Ideal cardiovascular health predicts lower risks of myocardial infarction, stroke, and vascular death across whites, blacks, and hispanics: the northern Manhattan study

Status of cardiovascular health among adults in a rural area of Northwest China: Results from a cross-sectional study

The aim of this study was to assess the status of cardiovascular health among a rural population in Northwest China and to determine the associated factors for cardiovascular health.A population-based cross-sectional study was conducted in the rural areas of Hanzhong in Northwest China. Interview, physical examination, and fasting blood glucose and lipid measurements were completed for 2693 adults. The construct of cardiovascular health and the definitions of cardiovascular health metrics proposed by the American Heart Association were used to assess cardiovascular health. The proportions of subjects with cardiovascular health metrics were calculated, adjusting for age and sex. The multiple logistic regression model was used to evaluate the association between ideal cardiovascular health and its associated factors.Only 0.5% (0.0% in men vs 0.9% in women, P = 0.002) of the participants had ideal cardiovascular health, whereas 33.8% (18.0% in men vs 50.0% in women, P < 0.001) and 65.7% (82.0% in men vs 49.1% in women, P < 0.001) of the participants had intermediate and poor cardiovascular health, respectively. The prevalence of poor cardiovascular health increased with increasing age (P < 0.001 for trend). Participants fulfilled, on average, 4.4 (95% confidence interval: 4.2-4.7) of the ideal cardiovascular health metrics. Also, 22.2% of the participants presented with 3 or fewer ideal metrics. Only 19.4% of the participants presented with 6 or more ideal metrics. 24.1% of the participants had all 4 ideal health factors, but only 1.1% of the participants had all 4 ideal health behaviors. Women were more likely to have ideal cardiovascular health, whereas adults aged 35 years or over and those who had a family history of hypertension were less likely to have ideal cardiovascular health.The prevalence of ideal cardiovascular health was extremely low among the rural population in Northwest China. Most adults, especially men and the elderly, had a poor cardiovascular health status. To improve cardiovascular health among the rural population, efforts, especially lifestyle improvements, education and interventions to make healthier food choices, reduce salt intake, increase physical activities, and cease smoking, will be required at the individual, population, and social levels.

Comparison of risk scores for the prediction of stroke in African Americans: Findings from the Jackson Heart Study

BACKGROUND

Evidence from existing cohort studies supports the prediction of incident coronary heart disease and stroke using 10-year cardiovascular disease (CVD) risk scores and the American Heart Association/American Stroke Association's cardiovascular health (CVH) metric.

METHODS

We included all Jackson Heart Study participants with complete scoring information at the baseline study visit (2000-2004) who had no history of stroke (n = 4,140). We used Kaplan-Meier methods to calculate the cumulative incidence of stroke and used Cox models to estimate hazard ratios and 95% CIs for stroke according to CVD risk and CVH score. We compared the discrimination of the 2 models according to the Harrell c index and plotted predicted vs observed stroke risk calibration plots for each of the 2 models.

RESULTS

The median age of the African American participants was 54.5 years, and 65% were female. The cumulative incidence of stroke increased across worsening categories of CVD risk and CVH. A 1-unit increase in CVD risk increased the hazard of stroke (1.07, 1.06-1.08), whereas each 1-unit increase in CVH corresponded to a decreased hazard of stroke (0.76, 0.69-0.83). As evidenced by the c statistics, the CVH model was less discriminating than the CVD risk model (0.59 [0.55-0.64] vs 0.79 [0.76-0.83]).

CONCLUSIONS

Both scores were associated with incident stroke in a dose-response fashion; however, the CVD risk model was more discriminating than the CVH model. The CVH score may still be preferable for its simplicity in application to broad patient populations and public health efforts.

Life's Simple 7's Cardiovascular Health Metrics are Associated with Hispanic/Latino Neurocognitive Function: HCHS/SOL Results

BACKGROUND

Hispanics/Latinos are purportedly at increased risk for neurocognitive decline and dementias. Without dementia cures, low-cost, well-tolerated public health means for mitigating neurocognitive decline are needed.

OBJECTIVE

We examined associations between neurocognition and cardiovascular health (CVH) metrics (Life's Simple 7; LS7) among diverse Hispanics/Latinos. We hypothesized that higher LS7 would be associated with healthier brain function (neurocognitive performance).

METHODS

We used baseline (2008-2011) Hispanic Community Health Study/Study of Latinos (HCHS/SOL; N = 9,623; ages 45-74 years) to examine neurocognition in relation to CVH LS7 scores.

RESULTS

In age and sex adjusted models, a one unit LS7 score increase (range = 0-14) was associated with higher neurocognitive function on the B-SEVLT sum (0.23 [p < 0.01]; range = 3-42), B-SEVLT recall (0.12 [p < 0.01]; range = 0-15), Word Fluency (phonemic; 0.46 (p < 0.01); range = 0-49), and Digit Symbol Substitution (0.49 (p < 0.01); range = 0-83) tests, respectively. Stated differently, a change from the minimum LS7 (0) to maximum LS7 (14) score corresponded to higher scores on verbal learning (4.62) and memory (2.24), verbal fluency (7.0), and psychomotor processing speed (12). In fully adjusted models the associations were attenuated, but remained statistically significant. Incremental adjustments indicated that Latino background and, to a lesser extent, education were primary contributors to the evinced attenuations.

CONCLUSIONS

We found that higher neurocognitive function was associated with better LS7 CVH metrics among middle-aged and older Hispanics/Latinos. Associations between neurocognitive function and LS7 were strongest among two at-risk groups for neurocognitive decline and dementia, women and Hispanics/Latinos with lower education. Public health efforts to reduce cardiovascular disease morbidity and mortality may have additional neurocognitive benefits among at-risk Hispanics/Latinos.

Association between ideal cardiovascular health and the atherogenic index of plasma

The American Heart Association aims to improve cardiovascular health by encouraging the general population to meet 7 cardiovascular health behaviors and factors. The atherogenic index of plasma (AIP) is an important index. Our aim is to evaluate the relationship between ideal cardiovascular health and the atherogenic index of plasma (AIP) in middle-aged Chinese men.A cross-sectional study was performed. A total of 27,824 middle-aged Chinese men were enrolled. The association between ideal cardiovascular health behaviors and factors and AIP was determined. The 7 cardiovascular health metrics were scored as follows: 0, poor; 1, general; and 2, ideal. The cardiovascular health status was classified according to the total score, as follows: 0 to 4, inadequate; 5 to 9, average; and 10 to 14, optimum. Analyses assessed the prevalence of 7 cardiovascular health metrics, its association with AIP. Logistic regression models were used to calculate odds ratios (ORs), adjusting for age.All 7 cardiovascular health metrics were shown to correlate with AIP (all P values < 0.05), and the strongest correlation existed between body mass and AIP, followed by total cholesterol and AIP. The mean AIP level increased with the decrease in the score of each of the 7 cardiovascular health metrics (all P values < 0.05). The subjects with poor cardiovascular health status had a 4.982-fold increase in the high risk of developing atherosclerosis, whereas a 1-point increase in the cardiovascular health score resulted a 0.046 reduction in AIP and a 22.3% reduction in the high-risk of developing atherosclerosis (OR = 0.777, 95% CI: 0.768-0.787).The ideal cardiovascular health score correlated significantly with AIP, and a 1-point increase in the cardiovascular health score led to a 0.046 reduction in AIP and a 22.3% reduction in the high risk of developing atherosclerosis. These validated the value of ideal cardiovascular health behaviors and factors in the prediction of high risk of developing cardiovascular diseases. Ideal cardiovascular health metrics are of great realistic significance for the prevention and control of atherosclerosis and cardiovascular diseases.

