Primordial Prevention Of Cardiovascular Disease Research Articles

Evidence for the Association Between Adverse Childhood Family Environment, Child Abuse, and Caregiver Warmth and Cardiovascular Health Across the Lifespan: The Coronary Artery Risk Development in Young Adults (CARDIA) Study.

This study aimed to quantify the association between childhood family environment and longitudinal cardiovascular health (CVH) in adult CARDIA (Coronary Artery Risk Development in Young Adults) Study participants. We further investigated whether the association differs by adult income. We applied the CVH framework from the American Heart Association including metrics for smoking, cholesterol, blood pressure, glucose, body mass index, physical activity, and diet. CVH scores (range, 0-14) were calculated at years 0, 7, and 20 of the study. Risky Family environment (range, 7-28) was assessed at year 15 retrospectively, for childhood experiences of abuse, caregiver warmth, and family or household challenges. Complete case ordinal logistic regression and mixed models associated risky family (exposure) with CVH (outcome), adjusting for age, sex, race, and alcohol use. The sample (n=2074) had a mean age of 25.3 (±3.5) years and 56% females at baseline. The median risky family was 10 with ideal CVH (≥12) met by 288 individuals at baseline (28.4%) and 165 (16.3%) at year 20. Longitudinally, for every 1-unit greater risky family, the odds of attaining high CVH (≥10) decreased by 3.6% (OR, 0.9645 [95% CI, 0.94-0.98]). Each unit greater child abuse and caregiver warmth score corresponded to 12.8% lower and 11.7% higher odds of ideal CVH (≥10), respectively (OR, 0.872 [95% CI, 0.77-0.99]; OR, 1.1165 [95% CI, 1.01-1.24]), across all 20 years of follow-up. Stratified analyses by income in adulthood demonstrated associations between risky family environment and CVH remained significant for those of the highest adult income (>$74k), but not the lowest (<$35k). Although risky family environmental factors in childhood increase the odds of poor longitudinal adult CVH, caregiver warmth may increase the odds of CVH, and socioeconomic attainment in adulthood may contextualize the level of risk. Toward a paradigm of primordial prevention of cardiovascular disease, childhood exposures and economic opportunity may play a crucial role in CVH across the life course.

Comparison of Cardiovascular Health Profiles Across Population Surveys From 5 High- to Low-Income Countries

BackgroundTo facilitate the shift from risk-factor management to primordial prevention of cardiovascular disease, the American Heart Association developed guidelines to score and track cardiovascular health (CVH). How the prevalence and trajectories of a high level of CVH across the life course compare among high- and lower-income countries is unknown. MethodsNationally representative survey data with CVH variables (physical activity, cigarette smoking, body mass index, blood pressure, blood glucose, and total cholesterol levels) were identified in Ethiopia, Bangladesh, Brazil, England, and the US for adults (aged 18–69 years and not pregnant). Data were harmonized, and CVH metrics were scored using the American Heart Association guidelines, as high (2), moderate (1), or low (0), with the prevalence of high scores (better CVH) across the life course compared across countries. ResultsAmong 28,092 adults (Ethiopia n = 7686, 55.2% male; Bangladesh n = 6731, 48.4% male; Brazil n = 7241, 47.9% male; England n = 2691, 49.5% male, and the US n = 3743, 50.3% male), the prevalence of high CVH scores decreased as country income level increased. Declining CVH with age was universal across countries, but differences were already observable in those aged 18 years. Excess body weight appeared to be the main driver of poor CVH in higher-income countries, and the prevalence of current smoking was highest in Bangladesh. ConclusionsOur findings suggest that CVH decline with age may be universal. Interventions to promote and preserve CVH throughout the life course are needed in all populations, tailored to country-specific time courses of the decline. In countries where the level of CVH remains relatively high, protection of whole societies from risk-factor epidemics may still be feasible.

