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

Comparison of Cardiovascular Health Between Parents and Non-Parents in NHANES 2011-2018

BACKGROUND AND OBJECTIVES

We compared cardiovascular health for parents and non-parents using the American Heart Association's Life's Essential 8 (LE8).

METHODS

This cross-sectional cohort analyzed 2011-2018 NHANES participants aged 20 to 54. The exposure was parenting, defined as living with a child. Logistic regression assessed whether parenting was associated with odds of ideal LE8 total or sub-scores. Regression adjusted for age, sex, race and ethnicity, educational attainment, marital status, and income. Subgroups included female sex, male sex, income <150% federal poverty levels, and parents of younger children.

RESULTS

6847 participants represented a weighted population of 79 120 285 (57% parents). Parenting was not associated with adjusted odds of ideal total LE8 (OR 0.91, 95% CI 0.76-1.09). Parenting was associated with decreased odds of ideal body mass index (BMI) (OR 0.81, 95% CI 0.72-0.91) and increased odds of smoking avoidance (OR 1.22, 95% CI 1.09-1.38). Associations varied by subgroup. Only the subgroup with lower incomes demonstrated reduced odds of ideal total LE8 for parents (OR 0.58, 95% CI 0.41-0.82).

CONCLUSIONS

Parents and non-parents differed in smoking and BMI, though not in LE8 total. Families with low incomes may particularly benefit from dual generation cardiovascular risk reduction.

Association between ideal cardiovascular health and multiple disabilities among US adults, BRFSS 2017-2019

OBJECTIVES

Cardiovascular health is the leading cause of death and disability in the United States. Our objective was to estimate the association between ideal cardiovascular health (ICVH) and multiple disabilities among US adults stratified into the three age groups of young (18-44 years), midlife (45-64 years), and older adults (≥65 years).

STUDY DESIGN

We conducted a cross-sectional analysis using data pooled from the 2017 and 2019 Behavioral Risk Factor Surveillance System (BRFSS).

METHODS

Using American Heart Association's seven-component (four ideal behaviors and three ideal health factors) scoring tool, we identified ICVH as a composite score ≥5 and also computed the ideal behavioral (score ≥3) and ideal health factors (score = 3) submetrics. The outcome, single vs multiple disabilities indicator, was defined using US Census's disability domains and analyzed using multinomial regression.

RESULTS

For all three groups, the prevalence of multiple disabilities was significantly lower among those meeting ICVH, ideal behavioral, and ideal health factors compared with those that did not. After controlling for covariates, ICVH score ≥5 was associated with lower relative risk of multiple disabilities in all groups. Although both ideal health and ideal behavioral factors were associated with lower relative risk of multiple disabilities among all groups, the reduction in risk was the highest for multiple disabilities and ideal behavioral factors among midlife (relative risk ratio: 0.30, 95% confidence interval: 0.25, 0.36) and older adults (relative risk ratio: 0.40, 95% confidence interval: 0.33, 0.48).

CONCLUSION

Adults with less-than-ideal cardiovascular health had a higher relative risk of multiple disabilities. Addressing the risk of multiple disabilities of US adults will require effective promotion of ICVH.

Prevalence and Associated Factors with Ideal Cardiovascular Health Metrics in Bangladesh: Analysis of the Nationally Representative STEPS 2018 Survey