Cardiovascular health among diverse Hispanics/Latinos: Hispanic Community Health Study/Study of Latinos (HCHS/SOL) results

BACKGROUND

Seven national 2020 Strategic Impact Goals for cardiovascular health (Life's Simple 7 [LS7]) estimates for major ethnic/racial groups are available, but not for diverse Hispanics/Latinos. Herein, we describe and examine LS7 profiles of diverse Hispanic/Latino groups.

METHODS

HCHS/SOL (analytic n = 15,825; ages 18-74 years) data were used to estimate LS7 metrics. LS7 metrics were operationalized as Ideal, Intermediate, or Poor and indexed as an additive score. We calculated Hispanic/Latino group and sex-specific prevalence estimates for LS7 metrics and used survey-based regression models to examine (1) associations between LS7 scores and pertinent sociocultural characteristics and (2) relationships between LS7 scores and coronary heart disease, and stroke and transient ischemic attacks prevalence.

RESULTS

Few HCHS/SOL participants met all 7 Ideal LS7 criteria (<1%), and a similarly small proportion did not meet any Ideal LS7 criteria (1.1%). We found significant variability in LS7 distributions between men and women and across HCHS/SOL Hispanic/Latino heritages. We also found a substantial sex-adjusted age gradient in LS7 cardiovascular health (ie, ≥4 Ideal LS7s). Finally, higher Ideal LS7 scores were associated with decreased odds of both coronary heart disease and self-reported stroke/transient ischemic attack; these associations persisted after model covariate adjustments.

CONCLUSIONS

Hispanic/Latino LS7s compared favorably with existing national estimates; however, we found areas for improvement. Several Hispanic/Latino LS7 strengths and weaknesses varied by sex and heritage, providing important information to guide targeted health promotion efforts toward achieving 2020 goals.

A Systematic Review of the Prevalence and Outcomes of Ideal Cardiovascular Health in US and Non-US Populations

Several population-based studies have examined the prevalence and trends of the American Heart Association's ideal cardiovascular health (CVH) metrics as well as its association with cardiovascular disease (CVD)-related morbidity and mortality and with non-CVD outcomes. However, no efforts have been made to aggregate these studies. Accordingly, we conducted a systematic review to synthesize available data on the distribution and outcomes associated with ideal CVH metrics in both US and non-US populations. We conducted a systematic search of relevant studies in the MEDLINE and CINAHL databases, as well as the Cochrane Register of Controlled Trials (CENTRAL). Search terms used included "life's simple 7", "AHA 2020" and "ideal cardiovascular health". We included articles published in English Language from January 1, 2010, to July 31, 2015. Of the 14 US cohorts, the prevalence of 6 to 7 ideal CVH metrics ranged from as low as 0.5% in a population of African Americans to 12% in workers in a South Florida health care organization. Outside the United States, the lowest prevalence was found in an Iranian study (0.3%) and the highest was found in a large Chinese corporation (15%). All 6 mortality studies reported a graded inverse association between the increasing number of ideal CVH metrics and the all-cause and CVD-related mortality risk. A similar relationship between ideal CVH metrics and incident cardiovascular events was found in 12 of 13 studies. Finally, an increasing number of ideal CVH metrics was associated with a lower prevalence and incidence of non-CVD outcomes such as cancer, depression, and cognitive impairment. The distribution of ideal CVH metrics in US and non-US populations is similar, with low proportions of persons achieving 6 or more ideal CVH metrics. Considering the strong association of CVH metrics with both CVD and non-CVD outcomes, a coordinated global effort for improving CVH should be considered a priority.

Immigrant status and cardiovascular risk over time: results from the Multi-Ethnic Study of Atherosclerosis

PURPOSE

Despite cross-sectional evidence that foreign-born United States (US) residents often have better health than US-born residents of similar race and/or ethnicity, we know little about overall cardiovascular risk progression over time among immigrants as they age in the US.

METHODS

Using longitudinal data from the Multiethnic Study of Atherosclerosis on 6446 adults aged 45-84 years at baseline, we examined how nativity and length of US residence related to change in cardiovascular health (CVH) and cardiovascular event incidence over 11-year follow-up. CVH was measured using the American Heart Association's CVH measure (range, 0-14; higher is better).

RESULTS

Immigrants, particularly those with shorter US residence, had better baseline CVH and lower cardiovascular event incidence than the US born. Baseline CVH scores ranged from 8.67 (8.42-8.92) among immigrants living in the US less than 10 years to 7.86 (7.76-7.97) among the US born. However, recent immigrants experienced the largest CVH declines over time: 10-year declines ranged from -1.04 (-1.27 to -0.80) among immigrants living in the US less than 10 years at baseline to -0.47 (-0.52 to -0.42) among the US born.

CONCLUSIONS

Public health prevention efforts targeting new immigrants may help slow the deterioration of CVH and reduce future cardiovascular risk.

Status of cardiovascular health in Chinese adults

BACKGROUND

Cardiovascular disease has become the leading cause of death in China.

OBJECTIVES

The goal of this study was to evaluate the current status of cardiovascular health in Chinese adults.

METHODS

Cardiovascular health data were collected from a nationally representative sample of 96,121 Chinese adults age ≥ 20 years in 2010. Ideal cardiovascular health was defined according to the American Heart Association's 2020 Strategic Impact Goals as follows: the simultaneous presence of 4 favorable health behaviors (ideal smoking status, ideal body mass index, physical activity at goal, and healthy dietary habits) and 4 favorable health factors (ideal smoking status, untreated total cholesterol <200 mg/dl, untreated blood pressure <120/<80 mm Hg, and untreated fasting plasma glucose <100 mg/dl) in the absence of a history of cardiovascular disease.

RESULTS

The estimated percentage of ideal cardiovascular health was 0.2% in the general adult population in China (0.1% in men and 0.4% in women). An estimated 0.7% (0.4% in men and 1.0% in women) of Chinese adults had all 4 ideal health behaviors, and 13.5% (5.0% in men and 22.3% in women) had all 4 ideal health factors. Men most frequently had 3 to 4 ideal components, and women most commonly had 4 to 5 ideal components of the 7 cardiovascular health metrics. Ideal diet (1.6%) was the least common among all cardiovascular health metrics. Female sex and younger age were the 2 most common protective factors for cardiovascular health in Chinese adults.