Low prevalence of ideal cardiovascular health metrics in Nigerians: A cross-sectional study

Abstract Background: Ideal cardiovascular health (ICH) is a metric for primordial prevention of cardiovascular disease. Its prevalence in Nigerians is not known. Methods: This cross-sectional study assessed the seven American Heart Association’s ICH metrics of 889 Nigerians. The metrics included nonsmoking, healthy diet, physical activity, body mass index (&lt;25 kg/m2), untreated blood pressure (BP) &lt;120/&lt;80 mmHg, untreated total cholesterol &lt;200 mg/dL, and untreated fasting blood glucose &lt;100 mg/dL). Logistic regressions were used to estimate associations between sociodemographic factors (age and sex) and meeting 5–7 CVH metrics. Results: No one met all 7 of ICH metrics while 70 (7.8%) had 5–7 metrics. The most prevalent and least prevalent ideal biological factors were ideal fasting plasma cholesterol (62.8%) and ideal BP (31.5%), respectively. The most prevalent and least prevalent behavioral factors were ideal smoking status (86.2%) and ideal diet (6.5%) respectively. Compared to males, females had better ideal BP, P = 0.005; better ideal fasting plasma glucose, P = 0.031; better ideal fasting plasma cholesterol, P &lt; 0.001; and ideal smoking status, P &lt; 0.001. Ages 45–64 had better ideal smoking status and ideal physical activity (P &lt; 0.001 and P = 0.001, respectively). Conclusions: There is a low prevalence of ICH among Nigerians. Concerted efforts should be made to improve healthy living among Nigerians.

Cardiovascular Health at Age 5 Years: Distribution, Determinants, and Association With Neurodevelopment.

BackgroundEarly childhood may represent an opportune time to commence primordial prevention of cardiovascular disease (CVD, i.e., prevention of risk factors onset), but epidemiological evidence is scarce. We aimed to examine the distribution and parental and early life determinants of ideal cardiovascular health (CVH) in children up to 5 years and to compare the level of cognitive development between children with and without ideal CVH at age 5 years.MethodsUsing data from the Etude sur les déterminants pré et post natals précoces du Développement psychomoteur et de la santé de l'Enfant (EDEN) study, a French population-based mother–child cohort study, CVH was examined in children at 5 years of age based on the American Heart Association CVH metrics (ideal body mass index, physical activity, diet, blood pressure, cholesterol and glucose levels, and passive smoking, considered in sensitivity analysis only). Children were categorized as having ideal (five to six ideal metrics) or non-ideal CVH (<5 ideal metrics). Intelligence quotient (IQ) at age 5 years was assessed using the French version of the Wechsler Preschool and Primary Scale of Intelligence.ResultsAmong the 566 children (55% boys), only 34% had ideal CVH. In fully adjusted logistic regression, boys compared to girls (OR = 1.77, 95% CI 1.13–2.78), children with intermediate (1.77, 1.05–2.98) or ideal (2.58, 1.38–4.82) behavioral CVH at age 3 years and children who spent < 30 min/day watching television (1.91, 1.09–3.34) at age 3 years were more likely to have ideal CVH at age 5 years. At age 5 years, there was a significant 2.98-point difference (95% CI 0.64–5.32) in IQ between children with and without ideal biological CVH after adjusting for confounders.ConclusionThis study highlights that only a third of children aged 5 years had ideal CVH and identified modifiable determinants of ideal CVH and is suggestive of an association between CVH and neurodevelopment at a young age.

Abstract P074: A Cluster Randomized Trial Of An Mhealth Intervention To Promote Cardiovascular Health In Emerging Adults: Results Of The Nuyou Study

Background: Cardiovascular disease (CVD) persists as the leading preventable cause of death in the US and worldwide. The American Heart Association (AHA) defines ideal cardiovascular health as the presence of: non-smoking, normal weight, adequate physical activity, healthy diet, normal blood pressure, normal fasting plasma glucose, and normal cholesterol. Only 45% of youth under 20 years old in the US exhibit five of the seven factors at ideal levels and that proportion plummets to 10% by age 40. Thus, novel strategies are needed to support primordial prevention of CVD via promotion of the seven health factors. Targeting young adults could stave off the alarming drop in cardiovascular health and contribute to healthier longevity. Objective: The NUYou trial was a two arm prospective cluster randomized trial to evaluate whether an mHealth intervention focused on cardiovascular health promotion improved cardiovascular health more than an active comparator in college students. Methods: Northwestern University Freshmen were cluster randomized by dormitory into two mHealth intervention groups: 1) Cardiovascular Health (CVH), addressing behaviors related to CVD risk; or 2) Whole Health (WH), addressing behaviors unrelated to CVD. Both groups received smartphone applications, co-designed with students to help them manage time, connect via social media, and report health behaviors weekly. The CVH group also received tailored self-monitoring features to track their risk behaviors. Cardiovascular health was assessed at the beginning of freshman, sophomore, and junior years. Health questionnaires, blood pressure, height, weight, glucose, and cholesterol were used to calculate the AHA’s Life’s Simple Seven (LSS) composite score (0-14, 14 being ideal health). Linear mixed models were used to compare CVD vs WH on LSS score. Results: Over 2 years, we recruited 302 participants (60% female). Participants were an average age of 18.1 (1.2) years and had a mean LSS score of 11.3 (1.4). Participant race was reported as, 28% Asian, 10% Black, 12% other/unknown/unreported, and 50% White. Ethnicity was reported as 12% Hispanic, 79% Non-Hispanic, and 9% unknown or unreported. There were no group, time, or group by time differences in LSS over 2-years. However, cholesterol increased as a function of time, by 7.39 mg/dL from Freshmen to Junior year and was not different by group. Conclusion: Despite using evidence-based behavior change techniques and employing a co-development approach with students, the groups did not differ on LSS over the 2-year intervention. The non-significant effects could be explained by high baseline LSS scores, the relatively short follow up time where a drop in LSS score would not be evident, or the absence of a human contact in the intervention. More research over a longer time span is needed to identify opportunistic time frames and strategies to intervene during young adulthood.

