORoverweight/obese vs nonoverweight/obese=0.41 [0.23, 0.73]) and offspring sex (ORmale vs female=2.14 [1.22, 3.65]). At age 4-7years, ICVH prevalence is already low, with diet and adequate physical activity being the limiting factors. Healthy maternal weight prior to pregnancy and male sex are potential determinants of childhood ICVH. Additional work is required to explore associations of early-life ICVH with future health outcomes.

Prevalence of ideal cardiovascular health in young adults: A birth cohort from southern Brazil

Ideal cardiovascular health (ICH) aims at primordial prevention of cardiovascular diseases in the population. However, there is a lack of research describing ICH in youth from middle-income countries. The aims of this study were to describe the prevalence of ICH at 18- and 22-year-old and to investigate the influence of socioeconomic status. The sample consisted of participants from the Pelotas 1993 birth-cohort followed-up at 18- (n = 4,106) and 22-year-old (n = 3,810). Ideal metrics were created for diet, smoking, body mass index, physical activity, blood pressure, total cholesterol, and blood glucose. The presence of 4 or more ideal metrics was defined as ICH. Socioeconomic status was obtained using wealth quintiles calculated with factor analysis based on analysis based on the ownership of household and education. The impact of socioeconomic status on ICH metrics was statistically measured using the slope index of inequality. The prevalence of ICH was 84.5% (95% confidence interval [CI] = 82.7-86.2%) and 84.1% (82.3-85.8%) at 18-year-old and decreased to 61.1% (58.4-63.7%) and 68.7% (66.2-71.2%) at 22-years old, for male and female, respectively. Socioeconomic status influenced ICH and its components differently in males and females. Wealthiest females had ICH prevalence 19 percentage points (pp) (11-27 pp) higher compared to the poorest, whereas poorest males had ICH prevalence 12 pp (1-21 pp) higher compared to the wealthiest. Longitudinal decreases in ICH components were mostly present in the poorest females. In middle-income countries, the prevalence of ICH is high at 18-year-old and decreases in a 4-year follow-up. Socioeconomic status influences differently individuals' ICH between sexes. Efforts are needed to maintain ICH in youth and different strategies may be required between the social status.