CONCLUSIONS

The percentage of ideal cardiovascular health in Chinese adults is extremely low. Both population-wide and high-risk strategies should be implemented with great effort to promote cardiovascular health in China.

Assessing Cardiovascular Health Using Life's Simple 7 in a Chinese Population Undergoing Stroke Prevention

Background:

The American Heart Association/American Stroke Association proposed a metric called Life's Simple 7 (LS7) to define cardiovascular health (CVH). The presence of a large number of ideal components of CVH is associated with lower cardiovascular disease and all-cause mortality. We aimed to assess CVH using LS7 in a Chinese population undergoing primary and secondary stroke prevention.

Methods:

Patients with either ischemic stroke or cardiovascular risk factors were enrolled in the study from October 2010 to July 2013. LS7 components were scored as poor (0 points), intermediate (1 point), or ideal (2 points). The overall LS7 score was categorized as inadequate (0–4), average (5–9), or optimal (10–14) CVH. The Chi-square test, Mann–Whitney U-test, and Kruskal–Wallis test were used.

Results:

In total, 706 patients were enrolled. (1) The distribution of the overall LS7 score (n = 255) indicated that 9.4%, 82.4%, and 8.2% of the patients had inadequate, average, and optimal CVH, respectively. The proportion of patients with optimal CVH undergoing secondary stroke prevention was lower than that for patients undergoing primary stroke prevention (3.8% vs. 12.8%, P = 0.005). The vast majority of participants (76.1%) presented with ≤2 ideal health components. (2) The proportions of patients with poor, intermediate, and ideal status, respectively, for the following LS7 components were assessed: Total cholesterol (n = 275; 5.1%, 73.8%, and 21.1%), blood pressure (n = 351; 32.5%, 59.0%, and 8.5%), blood glucose (n = 280; 9.3%, 39.6%, and 51.1%), physical activity (n = 540; 90.7%, 8.7%, and 0.6%), diet (n = 524; 0.2%, 92.4%, and 7.4%), smoking (n = 619; 20.7%, 2.9%, and 76.4%), and body mass index (n = 259; 6.6%, 35.5%, and 57.9%).

Conclusions:

Few Chinese patients undergoing stroke prevention had optimal CVH (determined using LS7). Additionally, fewer patients undergoing secondary prevention had optimal CVH than those undergoing primary prevention. In particular, physical activity and diet status in this population require improvement.

Association of Ideal Cardiovascular Health With Vascular Brain Injury and Incident Dementia

BACKGROUND AND PURPOSE

The American Heart Association developed the ideal cardiovascular health (CVH) index as a simple tool to promote CVH; yet, its association with brain atrophy and dementia remains unexamined.

METHODS

Our aim was to investigate the prospective association of ideal CVH with vascular brain injury, including the 10-year risks of incident stroke and dementia, as well as cognitive decline and brain atrophy on magnetic resonance imaging, measured for ≈7 years. We studied 2750 stroke- and dementia-free Framingham Heart Study Offspring cohort participants (mean age, 62±9 years; 45% men). Ideal CVH was quantified on a 7-point scale with 1 point awarded for each of the following: nonsmoking status, ideal body mass index, regular physical activity, healthy diet, as well as optimum blood pressure, cholesterol, and fasting blood glucose. Both recent (baseline) and remote (6.9 years earlier) ideal CVH scores were examined.

RESULTS

Recent ideal CVH was associated with stroke (hazard ratio, 0.80; 95% confidence interval, 0.67-0.95), vascular dementia (hazard ratio, 0.49; 95% confidence interval, 0.30-0.81), frontal brain atrophy (P=0.003), and cognitive decline on tasks measuring visual memory and reasoning (P<0.05). In addition to predicting stroke, vascular dementia, whole-brain atrophy, and cognitive decline, remote ideal CVH was associated with the incidence of all-cause dementia (hazard ratio, 0.80; 95% confidence interval, 0.67-0.97) and Alzheimer disease (hazard ratio, 0.79; 95% confidence interval, 0.64-0.98).

CONCLUSIONS

Adherence to the American Heart Association's ideal CVH factors and behaviors, particularly in midlife, may protect against cerebrovascular disease and dementia.

Fostering African-American Improvement in Total Health (FAITH!): An Application of the American Heart Association's Life's Simple 7™ among Midwestern African-Americans

OBJECTIVE

African-Americans have a strikingly low prevalence of ideal cardiovascular health metrics of the American Heart Association's Life's Simple 7 (LS7). This study was conducted to assess the impact of a community-based cardiovascular disease prevention intervention on the knowledge and achievement of cardiovascular health metrics among a marginalized African-American community.

METHODS

Adult congregants (n = 37, 70 % women) from three African-American churches in Rochester, MN, participated in the Fostering African-American Improvement in Total Health (FAITH!) program, a theory-based, culturally-tailored, 16-week education series incorporating the American Heart Association's LS7 framework. Feasibility testing included assessments of participant recruitment, program attendance, and retention. We classified participants according to definitions of ideal, intermediate, and poor cardiovascular health based on cardiac risk factors and health behaviors and calculated an LS7 score (range 0 to 14) at baseline and post-intervention. Knowledge of cardiac risk factors was assessed by questionnaire. Main outcome measures were changes in cardiovascular health knowledge and cardiovascular health components related to LS7 from baseline to post-intervention. Psychosocial measures included socioeconomic status, outlook on life, self-reported health, self-efficacy, and family support.

RESULTS

Thirty-six out of 37 recruited participants completed the entire program including health assessments. Participants attended 63.5 % of the education series and attendance at each session was, on average, 62 % of those enrolled. There was a statistically significant improvement in cardiovascular health knowledge (p < 0.02). A higher percentage of participants meeting either ideal or intermediate LS7 score categories and a lower percentage within the poor category were observed. Higher LS7 scores correlated with higher psychosocial measures ratings.

CONCLUSIONS

Although small, our study suggests that the FAITH! program is a feasible, community intervention promoting ideal cardiovascular health that has the potential to improve cardiovascular health literacy and LS7 among African-Americans.

Which Measures of Health Status Assessment are the Most Significant in Organized Cohorts with Low Current Cardiovascular Risk? The Screening Study of Penitentiary Staff in Saratov Region, Russia

OBJECTIVE

The aim of the present study was to compare different methods of health status assessment in organized cohort of penitentiary employees in Saratov Region, Russian Federation.

MATERIALS AND METHODS

1,014 penitentiary employees (81.8% male) aged 33.4±6.8 years were included in the cohort study. All participants underwent an annual preventive health examination in the Center of Medical and Social Rehabilitation of Russian Federal Penitentiary Service in Saratov Region. The prevalence of common cardiovascular risk factors was assessed. Risk Score and the number of fulfilled health metrics proposed by American Heart Association (AHA) were calculated for each participant.