Abstract P173: Sex Differences In Risk Factors For Cardiovascular Disease Mortality Among US Women And Men

Ling Tian, Amanda H. Anderson, Kirsten S. Dorans, Marie A. Krousel-wood, Joshua D. Bundy Introduction: Previous studies suggest cardiovascular disease (CVD) risk factors differ among women compared with men. Quantifying sex differences in the associations of risk factors for CVD mortality in US nationally representative data could aid researchers and clinicians in improving the efficiency of primordial prevention of CVD. Hypothesis: Associations of systolic blood pressure (SBP), total cholesterol, glycated hemoglobin (HbA1c), body mass index (BMI), current smoking, and predicted 10-year risk of atherosclerotic CVD with CVD mortality differ among women compared with men, and these sex differences are modified by age. Methods: Data from non-pregnant and non-breastfeeding participants aged ≥40 years from the National Health and Nutrition Examination Survey (NHANES) 1999-2006, linked to the National Death Index through December 31, 2015, were analyzed. Multivariable-adjusted Cox proportional hazards regression was used to estimate hazard ratios (95% confidence intervals) for CVD mortality. Interaction terms were used to model associations by age (40-49, 50-59, and ≥60 years) and sex (women and men) subgroups. Results: 9,486 participants (mean age, 57.7; 51.9% women) were included in the current analysis. During an average 12.3-year follow-up, we observed 807 (8.5%) CVD deaths (328 in women; 479 in men). Associations of risk factors with CVD mortality were similar among women compared with men, although they were attenuated with increasing age (Figure). Conclusions: Among both US women and men, higher levels of SBP, smoking, and predicted 10-year ASCVD risk are strongly associated with higher risk of CVD mortality. Population-level interventions targeting these risk factors as early as possible in US men and women could reduce the burden of CVD.

Ideal cardiovascular health, inflammation, and arterial stiffness in the transition to adulthood

BackgroundIdeal cardiovascular health (ICH) promotes primordial prevention of cardiovascular diseases. However, whether ICH is associated with arterial stiffness in the transition to adulthood and the mechanisms associated have yet to be shown. The aims of this investigation were to: 1) investigate whether there is a prospective association between ICH and pulse wave velocity (PWV) in the transition to adulthood; and 2) to stablish whether the association between ICH and PWV is mediated by inflammatory markers. MethodsParticipants were part of the 1993 Pelotas Birth Cohort and follow-ups at 18- and 22-years were used in this study. At the age of 18 years, ICH was computed as the presence of ideal for the following metrics: physical activity, diet, smoking, blood cholesterol and glucose, blood pressure, and body mass index. At the age of 22 years, aortic PWV was obtained as well as interleukin-6 (IL-6) and C-reactive protein (CRP). ResultsA total of 3528 (1851 females) were included in the analysis. A significant linear effect was observed for ICH on PWV. After adjusting for socioeconomical status, skin colour, birth weight, and mother schooling male and female participants with better ICH profile had PWV of 0.70 m·s−1 and 0.60 m·s− slower than participants with poor ICH. No evidence for a mediating role of inflammatory markers was observed for male (<1%) and female (<5%). ConclusionsICH is inversely associated with PWV among male and female in the transition to adulthood with no mediating role of inflammation.