This study aims to find out the prevalence of the American Heart Association's (AHA)'s cardiovascular health metrics and associated socio-demographic factors. A secondary analysis of the World Health Organization (WHO) STEPwise approach to surveillance survey 2018 (STEPS 2018) data was conducted. Ideal Cardiovascular Health (ICH) was defined as the presence of 5-7 ideal metrics as defined by the AHA. Design-adjusted multivariable logistic regression was used to determine the associated factors of ICH. In total, 5930 respondents were included in our analysis, and 43.1% of the participants had ICH. The odds of ICH decreased with age [compared to 18-29 years old individuals, 30-49 years: AOR (Adjusted Odds Ratio): 0.4; 95% Confidence Interval (CI): 0.4-0.5; 50-69 years: AOR: 0.7; 95% CI: 0.6-0.8], and higher educational attainment (compared to those who received no formal education, being educated up to primary level: AOR:0.7; 95% CI: 0.6-0.8; being educated up to secondary level: AOR: 0.4; 95% CI: 0.4-0.5; being educated up to college and higher: AOR: 0.4; 95% CI: 0.3-0.5). Compared with female and urban residents, the odds were 30% and 40% less among male and rural residents, respectively. The public health promotion programs of Bangladesh should raise awareness among high-risk groups to prevent cardiovascular diseases.

Life's Simple 7 and Nonalcoholic Fatty Liver Disease: The Multiethnic Study of Atherosclerosis

BACKGROUND

The American Heart Association (AHA) has defined Life's Simple 7 (LS7) as a measure of overall cardiovascular health . Nonalcoholic fatty liver disease (NAFLD) has been involved as a risk factor for cardiovascular disease. We evaluated the association between LS7 and NAFLD.

METHODS

We evaluated participants form the Multi-Ethnic Study of Atherosclerosis (MESA) cohort. Cardiovascular health score was calculated from the Life's Simple 7 metrics. A score of 0-8 was considered inadequate, 9-10 average, and 11-14 optimal. NAFLD was defined using noncontrast cardiac computed tomography (CT) and a liver/spleen attenuation ratio (L/S) < 1. Multivariable regression were performed to evaluate the association.

RESULTS

Our cross-sectional analysis of 3901 participants showed 19% (n = 747) had optimal cardiovascular health, 33% (n = 1270) had average, and 48% (n = 1884) had inadequate. White participants were most likely to have an optimal score (51%, n = 378), whereas African American participants had the lowest proportion with optimal scores (16%, n = 120; P < 0.001). The overall prevalence of NAFLD was 18% with a distribution of 7%, 14%, and 25% in the optimal, average, and inadequate score categories, respectively (P < 0.001). Adjusted for risk factors, average and optimal health categories had lower odds of NAFLD compared to those with inadequate scores: odds ratio for average, 0.44 (95% confidence interval 0.36-0.54); optimal, odds ratio 0.19 (95% confidence interval 0.14-0.26). This association was similar across gender, race and age groups.

CONCLUSION

A more favorable cardiovascular health score was associated with a lower prevalence of NAFLD. This study may suggest a potential of Life's Simple 7 in the prevention of liver disease.

Metrics of Ideal Cardiovascular Health are Unequally Distributed between Peruvian Men and Women: Analysis of a National Population-Based Survey in 2017

Background:

To determine socioeconomic inequalities in cardiovascular health (CVH) metrics among Peruvian adults as well as differences according to sex.

Methods:

An observational, cross-sectional study was conducted in 26,175 individuals aged 18–65 years using the 2017 Peruvian Demographic and Health Survey. According to the American Heart Association, 5 CVH metrics which comprised three ideal health behaviors (diet, non smoking, ideal body mass index [BMI]), and two ideal health factors (ideal blood pressure and no history of diabetes) were evaluated. The concentration curves (CC) methodology was used to analyze whether CVH metrics vary between socioeconomic status and sex. The concentration index (CI) was used to quantify socioeconomic-related inequality in health variables.

Results:

Overall, the mean age was 36.5 years (SD = 11.9) and 51.2% were women. Only 2.4% had 5 ideal CVH metrics (women 3.7%, men 1.0%) with a CI very close to the equality line (0.0135). (0.0135; higher in women [0.0262], compared to men [0,0002]). A greater prevalence of ideal CHV metrics (3 or more) was found in women (P < 0.001). Ideal health factors were more prevalent (52.1%) than ideal health behaviors (13.8%). Regarding inequality measures, CCs for most CVH metrics had a higher concentration in the lowest wealth population, except for ideal diet, which was more frequent among higher levels of wealth. An ideal BMI was the CVH metric with the lowest CI (overall: −0.0817; men: −0.2699).