RESULTS

It is shown that penitentiary staff in Saratov Region is characterized by low current risk score (1.2±0.8%), but high prevalence of such risk factors as increased body weight and obesity (51%), tobacco use or passive smoking (81%), and unhealthy diet (55%). 98.4% of participants had the Score level of ≤5%, but only 4.5% of penitentiary staff met the ideal cardiovascular health (they met all seven AHA health metrics). One fifth of the participants met three or less AHA health metrics. A statistically significant correlation between the risk Score and the number of fulfilled AHA health metrics is revealed (Chi-square = 5.1, p=0.024). The probability of fulfilment of less than 5 AHA health metrics in subjects with medium risk score is shown to be almost twofold greater than in subjects with low risk Score. However, there are a lot of differences in the assessment of cardiovascular health by risk Score and AHA health metrics.

CONCLUSION

AHA health metrics are more preferable than the risk Score or assessment of separate cardiovascular risk factors for preventive management in organized cohorts with low current cardiovascular risk such as penitentiary staff in Saratov Region.

Ideal Cardiovascular Health and Cognitive Aging in the Northern Manhattan Study

BACKGROUND

The 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 RESULTS

A 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.

CONCLUSIONS

The 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.

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.

Evidence to Maintain the Systolic Blood Pressure Treatment Threshold at 140 mm Hg for Stroke Prevention: The Northern Manhattan Study

In 2014, the Eighth Joint National Committee revised the target maximum systolic blood pressure (SBP) from 140 to 150 mm Hg in patients aged ≥60 years without diabetes mellitus or chronic kidney disease. The evidence from cohort studies supporting this change was sparse, particularly among US minority populations. In the Northern Manhattan Study, 1750 participants aged ≥60 years and free of stroke, diabetes mellitus, and chronic kidney disease had SBP measured at baseline and were annually followed up for incident stroke. Mean age at baseline was 72±8 years, 63% were women, 48% Hispanic, 25% non-Hispanic white, and 25% non-Hispanic black. Among all participants, 40% were on antihypertensive medications; 43% had SBP <140 mm Hg, 20% had 140 to 149 mm Hg, and 37% had ≥150 mm Hg. Over a median follow-up of 13 years, 182 participants developed stroke. The crude stroke incidence was greater among individuals with SBP≥150 mm Hg (10.8 per 1000 person-years) and SBP 140 to 149 (12.3) than among those with SBP<140 (6.2). After adjusting for demographics, vascular risk factors, diastolic BP, and medication use, participants with SBP 140 to 149 mm Hg had an increased risk of stroke (hazard ratio, 1.7; 95% confidence interval, 1.2-2.6) compared with those with SBP <140 mm Hg. The increased stroke risk was most notable among Hispanics and non-Hispanic blacks. Raising the SBP threshold from 140 to 150 mm Hg as a new target for hypertension treatment in older individuals without diabetes mellitus or chronic kidney disease could have a detrimental effect on stroke risk reduction, especially among minority US populations.

Ethnic Minorities and Coronary Heart Disease: an Update and Future Directions

Heart disease remains the leading cause of death in the USA. Overall, heart disease accounts for about 1 in 4 deaths with coronary heart disease (CHD) being responsible for over 370,000 deaths per year. It has frequently and repeatedly been shown that some minority groups in the USA have higher rates of traditional CHD risk factors, different rates of treatment with revascularization procedures, and excess morbidity and mortality from CHD when compared to the non-Hispanic white population. Numerous investigations have been made into the causes of these disparities. This review aims to highlight the recent literature which examines CHD in ethnic minorities and future directions in research and care.

Positive changes in ideal CVH metrics reduce the incidence of stroke

The American Heart Association defined 7 ideal cardiovascular health (CVH) metrics and the benefits of them in reducing the incidence of stroke are well established, but it is unclear whether changes in them alter stroke risk. We calculated the changes of 7 ideal CVH metrics from 2006 to 2008 among 64,373 participants in the Kailuan study. We tested whether changes in the numbers and total scores for the CVH metrics were associated with the incidence of stroke in the 4.89 person-years follow-up. Cox regression modeling was used to estimate the risk of stroke. By year 2008, CVH metrics number of 32.54% participants improved (change ≥+1); 31.90% deteriorated (≤−1); 35.56% stayed the same; In the follow-up,we identified1,182 incident stroke events. Each increase in CVH metrics and every 1-point increase in total CVH score from 2006 to 2008 were associated with reduced odds of total stroke (hazard ratio = 0.87; 95% confidence interval; 0.83–0.92 and 0.89[0.86–0.92] respectively), after adjusting for age, gender, educational level, income and scores for the metrics of ideal CVH at baseline. Positive changes in ideal CVH metrics reduce the incidence of stroke. Our results support the concept that achieving ideal CVH helps to prevent stroke.

One-year outcomes of an intense workplace cardio-metabolic risk reduction program among high-risk employees: The My Unlimited Potential

OBJECTIVE

This study details 6- and 12-month cardio-metabolic outcomes of an intense 12-week workplace lifestyle intervention program, the My Unlimited Potential (MyUP), conducted in a large healthcare organization.

METHODS

This study was conducted among 230 employees of Baptist Health South Florida with high cardiovascular disease (CVD) risk. Employees were considered at high risk and eligible for the study if they had two or more of the following cardio-metabolic risk factors: total cholesterol ≥ 200 mg/dl, systolic blood pressure (SBP) ≥ 140 mmHg or diastolic blood pressure (DBP) ≥ 90 mmHg, hemoglobin A1C (HbA1c) ≥ 6.5%, body mass index (BMI) ≥ 30 kg/m(2) .

RESULTS

At the end of 12 weeks, there was significant reduction in the mean BMI, SBP and DBP, serum lipids, and HbA1c among persons with diabetes. At 1 year, there was significant decline in the mean BMI, SBP and DBP, HbA1c, and high-sensitivity C-reactive protein, and in the prevalence of poor BP control, BMI ≥ 35 kg/m(2) , and abnormal HbA1c among all persons and those with diabetes.

CONCLUSIONS

This intensive 12-week lifestyle change program was successful at improving cardio-metabolic risk factors at 1 year. This study provides a template for other workplace programs aimed at improving CVD risk in high-risk employees.

Cardiovascular Health Status and Incidence of Heart Failure in the Framingham Offspring Study

BACKGROUND

The American Heart Association Cardiovascular Health (CVH) score is inversely associated with cardiovascular disease, but its relations to cardiac remodeling traits and heart failure (HF) incidence have not been examined.

METHODS AND RESULTS

A 14-point score was constructed for each participant based on the presence of poor, intermediate, or ideal status on each of the 7 CVH metrics (ideal score=14). We related the CVH score to echocardiographic traits cross-sectionally and to HF incidence prospectively in the Framingham Offspring Study. In age- and sex-adjusted models, a higher CVH score was associated with lower left ventricular (LV) mass, LV wall thickness, LV diastolic dimension, and left atrial dimension (P<0.01 for all; n=2392; mean age, 58 years; 56% women), and with a 12% to 15% lower odds of prevalent LV concentric remodeling and concentric hypertrophy, respectively (P<0.0001 for both). On follow-up (mean, 12.3 years), 188 incident HF events were observed in 3201 participants (mean age, 59 years; 53% women). In age- and sex-adjusted Cox proportional hazard models, the CVH score was inversely associated with HF incidence (hazard ratio per 1-point higher CVH score, 0.77; 95% confidence interval, 0.72-0.83). This association was partially attenuated upon adjustment for LV mass and interim myocardial infarction (hazard ratio, 0.84; 95% confidence interval, 0.76-0.93), and it was consistent for HF with preserved and reduced ejection fractions.