Transformer-based Multi-target Regression on Electronic Health Records for Primordial Prevention of Cardiovascular Disease.

Machine learning algorithms have been widely used to capture the static and temporal patterns within electronic health records (EHRs). While many studies focus on the (primary) prevention of diseases, primordial prevention (preventing the factors that are known to increase the risk of a disease occurring) is still widely under-investigated. In this study, we propose a multi-target regression model leveraging transformers to learn the bidirectional representations of EHR data and predict the future values of 11 major modifiable risk factors of cardiovascular disease (CVD). Inspired by the proven results of pre-training in natural language processing studies, we apply the same principles on EHR data, dividing the training of our model into two phases: pre-training and fine-tuning. We use the fine-tuned transformer model in a "multi-target regression" theme. Following this theme, we combine the 11 disjoint prediction tasks by adding shared and target-specific layers to the model and jointly train the entire model. We evaluate the performance of our proposed method on a large publicly available EHR dataset. Through various experiments, we demonstrate that the proposed method obtains a significant improvement (12.6% MAE on average across all 11 different outputs) over the baselines.

Primordial prevention of cardiovascular diseases in Lithuania: Pediatric dyslipidemia and cascade screening of large risk families

Background and Aims: Cardiovascular mortality rates are extremely high in Lithuania (56.1% of all deaths in 2017). One of the main causes of atherosclerotic cardiovascular diseases is familial hypercholesterolemia (FH). When establishing a national screening programme for FH in Lithuania only adult patients were included into the program. There is also a lack of recommendations for pediatric or familial screening in Lithuania. By the end of last year, we have started inviting families at high risk for FH for genetic screening in Vilnius University Hospital Santaros Klinikos.

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.

Risk factors during first 1,000 days of life for carotid intima-media thickness in infants, children, and adolescents: A systematic review with meta-analyses.

The first 1,000 days of life, i.e., from conception to age 2 years, could be a critical period for cardiovascular health. Increased carotid intima-media thickness (CIMT) is a surrogate marker of atherosclerosis. We performed a systematic review with meta-analyses to assess (1) the relationship between exposures or interventions in the first 1,000 days of life and CIMT in infants, children, and adolescents; and (2) the CIMT measurement methods. Systematic searches of Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica database (EMBASE), and Cochrane Central Register of Controlled Trials (CENTRAL) were performed from inception to March 2019. Observational and interventional studies evaluating factors at the individual, familial, or environmental levels, for instance, size at birth, gestational age, breastfeeding, mode of conception, gestational diabetes, or smoking, were included. Quality was evaluated based on study methodological validity (adjusted Newcastle-Ottawa Scale if observational; Cochrane collaboration risk of bias tool if interventional) and CIMT measurement reliability. Estimates from bivariate or partial associations that were least adjusted for sex were used for pooling data across studies, when appropriate, using random-effects meta-analyses. The research protocol was published and registered on the International Prospective Register of Systematic Reviews (PROSPERO; CRD42017075169). Of 6,221 reports screened, 50 full-text articles from 36 studies (34 observational, 2 interventional) totaling 7,977 participants (0 to 18 years at CIMT assessment) were retained. Children born small for gestational age had increased CIMT (16 studies, 2,570 participants, pooled standardized mean difference (SMD): 0.40 (95% confidence interval (CI): 0.15 to 0.64, p: 0.001), I2: 83%). When restricted to studies of higher quality of CIMT measurement, this relationship was stronger (3 studies, 461 participants, pooled SMD: 0.64 (95% CI: 0.09 to 1.19, p: 0.024), I2: 86%). Only 1 study evaluating small size for gestational age was rated as high quality for all methodological domains. Children conceived through assisted reproductive technologies (ART) (3 studies, 323 participants, pooled SMD: 0.78 (95% CI: -0.20 to 1.75, p: 0.120), I2: 94%) or exposed to maternal smoking during pregnancy (3 studies, 909 participants, pooled SMD: 0.12 (95% CI: -0.06 to 0.30, p: 0.205), I2: 0%) had increased CIMT, but the imprecision around the estimates was high. None of the studies evaluating these 2 factors was rated as high quality for all methodological domains. Two studies evaluating the effect of nutritional interventions starting at birth did not show an effect on CIMT. Only 12 (33%) studies were at higher quality across all domains of CIMT reliability. The degree of confidence in results is limited by the low number of high-quality studies, the relatively small sample sizes, and the high between-study heterogeneity. In our meta-analyses, we found several risk factors in the first 1,000 days of life that may be associated with increased CIMT during childhood. Small size for gestational age had the most consistent relationship with increased CIMT. The associations with conception through ART or with smoking during pregnancy were not statistically significant, with a high imprecision around the estimates. Due to the large uncertainty in effect sizes and the limited quality of CIMT measurements, further high-quality studies are needed to justify intervention for primordial prevention of cardiovascular disease (CVD).

