Association between ideal cardiovascular health metrics and risk of cardiovascular events or mortality: A meta‐analysis of prospective studies

Abstract

Background Observational studies evaluating the relationship between ideal cardiovascular health (CVH) metrics and risk of cardiovascular (CV) events and mortality yielded inconsistent results. Hypothesis Improvement in CVH metrics can result in substantial reductions in the risk of cardiovascular disease (CVD), stroke, and mortality. Methods We examined associations between ideal CVH metrics and CV events and mortality by conducting a meta‐analysis of data from prospective cohort studies identified by searching PubMed and Web of Science from their inception to February 2017 and reviewing the reference lists of the retrieved articles. Results Thirteen prospective studies involving a total of 193 126 cohort members were included in this meta‐analysis. When comparing the most to the least category of ideal CVH metrics, the overall relative risks (RRs) were 0.54 (95% confidence interval [CI]: 0.41‐0.69) for all‐cause mortality, 0.30 (95% CI: 0.18‐0.51) for CV mortality, 0.22 (95% CI: 0.11‐0.42) for CVD, and 0.33 (95% CI: 0.20‐0.55) for stroke, respectively. A linear dose–response relationship was seen in all‐cause and CV mortality. The risk decreased by 11% and 19% for each increase in ideal CVH metrics. For the analyses of ideal health status in relation to all‐cause and CV mortality, significant results were obtained from smoking, diet, physical activity, plasma glucose levels, and blood pressure. Conclusions Ideal CVH status, or even 1 point increase in CVH metrics, can result in substantial reductions in the risk of CVD, stroke, and mortality. Improving metrics of smoking, diet, physical activity, plasma glucose levels, and blood pressure will achieve the highest benefits.

Association between ideal cardiovascular health and markers of subclinical cardiovascular disease

“…Prior studies have evaluated the association of ideal CVH and clinical endpoints. 16,18,31,[33][34][35] In conclusion, in a community-based study of black and white participants with low prevalence of ideal CVH, even achieving 3 or more ideal CVH factors was associated with lower burden of subclinical atherosclerosis, indicating the utility of this construct for disease prevention.…”

“…Finally, our focus was primarily on studying the relationship between ideal CVH and subclinical CVD including microvascular endothelial function, and so we have not looked at clinical CVD outcomes in these analyses. Prior studies have evaluated the association of ideal CVH and clinical endpoints …”

Cardiovascular health status and its associations with cardiovascular disease and ischemic heart disease prevalence in Australian adults

“…We observed that the increased ideal CVH metrics number was significantly associated with reduced CVD prevalence in most sex and age subgroups and the dose-response fashion was also noticed in a few recent meta-analyses. 14,141 The number of ideal metrics has more significant influences on CVD prevalence in men compared with women in our study. Two studies indicated the association strengths between the number of ideal CVH metrics and HF incidence/asymptomatic ICAS prevalence were similar in both sexes 91,145 whereas several studies found that males are more likely to influenced by the CVH metrics for CVD events 29,150 and stroke.…”

“…Given the advantages of Life's Simple 7, a number of studies have used Life's Simple 7 to measure the CVH status in the general population 11,12 and explored its association with CVD/IHD risk. 13,14 Most studies implied the low prevalence of the ideal CVH status in the general population and indicated the significant separate and combined effects of the CVH status on CVD/IHD risk.…”

“…7 A number of studies have explored the individual and combined effects of those metrics on the risk of CVD and several systematic reviews and meta-analyses have indicated the negative relationship between the number of ideal CVH metrics and CVD risk in adults. 11,14,141 However, they ignored several studies that were cross-sectional design and chosen certain types of CVD as outcomes, like heart failure (HF) and atrial fibrillation (AF). In addition, they only summarized articles that were published before February 2017 and several studies have been published since then.…”