CONCLUSIONS

In our community-based sample, comprised predominantly of middle-aged white individuals of European descent, better CVH was associated with lower HF incidence, in part due to a lower prevalence of adverse cardiac remodeling.

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

BACKGROUND

The 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 RESULTS

We 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).

CONCLUSIONS

Achieving 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.

Health Insurance Status as a Barrier to Ideal Cardiovascular Health for U.S. Adults: Data from the National Health and Nutrition Examination Survey (NHANES)

Background

Little is known about the association between cardiovascular (CV) health and health insurance status. We hypothesized that U.S. adults without health insurance coverage would have a lower likelihood of ideal cardiovascular health.

Methods and Results

Using National Health and Nutrition Examination Survey (NHANES) data from 2007–2010, we examined the relationship between health insurance status and ideal CV health in U.S. adults aged ≥19 years and <65 (N = 3304). Ideal CV health was defined by the American Heart Association (AHA) as the absence of clinically manifested CV disease and the simultaneous presence of 6–7 “ideal” CV health factors and behaviors. Logistic regression modeling was used to determine the relationship between health insurance status and the odds of ideal CV health. Of the U.S. adult population, 5.4% attained ideal CV health, and 23.5% were without health insurance coverage. Those without health insurance coverage were more likely to be young (p<0.0001), male (p<0.0001), non-white (p<0.0001), with less than a high school degree (p<0.0001), have a poverty-to-income ratio less than 1 (p<0.0001) and unemployed (p<0.0001) compared to those with coverage. Lack of health insurance coverage was associated with a lower likelihood of ideal CV health; however, this relationship was attenuated by socioeconomic status.

Conclusions

U.S. adults without health insurance coverage are less likely to have ideal CV health. Population-based strategies and interventions directed at the community-level may be one way to improve overall CV health and reach this at-risk group.

Optimal Lifestyle Components in Young Adulthood Are Associated With Maintaining the Ideal Cardiovascular Health Profile Into Middle Age

BACKGROUND

Middle-aged adults with ideal blood pressure, cholesterol, and glucose levels exhibit substantially lower cardiovascular mortality than those with unfavorable levels. Four healthy lifestyle components-optimal body weight, diet, physical activity, and not smoking-are recommended for cardiovascular health (CVH). This study quantified associations between combinations of healthy lifestyle components measured in young adulthood and loss of the ideal CVH profile into middle age.

METHODS AND RESULTS

Analyses included 2164 young adults in the Coronary Artery Risk Development in Young Adults study with the ideal CVH profile (defined as untreated blood pressure <120/80 mm Hg, total cholesterol <200 mg/dL, fasting blood glucose <100 mg/dL, and absence of cardiovascular disease) at baseline. Cox proportional hazards regression models estimated hazard ratios for loss of the ideal CVH profile over 25 years according to 4 individual and 16 combinations of optimal healthy lifestyle components measured in young adulthood: body mass index, physical activity, nonsmoking status, and diet quality. Models were adjusted for age, sex, race, education, study center, and baseline blood pressure, cholesterol, and glucose. Eighty percent (n=1737) of participants lost the ideal CVH profile by middle age; loss was greatest for young adults with no optimal healthy lifestyle components at baseline. Relative to young adults with no optimal healthy lifestyle components, those with all 4 were less likely to lose the ideal CVH profile (hazard ratio 0.59, 95% CI 0.44-0.80). Combinations that included optimal body mass index and nonsmoking status were each associated with lower risk.

CONCLUSIONS

Optimal body mass index and not smoking in young adulthood were protective against loss of the ideal CVH profile through middle age. Importance of diet and physical activity may be included through their effects on healthy weight.

From Data to Action: Neuroepidemiology Informs Implementation Research for Global Stroke Prevention and Treatment

As a scientific field of study, neuroepidemiology encompasses more than just the descriptive study of the frequency, distribution, determinants and outcomes of neurologic diseases in populations. It also includes experimental aspects that span the full spectrum of clinical and population science research. As such, neuroepidemiology has a strong potential to inform implementation research for global stroke prevention and treatment. This review begins with an overview of the progress that has been made in descriptive and experimental neuroepidemiology over the past quarter century with emphasis on standards for evidence generation, critical appraisal of that evidence and impact on clinical and public health practice at the national, regional and global levels. Specific advances made in high-income countries as well as in low- and middle-income countries are presented. Gaps in implementation as well as evidence gaps in stroke research, stroke burden, clinical outcomes and disparities between developed and developing countries are then described. The continuing need for high quality neuroepidemiologic data in low- and middle-income countries is highlighted. Additionally, persisting disparities in stroke burden and care by sex, race, ethnicity, income and socioeconomic status are discussed. The crucial role that national stroke registries have played in neuroepidemiologic research is also addressed. Opportunities presented by new directions in comparative effectiveness and implementation research are discussed as avenues for turning neuroepidemiological insights into action to maximize health impact and to guide further biomedical research on neurological diseases.

Relationship between cardiovascular health score and year-to-year blood pressure variability in China: a prospective cohort study

OBJECTIVES

On the basis of cardiovascular health factors and behaviours, the American Heart Association proposed the Cardiovascular Health Score (CHS). It has been widely used to estimate the cardiovascular health status of individuals. The aim of this study was to investigate the relationship between CHS and year-to-year blood pressure variability (BPV).

DESIGN

Prospective cohort study.

SETTINGS

We stratified participants into two groups by gender: first group, female group; second group, male group. The relationship between CHS and year-to-year blood pressure variability were analysed.

PARTICIPANTS

A total of 41,613 individuals met the inclusion criteria (no history of stroke, transient ischaemic attack, myocardial infarction, malignant tumour or atrial fibrillation) and had complete blood pressure data.

RESULTS

The coefficient of the variation of systolic blood pressure (SCV) was 8.33% in the total population and 8.68% and 8.22% in female and male groups, respectively (p<0.05). Multivariable linear regression analysis revealed that higher CHS was inversely associated with increasing year-to-year BPV, which persisted after adjusting for baseline systolic blood pressure and other risk factors. Each SD increase in CHS could lead to a 0.016SD decrease in SCV (p<0.05).

CONCLUSIONS

In summary, CHS was inversely related to year-to-year BPV, which suggested that a healthy lifestyle may contribute to better blood pressure management.