Maternal diabetes during pregnancy and carotid intima-media thickness in children

Abstract Background Cardiovascular risk over the life course may be related to intrauterine risk factors, for instance, the exposure to maternal diabetes. Our objective was to systematically review studies that assessed the association of maternal diabetes during pregnancy and carotid-intima media thickness (CIMT), a marker of cardiovascular risk, in children. Methods We followed methods outlined in a published protocol for a systematic review on risk factors and determinants of CIMT in children (PROSPERO registration: CRD42017075169). Standardized mean differences in CIMT between offspring of women with and without diabetes during pregnancy were computed. Random effects meta-analyses were performed. The reliability of CIMT measurements was assessed. Funding SNSF 32003B-163240. Results Three observational studies involving 658 children were retained. Two studies were conducted in Europe and one in Australia. Age at CIMT assessment ranged from 2 days to 8 years. Two studies evaluated gestational diabetes during pregnancy and found no difference in CIMT among exposed children compared to controls (0.00 (95% CI: -0.41 to 0.41); 0.00 (95% CI; -0.28 to 0.28)). One study, that did not specify the type of diabetes evaluated, identified a higher CIMT (0.46 (95% CI; -0.07 to 1.00)). The pooled standardized mean difference in CIMT between offspring of women with and without diabetes during pregnancy was 0.08 (95% CI: -0.16 to 0.33; I2: 17.1%). Conclusions Overall, there is no clear association between maternal diabetes during pregnancy and offspring's CIMT. The degree of confidence in results is limited by the low number of studies, with relatively small sample sizes and a low number of participants exposed to maternal diabetes. Key messages Children exposed to maternal diabetes have no substantial alterations in vascular structure. More research is needed to inform primordial prevention of cardiovascular disease among these children.

Association of exposure to phthalates with cardiometabolic risk factors in children and adolescents: a systematic review and meta-analysis.

Recent studies revealed controversial results on the association of exposure to phthalates with cardiometabolic risk factors in children and adolescents. Therefore, this systematic review and meta-analysis was conducted in this regard. At first, we searched English-language papers in Scopus, Web of Science, and PubMed databases, with no restriction of time, till the end of the year 2018. We performed a comprehensive literature search for association between phthalate exposure and cardiometabolic risk factors including obesity, hypertension, hyperglycemia, and dyslipidemia. Among 99 published papers found in scientific databases, 17 cohort, 15 cross-sectional, and three case-control studies were included in the meta-analysis. We observed a significant association between the concentrations of phthalates and their metabolites with body mass index (BMI), BMI z-score, waist circumference (WC), and low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), and glucose in serum. In addition, significant association was observed between prenatal phthalate exposure and birth weight. To the best of our knowledge, this is the first meta-analysis of its kind. It shows positive association between phthalate exposure and some cardiometabolic risk factors in children and adolescents. Therefore, prevention of exposure to phthalates and reduction of their use should be underscored in strategies for primordial prevention of cardiovascular diseases. Recent studies revealed controversial results on the association of exposure to phthalates with cardiometabolic risk factors in children and adolescents. Therefore, this systematic review and meta-analysis was conducted in this regard.

Dynamic prediction of childhood high blood pressure in a population-based birth cohort: a model development study

ObjectivesTo develop a dynamic prediction model for high blood pressure at the age of 9–10 years that could be applied at any age between birth and the age of 6...