Conclusions:

Peruvian women presented a higher prevalence of ideal CVH metrics and fewer inequalities. Ideal CVH metrics tend to be concentrated in the wealthiest women. Low- and middle-income countries should consider socioeconomic inequalities in cardiovascular disease prevention programs.

Cardiovascular Health Is Associated With Disability Among Older Community Dwelling Men and Women

Objective: The aim of this study was to investigate whether an index of overall cardiovascular health (CVH) is associated with disability in older individuals. Method: Data on 925 participants of the InCHIANTI study (Invecchiare in Chianti, aging in the Chianti area, ≥65 years, 55% women) with median follow-up of 9 years were used. CVH score was assessed by smoking status, physical activity, body mass index, diet quality, blood pressure, plasma cholesterol, and fasting blood glucose. Disability was examined using instrumental activities of daily living (IADL disabilities >0 vs. 0) and activities of daily living (ADL disabilities >0 vs. 0). Generalized estimating equations and Cox models assessed relationships between baseline CVH with disability and worsening over 9 years. Results: A 1-point increase in the CVH score was associated with 23% and 17% of lower odds of ADL (p < .001) and IADL (p < .001) disability and was protective of worsening of disability over 9 years. Cox models demonstrated that a 1-point increase in CVH score was associated with lower hazards of both ADL (hazard ratio [HR] = 0.86, p = .005) and IADL (HR = 0.91, p = .007) disability. Discussion: Among older individuals, better CVH was associated with lower risk of disability and worsening over 9 years.

Relationship between cardiovascular health metrics and physical performance in community-living people: Results from the Longevity check-up (Lookup) 7+ project

Cardiovascular health metrics (CHMs) may predict disability independent of vascular events. Though, the link between CHMs and physical performance is unclear. This relationship was explored using data from the Longevity check-up (Lookup) 7+ project. Lookup 7+ is an ongoing cross-sectional survey conducted in unconventional settings across Italy. People who are at least 18-year-old and provide written informed consent are eligible. CHMs [i.e., smoking status, healthy diet, body mass index (BMI), blood pressure, blood cholesterol, and diabetes status] are assessed through closed questions and objective measurements. Physical performance is measured via the 5-repetition chair-stand test. Analyses included 7446 participants (55.5 ± 14.9 years; 56% women). Physical performance positively correlated with CHMs scores, such that participants who scored higher (6-7 points) completed the chair-stand test about 2 s faster than those scoring lower (1-2 points). In fully adjusted analysis, better physical performance was more frequently observed in younger, non-smoking, physically active men, with ideal BMI, and no diabetes. Our findings indicate a gradient of better physical function with increasing CHMs scores. Future investigations should establish the longitudinal effect of unhealthy behaviours and cardiovascular risk factors on physical performance and verify whether implementation of large-scale primordial cardiovascular prevention may positively impact physical fitness.

Cardiovascular Risk Factors and the Risk of Disability in Older Adults: Variation by Age and Functional Status

OBJECTIVES

We aimed to quantify the increased risk of disability associated with cardiovascular risk factors among older adults, and to verify whether this risk may vary by age and functional status.

DESIGN

Longitudinal population-based cohort study.

SETTING

Urban area of Stockholm, Sweden.

PARTICIPANTS

Community-dwelling and institutionalized adults ≥60 years in the Swedish National study on Aging and Care in Kungsholmen free of cardiovascular diseases and disability (n = 1756) at baseline (2001-2004).

MEASURES

Incident disability in activities of daily living (ADL) was ascertained over 9 years. Cardiovascular risk factors (physical inactivity, alcohol consumption, smoking, high blood pressure, diabetes, high body mass index, high levels of total cholesterol, and high C-reactive protein) and walking speed were assessed at baseline. Data were analyzed using Cox proportional hazards models, stratifying by younger-old (age 60-72 years) and older-old (≥78 years).