Brain health and shared risk factors for dementia and stroke

Impaired brain health encompasses a range of clinical outcomes, including stroke, dementia, vascular cognitive impairment, cognitive ageing, and vascular functional impairment. Conditions associated with poor brain health represent leading causes of global morbidity and mortality, with projected increases in public health burden as the population ages. Many vascular risk factors are shared predictors for poor brain health. Moreover, subclinical brain MRI markers of vascular damage are risk factors shared between stroke and dementia, and can be used for risk stratification and early intervention. The broad concept of brain health has resulted in a conceptual shift from vascular risk factors to determinants of brain health. Global campaigns to reduce cardiovascular diseases by targeting modifiable risk factors are necessary and will have a broad impact on brain health. Research is needed on the distinct and overlapping aetiologies of brain health conditions, and to define MRI markers to help clinicians identify patients who will benefit from aggressive prevention measures.

Changes in Cardiovascular Health in the United States, 2003-2011

BACKGROUND

Cardiovascular disease is the leading cause of death in the United States, making improving cardiovascular health a key population health goal. As part of efforts to achieve this, the American Heart Association has developed the first comprehensive cardiovascular health index (CVHI). Our objective was to investigate the changes in CVHI in US states from 2003 to 2011.

METHODS AND RESULTS

CVHI was examined using Behavioral Risk Factor Surveillance System data between 2003 and 2011 (odd-numbered years). Total CVHI decreased from 3.73±0.01 in 2003 to 3.65±0.01 in 2009. The majority of states (88%) experienced a decline in CVHI and an increase in the prevalence of "poor" CVHI between 2003 and 2009. Among CVHI components, the highest prevalence of "ideal" was observed for blood glucose followed by smoking, whereas the lowest prevalence of "ideal" was observed for physical activity and diet. Between 2003 and 2009, prevalence of "ideal" smoking and diet status increased, while "ideal" prevalence of blood pressure, cholesterol, blood glucose, body mass index, and physical activity status decreased. We observed statistically significant differences between 2009 and 2011, outside the scope of the 2003-2009 trend, which we hypothesize are partially attributable to differences in sample demographic characteristics related to changes in Behavioral Risk Factor Surveillance System methodology.

CONCLUSIONS

Overall, CVHI decreased, most likely due to decreases in "ideal" blood pressure, body mass index, and cholesterol status, which may stem from low prevalence of "ideal" physical activity and diet status. These findings can be used to inform state-specific strategies and targets to improve cardiovascular health.

Ideal Cardiovascular Health During Adult Life and Cardiovascular Structure and Function Among the Elderly

BACKGROUND

A higher American Heart Association cardiovascular health score (CVHS) predicts a lower incidence of cardiovascular disease (CVD). However, the relationship of CVHS attainment through midlife to late life with CVD prevalence and cardiovascular structure and function in late life is not well described.

METHODS AND RESULTS

The following 6 ideal cardiovascular health metrics were assessed in the Atherosclerosis Risk in Communities (ARIC) study participants at 5 examination visits between 1987 and 2013: nonsmoking, body mass index <25 kg/m(2), untreated total cholesterol <200 mg/dL, untreated blood pressure <120/<80 mm Hg, fasting blood glucose <100 mg/dL, and ideal physical activity. Attainment over time was assessed as the percentage of maximum possible CVHS metrics achieved at visits 1 through 5, the slope of change in CVHS per decade of follow-up, and CVHS trajectory through follow-up. At visit 5, participant groups were characterized with respect to CVD prevalence (n=6520) and echocardiographic measures of cardiac structure and function (n=5903 free of CVD). CVHS was low at baseline and declined with age. Both greater CVHS attainment and improvement in CVHS during follow-up were associated with a lower prevalence of CVD and better left ventricular structure and systolic and diastolic function at visit 5.

CONCLUSIONS

Greater attainment of, and improvements in, ideal cardiovascular health through midlife to late life are associated with lower CVD prevalence and better cardiovascular structure and function when elderly. These findings highlight the importance of consistent primordial and primary prevention efforts throughout midlife to late life as a potential intervention to decrease the burden of CVD among the elderly.

Changes in cardiovascular health score and atherosclerosis progression in middle-aged and older persons in China: a cohort study

OBJECTIVES

The American Heart Association (AHA) proposed a definition of 4 cardiovascular health behaviours and 3 health factors. On the basis of the 7 metrics, the cardiovascular health score (CHS) was used to estimate individual-level changes in cardiovascular health status. The aim of this study was to investigate whether changes in CHS (⊿CHS) at different time-points are associated with atherosclerosis progression in middle-aged and older persons.

DESIGN

Prospective cohort study in China.

SETTINGS

We defined 8 groups (≤-4, -3, -2, -1, 0, 1, 2 and ≥ 3) according to ⊿CHS. The impact of ⊿CHS on the change of brachial-ankle pulse wave velocity (⊿baPWV) and atherosclerosis progression was analysed.

PARTICIPANTS

A total of 3951 individuals met the inclusion criteria (≥ 40 years old; no history of stroke, transient ischaemic attack or myocardial infarction) and had complete information.

RESULTS

⊿baPWV decreased gradually (126.46 ± 355.91, 78.4 ± 343.81, 69.6 ± 316.27, 49.59 ± 287.57, 57.07 ± 261.17, 40.45 ± 264.27, 37.45 ± 283.26 and 21.66 ± 264.17 cm/s, respectively) with increasing ⊿CHS (p for trend<0.05). Multivariate linear regression analysis suggested a negative relationship between these 2 variables, which persisted after adjustment for other risk factors. Each increase in CHS was associated with a reduced baPWV for 15.22 cm/s (B value -15.22, p<0.001).

CONCLUSIONS

⊿CHS were negatively related to ⊿baPWV, which proved to be an independent predictor of the progression of atherosclerosis in middle-aged and older persons.

TRIAL REGISTRATION NUMBER

Kailuan study (ChiCTR-TNC-11001489).

Assessment of American Heart Association's Ideal Cardiovascular Health Metrics Among Employees of a Large Healthcare Organization: The Baptist Health South Florida Employee Study

BACKGROUND

Healthcare organizations and their employees are critical role models for healthy living in their communities. The American Heart Association (AHA) 2020 impact goal provides a national framework that can be used to track the success of employee wellness programs with a focus on improving cardiovascular (CV) health. This study aimed to assess the CV health of the employees of Baptist Health South Florida (BHSF), a large nonprofit healthcare organization.

HYPOTHESIS

HRAs and wellness examinations can be used to measure the cardiovascular health status of an employee population.

METHODS

The AHA's 7 CV health metrics (diet, physical activity, smoking, body mass index, blood pressure, total cholesterol, and blood glucose) categorized as ideal, intermediate, or poor were estimated among employees of BHSF participating voluntarily in an annual health risk assessment (HRA) and wellness fair. Age and gender differences were analyzed using χ(2) test.

RESULTS

The sample consisted of 9364 employees who participated in the 2014 annual HRA and wellness fair (mean age [standard deviation], 43 [12] years, 74% women). Sixty (1%) individuals met the AHA's definition of ideal CV health. Women were more likely than men to meet the ideal criteria for more than 5 CV health metrics. The proportion of participants meeting the ideal criteria for more than 5 CV health metrics decreased with age.