Ideal cardiovascular health in childhood—Longitudinal associations with cardiac structure and function: The Special Turku Coronary Risk Factor Intervention Project (STRIP) and the Cardiovascular Risk in Young Finns Study (YFS)

BackgroundIdeal cardiovascular health (CVH), defined by the American Heart Association, is associated with incident cardiovascular disease in adults. However, association of the ideal CVH in childhood with current and future cardiac structure and function has not been studied. Methods and resultsThe sample comprised 827 children participating in the longitudinal Special Turku Coronary Risk Factor Intervention Project (STRIP) and The Cardiovascular Risk in Young Finns Study (YFS). In STRIP, complete data on the seven ideal CVH metrics and left ventricular (LV) mass measured with echocardiography were available at the age of 15 (n=321), 17 (n=309) and 19 (n=283) years. In YFS, the cohort comprised children aged 12–18years (n=506) with complete ideal CVH metrics data from childhood and 25years later in adulthood, and echocardiography performed in adulthood. In STRIP, ideal CVH score was inversely associated with LV mass during childhood (P=0.036). In YFS, childhood ideal CVH score was inversely associated with LV mass, LV end-diastolic volume, E/e′ ratio, and left atrium end-systolic volume in adulthood (all P<0.01). In addition, improvement of the ideal CVH score between childhood and adulthood was inversely associated with LV mass, LV end-diastolic volume, E/e′ ratio, and left atrium end-systolic volume (all P≤0.03). ConclusionsChildhood ideal CVH score has a long-lasting effect on cardiac structure and function, and the association is evident already in childhood. Our findings support targeting the ideal CVH metrics as part of primordial prevention of cardiovascular diseases.

Alarming trends in ideal cardiovascular health among children and adolescents in Beijing, China, 2004 to 2014

BackgroundThe American Heart Association's 2020 Strategic Goals have defined a new concept of cardiovascular health for adults and children, emphasizing the importance of primordial prevention of cardiovascular diseases. However, detailed data on the trends of ideal cardiovascular health in Chinese children and adolescents are sparse. MethodsA total of 5596 children and adolescents (aged 6–18years) were selected from two cross-sectional surveys conducted in 2004 and 2014, respectively. Cardiovascular health behaviors (smoking, body mass index, physical activity, and diet) and factors (total cholesterol, blood pressure, and glucose) were evaluated, and only participants with information on all 7 metrics (n=4309) were included for the cardiovascular score analysis. ResultsDuring 2004–2014, ideal levels of almost all the seven metrics decreased, except for a marked increase in physical activity (boys: 23.0% vs 52.8%; girls: 16.2% vs 41.0%). Overall, only 19.5% of boys and 22.0% of girls had ideal cardiovascular health (score≥6) in 2004, which worsened in 2014 (boys: 9.8%; girls: 16.0%). The prevalence of ideal cardiovascular health factors also declined, but the prevalence of ideal cardiovascular health behaviors increased. Being a girl and having a younger age (aged 6–11years) were associated with higher prevalence of ideal cardiovascular health. Higher family income and parental education were associated with a higher prevalence of ideal cardiovascular health behaviors. ConclusionAdverse trends in ideal cardiovascular health were observed among Chinese children and adolescents during 2004–2014. Effective intervention programs, in particular targeting children and adolescents, need to be developed to promote cardiovascular health in China.

The Role of Healthy Lifestyle in the Primordial Prevention of Cardiovascular Disease.

Whereas primary prevention seeks to forestall development of disease in individuals with elevated risk, primordial prevention seeks to preempt the development of risk factors. Health behaviors-characterized as "lifestyle" factors-are key interventional targets in primordial prevention of cardiovascular disease. Appropriate dietary intake, including limiting salt and saturated fat consumption, can reduce the risk of developing hypertension and dyslipidemias. Regular physical activity is associated with lower blood pressure and healthier lipid profiles. Diet and exercise are critical to maintaining weight conducive to cardiovascular health. Behavioral factors such as stress management, sleep duration, portion control, and meal timing may play a role in weight management and offer additional routes of intervention. Any smoking elevates cardiovascular risk. Although lifestyle modification programs can be instrumental in reaching public health goals, maintaining cardiovascular health should not be a matter solely of willpower. Ideally, structural and social forces should make healthy lifestyles the default option.

Behavioral Cardiovascular Risk Factors - Effect of Physical Activity and Cardiorespiratory Fitness on Cardiovascular Outcomes.

Primary and primordial prevention of cardiovascular disease (CVD) requires not only identification of risk factors, but also appropriate and timely therapy. In order to prevent the expected increase in prevalence of CVD, it is essential that clinicians are aware of behavioral cardiovascular risk factors. A basic review is critical to clarify the difference between physical activity and fitness, as well as to discuss the role each plays in cardiovascular outcomes. We discuss observational epidemiological studies and randomized control trials that have examined the effect of physical activity and cardiorespiratory fitness on CVD.