RESULTS

During the follow-up, 23 and 148 persons developed ADL-disability among the younger- and older-old, respectively. In the younger-old, the adjusted hazard ratio (HR) of developing ADL-disability was 4.10 (95% confidence interval [CI] 1.22-13.76) for physical inactivity and 5.61 (95% CI 1.17-26.82) for diabetes. In the older-old, physical inactivity was associated with incident ADL-disability (HR 1.99, 95% CI 1.36-2.93), and there was a significant interaction between physical inactivity and walking speed limitation (<0.8 m/s), showing a 6-fold higher risk of ADL-disability in those who were both physically inactive and had walking speed limitation than being active with no limitation, accounting for a population-attributable risk of 42.7%.

CONCLUSIONS/IMPLICATIONS

Interventions targeting cardiovascular risk factors may be more important for the younger-old in decreasing the risk of disability, whereas improving physical function and maintaining physical activity may be more beneficial for the older-old.

Ideal Cardiovascular Health in the southern cone of Latin America

OBJECTIVE

The American Heart Association developed the concept of 'Ideal Cardiovascular Health', which is based on the presence of ideal levels across seven health factors. The goal of this study is to assess the prevalence of Ideal Cardiovascular Health in the Southern Cone of Latin America.

STUDY DESIGN

We conducted a cross-sectional analysis as part of CESCAS I cohort.

METHODS

This report included 5458 participants aged between 35 and 75 years who were selected using stratified multistage probability sampling in Argentina, Chile and Uruguay. Interviews included demographic information, the International Physical Activity Questionnaire, and a food frequency questionnaire on dietary habits. Participants were classified as current, former or non-smokers. Weight, height and blood pressure were measured by trained personnel, and fasting cholesterol and glucose plasma levels were measured.

RESULTS

Only 0.1% (95% confidence interval [CI]: 0.0-0.2) met the seven criteria that define the Ideal Cardiovascular Health. The least prevalent healthy behaviour was having a healthy diet: 0.5% (95% CI: 0.3-0.7), while the least prevalent health factor was having blood pressure < 120/80 mmHg: 23.6% (95% CI: 22.1-25.0).

CONCLUSIONS

The prevalence of Ideal Cardiovascular Health is very low in a representative sample of population from the Southern Cone of Latin America, and the levels of healthy lifestyle behaviours are even lower than ideal biochemical parameters. These results highlight the challenge of developing strategies to improve the levels of Ideal Cardiovascular Health at primary prevention levels.

Relationship Between Ideal Cardiovascular Health and Disability in Older Adults: The Chilean National Health Survey (2009-10)

This study aimed to examine the relationship between disability and the American Heart Association metric of ideal cardiovascular health (CVH) in older adults from the 2009-10 Chilean National Health Survey. Data from 460 older adults were analyzed. All subjects were interviewed using the standardized World Health Survey, which includes 16 health-related questions and assesses the domains of mobility, self-care, pain and discomfort, cognition, interpersonal activities, vision, sleep and energy, and affect. A person who responds with a difficulty rating of severe, extreme, or unable to do in at least one of these eight functioning domains is considered to have a disability. Ideal CVH was defined as meeting the ideal levels of four behaviors (smoking, body mass index, physical activity, diet adherence) and three factors (total cholesterol, fasting glucose, blood pressure). Logistic regression analysis suggested that ideal physical activity reduces the odds of disability (odds ratio (OR) = 0.55, 95% confidence interval (CI) = 0.36-0.85). Moreover, participants with intermediate (3-4 metrics) (OR = 0.63, 95% CI = 0.41-0.97) and ideal (5-7 metrics) (OR = 0.51, 95% CI = 0.24-0.97) CVH profiles had lower odds of disability independent of history of vascular events and arthritis disease than those with a poor profile (0-2 metrics). In conclusion, despite the cross-sectional design, this study suggests the importance of promoting ideal CVH because of their relationship with disability.