CONCLUSIONS

A combination of HRAs and wellness examinations can provide useful insights into the cardiovascular health status of an employee population. Future tracking of the CV health metrics will provide critical feedback on the impact of system wide wellness efforts as well as identifying proactive programs to assist in making substantial progress toward the AHA 2020 Impact Goal.

Genetic variants in LEKR1 and GALNT10 modulate sex-difference in carotid intima-media thickness: a genome-wide interaction study

BACKGROUND

There is an established sex-difference in carotid artery intima-media thickness (cIMT), a recognized marker of subclinical atherosclerosis. However, the genetic underpinnings of sex-differences in gene-IMT associations are largely unknown.

METHODS

With a multistage design using 731,037 single nucleotide polymorphisms (SNP), a genome wide interaction study was performed in a discovery sample of 931 unrelated Hispanics, followed by replication in 153 non-Hispanic whites and 257 non-Hispanic blacks. Assuming an additive genetic model, we tested for sex-SNP interactions on cIMT using regression analysis.

RESULTS

We did not identify any genome-wide significant SNPs but identified 14 loci with suggestive significance. Specifically, SNP-by-sex interaction was found for rs7616559 within LEKR1 gene (P = 3.5E-06 in Hispanic discovery sample, P = 0.018 in White, and P = 1.3E-06 in combined analysis) and for rs2081015 located within GALNT10 gene (P = 4.5E-06 in Hispanic discovery sample, P = 0.042 in Blacks, and P = 5.3E-07 in combined analysis). For rs7616559 within LEKR1, men had greater cIMT than women in G allele carriers (beta ± SE: 0.044 ± 0.007, P = 4.2E-09 in AG carriers; beta ± SE: 0.064 ± 0.007, P = 6.2E-05 in GG carriers). For rs2081015 within GALNT10, men had greater cIMT than women in C allele carriers (beta ± SE: 0.022 ± 0.007, P = 0.002 in CT carriers; beta ± SE: 0.051 ± 0.008, P = 3.1E-10 in CC carriers).

CONCLUSIONS

Our genome-wide interaction analysis reveals multiple loci that may modulate sex difference in cIMT. Of them, genetic variants on LEKR1 and GALNT10 genes have been associated with control of adiposity and weight. Given the consistent findings across different-ethnic groups, further studies are warranted to perform investigations of functional genetic variants in these regions.

Geographic variations in cardiovascular health in the United States: contributions of state- and individual-level factors

Background

Improving cardiovascular health (CVH) of all Americans by 2020 is a strategic goal of the American Heart Association. Understanding the sources of variation and identifying contextual factors associated with poor CVH may suggest important avenues for prevention.

Methods and Results

Cross-sectional data from the Behavioral Risk Factor Surveillance System for the year 2011 were linked to state-level coronary heart disease and stroke mortality data from the National Vital Statistics System and to state-level measures of median household income, income inequality, taxes on soda drinks and cigarettes, and food and physical activity environments from various administrative sources. Poor CVH was defined according to the American Heart Association definition using 7 self-reported CVH metrics (current smoking, physical inactivity, obesity, poor diet, hypertension, diabetes, and high cholesterol). Linked micromap plots and multilevel logistic models were used to examine state variation in poor CVH and to investigate the contributions of individual- and state-level factors to this variation. We found significant state-level variation in the prevalence of poor CVH (median odds ratio 1.32, P<0.001). Higher rates of poor CVH and cardiovascular disease mortality were clustered in the southern states. Minority and low socioeconomic groups were strongly associated with poor CVH and explained 51% of the state-level variation in poor CVH; state-level factors explained an additional 28%. State-level median household income (odds ratio 0.89; 95% CI 0.84–0.94), taxes on soda drinks (odds ratio 0.94; 95% CI 0.89–0.99), farmers markets (odds ratio 0.91; 95% CI 0.85–0.98), and convenience stores (odds ratio 1.09; 95% CI 1.01–1.17) were predictive of poor CVH even after accounting for individual-level factors.

Conclusions

There is significant state-level variation in poor CVH that is partly explained by individual- and state-level factors. Additional longitudinal research is warranted to examine the influence of state-level policies and food and physical activity environments on poor CVH.

Is dispositional optimism or dispositional pessimism predictive of ideal cardiovascular health? The Young Finns Study

OBJECTIVE

We examined the independent association between dispositional optimism compared to dispositional pessimism and ideal cardiovascular health (defined by the American Heart Association).

DESIGN

A prospective design with a study sample of 1113 participants aged 24-39 years from the longitudinal Young Finns Study.

MAIN OUTCOME MEASURES

Ideal cardiovascular health (comprised of seven ideal cardiovascular health metrics) was measured in 2001. The ideal cardiovascular health metrics were reassessed in 2007.

RESULTS

Low pessimism rather than high optimism was a better predictor of ideal cardiovascular health in 2007. When examining the association between optimism and pessimism and the seven ideal cardiovascular health metrics in 2007 (BMI, diet, physical activity, smoking status, blood pressure, total cholesterol and plasma glucose), low pessimism predicted non-smoking status, ideal physical activity and eating a healthy diet, while high optimism was associated with eating a healthy diet.

CONCLUSION

Our findings suggest that low pessimism rather than high optimism is associated with ideal cardiovascular health, especially with health behaviours such as not smoking, being physically active and eating a healthy diet. Socio-economic status was the potential mediating or confounding factor. Future studies should examine the differential meaning of the optimism/pessimism concepts to further clarify their relation to health outcomes.

Understanding and Improving Cardiovascular Health: An Update on the American Heart Association's Concept of Cardiovascular Health

The American Heart Association's 2020 Strategic Impact Goal is "By 2020, to improve the cardiovascular health of all Americans by 20% while reducing deaths from cardiovascular diseases and stroke by 20%." To monitor progress towards this goal, a new construct "ideal cardiovascular health" (iCVH) was defined that includes the simultaneous presence of optimal levels of seven health behaviors (physical activity, smoking, dietary intake, and body mass index) and factors (total cholesterol, blood pressure and fasting blood glucose). In this review, we present a summary of major concepts related to the concept of iCVH and an update of the literature in this area since publication of the 2020 Strategic Impact Goal, including trends in iCVH prevalence, new determinants and outcomes related to iCVH, strategies for maintaining or improving iCVH, policy implications of the iCVH model, and the remaining challenges to reaching the 2020 Strategic Impact Goal.

Trends in Cardiovascular Disease Risk Factor Prevalence and Estimated 10-Year Cardiovascular Risk Scores in a Large Untreated French Urban Population: The CARVAR 92 Study

BACKGROUND

Surveys measuring effectiveness of public awareness campaigns in reducing cardiovascular disease (CVD) incidence have yielded equivocal findings. The aim of this study was to describe cardiovascular risk factors (CVRFs) changes over the years in an untreated population-based study.

METHODS

Between 2007 and 2012, we conducted a screening campaign for CVRFs in men aged 40 to 65 yrs and women aged 50 to 70 yrs in the western suburbs of Paris. Data were complete for 20,324 participants of which 14,709 were untreated.