Abstract 25: Adolescent Diet Quality and Primordial Prevention of Cardiovascular Disease in the Nurses’ Health Study II

Background: Current clinical practice focuses on primary prevention of CVD through modification of clinical risk factors, such as high cholesterol, hypertension and diabetes. The absence of established risk factors at mid-life is associated with a low long-term risk of CVD. Previously, a healthy lifestyle in young adulthood was associated with a low CVD risk profile at mid-life. Whether a high quality diet in adolescence can prevent development of CVD risk factors in adulthood is unknown. Methods: As part of the Nurses’ Health Study II, which included women aged 25-42 at recruitment in 1989, women completed a validated high school food frequency questionnaire, reflecting intake in grades 9-12, in 1998. Diet quality was defined by a modified Alternative Healthy Eating Index (AHEI-hs), where high scores reflect a diet high in fruits, vegetables, whole grains and unsaturated fats and low in red/processed meat, sugar sweetened beverages and trans fat. Physician-diagnosed clinical risk factors (hypertension, high cholesterol, diabetes) were assessed every 2 years. We assessed the relation between the AHEI-hs and time-to-first-development of any risk factor in 28,284 women who were free of diagnosed clinical risk factors in 1998 (mean age 43). We also explored the AHEI-hs in relation to risk of CVD (CHD or ischemic stroke) in 43,721 women who were free from CVD, but not necessarily risk factors, in 1998 (mean age 44). Cox proportional hazards models were adjusted for potential confounders in high school (BMI, energy, smoking, physical activity) and adulthood (smoking, physical activity, oral contraceptives, postmenopausal hormones, aspirin use, energy, alcohol, family history of disease). Results: From 1998 through 2011, 11,328 risk factors and 520 CVD events were documented. After adjustment for high school and adult confounders, higher AHEI-hs scores were associated with a lower rate of diagnosed risk factors (HR comparing quartile 4 to 1: 0.84, 95% CI 0.80,0.89, p trend &lt;0.001). Further adjustment for adult diet quality did not alter results appreciably. A higher AHEI-hs was also associated with lower risk of CVD (HR comparing quartile 4 to 1: 0.77, 95% CI 0.60, 0.99, p trend = 0.03), but not after adjustment for adult confounders and adult diet quality (HR 0.98, 95% CI 0.75, 1.27, p trend = 0.85). Compared to women in the lowest tertiles of AHEI scores in high school and adulthood, women in the highest tertiles at both time points had a lower risk of developing a CVD risk factor (HR 0.78, 95% CI 0.73, 0.84) and of CVD (HR: 0.70, 95% CI 0.50, 0.97). Conclusions: A high quality diet during adolescence was associated with lower risk of developing clinical CVD risk factors in adulthood, and maintenance of good dietary habits throughout early adulthood was most strongly associated with lower risk of CVD. For ideal cardiovascular health, healthy diet habits should begin in early life and continue through adulthood.

Can Prevention of Low Birth Weight in Newborn may be Associated with Primordial Prevention of Cardiovascular Diseases and Type 2 Diabetes in Adult Life?

Poor nutrition during pregnancy may be a risk factor for low birth weight and for irreversible health issues including obesity, type 2 diabetes, hypertension and hypercholesterolemia in adult life. Low birth weight has also been related to greater mortality from coronary artery disease(CAD) and type 2 diabetes in adult life. One earlier study from Northern Europe proposed that poor social conditions in childhood may be risk factor for obesity, diabetes and cardiovascular diseases (CVDs) in later life. It is possible that multiple confounders related to energy and micronutrient deficiencies may be interacting in the process of adaptations in critical time periods, during fetal, postnatal and child development. A review of literature on the effects on birth size and length of babies and of multiple micronutrient supplementation during pregnancy in low-income countries indicates that incidence of low birth weight may be decreased by supplementation of about 15 micronutrients. This finding poses the possibility that for prevention of low birth weight, maternal micronutrient supplementation (15-20 nutrients) may be an important strategy. It is proposed that this strategy may lead the prevention of CVDs and type 2 diabetes in adult life. Cohort studies and long term follow up population based trials are needed to confirm this hypothesis.