RESULTS

The prevalence trend over six years was statistically significant for hypertension in men from 25.9% in 2007 to 21.1% in 2012 (p=0.002) and from 23% in 2007 to 12.7% in 2012 in women (p<0.0001). The prevalence trend of tobacco smoking decreased from 38.6% to 27.7% in men (p=0.0001) and from 22.6% to 16.8% in women (p=0.113). The Framingham 10-year risk for CVD decreased from 13.3 ± 8.2 % in 2007 to 11.7 ± 9.0 % in 2012 in men and from 8.0 ± 4.1 % to 5.9 ± 3.4 % in women. The 10-year risk of fatal CVD based on the European Systematic COronary Risk Evaluation (SCORE) decreased in men and in women (p <0.0001).

CONCLUSIONS

Over a 6-year period, several CVRFs have decreased in our screening campaign, leading to decrease in the 10-year risk for CVD and the 10-year risk of fatal CVD. Cardiologists should recognize the importance of community prevention programs and communication policies, particularly tobacco control and healthier diets to decrease the CVRFs in the general population.

Improving cardiovascular health of underserved populations in the community with Life's Simple 7

PURPOSE

The purpose of this nurse practitioner (NP) led initiative was to improve the cardiovascular health of two underserved populations in the community using the American Heart Association (AHA) Life's Simple 7 and My Life Check (MLC) tools.

DATA SOURCES

Two inner city community sites were targeted: (a) a senior center servicing African American (AA) older adults, and (b) a residential facility servicing homeless women. Preprogram health data (blood pressure, cholesterol, blood glucose levels, body mass index, and health behaviors) were collected to calculate MLC scores. Postprogram health data were obtained on participants with the lowest MLC scores who completed the program.

CONCLUSIONS

Eight older adults completed the program with a 37.1% increase in average MLC score (6.2 vs. 8.5). Ten women completed the program with a 9.3% decrease in average MLC score (4.3 vs. 3.9). Favorable benefits were observed in the AA older adults. In contrast, similar benefits were not observed in the women, which may be because of a constellation of social, environmental, biological, and mental health factors.

IMPLICATIONS FOR PRACTICE

NPs are prepared to target community-based settings to address the health of underserved populations. Engaging key stakeholders in the planning and implementation is essential for success.

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

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

These data demonstrate a strong and graded inverse relationship between AHA ideal CVH metrics and prevalent CAC in adult men and women.

American Heart Association's Life's Simple 7 and risk of venous thromboembolism: the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study

Background

The American Heart Association's Life's Simple 7 metric is being used to track the population's cardiovascular health (CVH) toward a 2020 goal for improvement. The metric includes body mass index (BMI), blood pressure, cholesterol, glucose, physical activity (PA), cigarette smoking, and diet. We hypothesized a lower risk of venous thromboembolism (VTE) with favorable Life's Simple 7 scores.

Methods and Results

REGARDS recruited 30 239 black and white participants ≥45 years of age across the United States in 2003–2007. A 14‐point summary score for Life's Simple 7 classified participants into inadequate (0 to 4 points), average (5 to 9 points), and optimal (10 to 14 points) categories. Hazard ratios (HRs) of incident VTE were calculated for these categories, adjusting for age, sex, race, income, education, and region of residence. For comparison, HRs of VTE were calculated using the Framingham 10‐year coronary risk score. There were 263 incident VTE cases over 5.0 years of follow‐up; incidence rates per 1000 person‐years declined from 2.9 (95% confidence interval [CI], 2.3 to 3.7) among those in the inadequate category to 1.8 (95% CI, 1.4 to 2.4) in the optimal category. Compared to the inadequate category, participants in the average category had a 38% lower VTE risk (95% CI, 11 to 57) and participants in the optimal category had a 44% lower risk (95% CI, 18 to 62). The individual score components related to lower VTE risk were ideal PA and BMI. There was no association of Framingham Score with VTE.

Conclusions

Life's Simple 7, a CVH metric, was associated with reduced VTE risk. Findings suggest that efforts to improve the population's CVH may reduce VTE incidence.

Ideal cardiovascular health predicts functional status independently of vascular events: the Northern Manhattan Study

BACKGROUND

We hypothesized that the American Heart Association's metric of ideal cardiovascular health (CVH) predicts improved long-term functional status after adjusting for incident stroke and myocardial infarction.

METHODS AND RESULTS

In the prospective, multiethnic Northern Manhattan Study, stroke-free individuals in northern Manhattan aged ≥40 years had annual assessments of the primary outcome of functional status with the Barthel index (BI), for a median of 13 years. Ideal CVH was calculated as a composite of 7 measures, each scored on a scale of 0 to 2. Primary predictors were (1) number of ideal CVH metrics, and (2) total score of all CVH metrics. Of 3219 participants, mean age was 69 years (SD 10), 63% were female, 21% were white, 25% were non-Hispanic black, and 54% were Hispanic. Twenty percent had 0 to 1 ideal CVH metrics, 32% had 2, 30% had 3, 14% had 4, and 4% had 5 to 7. Both number of ideal CVH categories and higher CVH metric scores were associated with higher mean BI scores at 5 and 10 years. 0047 Gradients persisted when results were adjusted for incident stroke and myocardial infarction, when mobility and nonmobility domains of the BI were analyzed separately, and when 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 status, even after accounting for incident vascular events. Vascular functional impairment is an important outcome that can be reduced by optimizing vascular health.

Cardiovascular Health Score and the Risk of Cardiovascular Diseases

In 2010 the American Heart Association proposed a definition of ideal health behaviors and health factors to measure cardiovascular health, from which Huffman et al. created the Cardiovascular Health Score (CVH score) to estimate these metrics on an individual level. We performed a prospective cohort study among employees of the Kailuan Group Corporation, who underwent a physical examination in 2006-2007 to investigate the relationship between the CVH score and the risk of cardiovascular disease (CVD). A total of 91,598 individuals free of stroke and myocardial infarction at baseline were included in the final analysis. We calculated baseline CVH score for each metric (poor=0, intermediate=1, ideal=2 points; range=0-14 points for all seven metrics) and categorized them into three groups: inadequate (0-4 points), average (5-9 points), and optimum (10-14 points). Incidence of total number of CVD events, myocardial infarction, and stroke was analyzed among these three groups and each incremental point on the CVH score. During an average 6.81 years of follow-up, there were 3276 CVD events, 2579 strokes and 747 myocardial infarction occurred. After adjusting for several confounding factors, each better health category of the CVH score was associated with reduced odds of 47% for all CVD events, and each point higher on the CVH score was associated with reduced odds of 18%. Similar trends were detected in the risks for myocardial infarction and stroke. A higher CVH score is therefore a protective factor for CVD, myocardial infarction, and stroke.

Cardiovascular health in adolescents with type 1 diabetes: the SEARCH CVD study

OBJECTIVE

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.

RESEARCH DESIGN AND METHODS

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)].

RESULTS

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)].

CONCLUSIONS

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.