Association of a Favorable Cardiovascular Health Profile With the Presence of Coronary Artery Calcification

Saleem, Yasir; DeFina, Laura F.; Radford, Nina B.; Willis, Benjamin L.; Barlow, Carolyn E.; Gibbons, Larry W.; Khera, Amit

doi:10.1161/circimaging.114.001851

Cited by 47 publications

(27 citation statements)

References 33 publications

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“…17 Furthermore, Ahmed et al 18 showed that 45% of subjects with 3 to 4 favorable lifestyle metrics by the American Heart Association 2020 goals (non smokers, normal body mass index, optimal diet, and optimal physical activity level) had positive CAC scores. On the contrary, consistent with findings reported by Saleem et al, 10 ≥35% to 45% of subjects with clustering of unfavorable risk factor and lifestyle metrics have been noted with signs of early atherosclerotic disease in these recent studies. [16][17][18] How can we explain these potentially unexpected but significant disparities?…”

Section: See Article By Saleem Et Alsupporting

confidence: 93%

“…8 Results from the Framingham offspring cohort convincingly revealed that with each additional ideal CV health metric, there was a 23% reduction in the probability of having a abnormal marker of subclinical CVD (defined as any combination of left ventricular hypertrophy, enlarged left ventricular end-systolic diameter, increased carotid intima-media thickness, peripheral arterial disease, and the presence of microalbuminuria). 9 In this issue of Circulation: Cardiovascular Imaging, Saleem et al 10 add to the current literature by examining association between ICH metrics with the presence and burden of coronary artery calcification (CAC), arguably one of the most robust marker of subclinical CVD and prognosis. In a large sample of self-referred individuals (n=3121), the investigators categorized cardiovascular health status as favorable (4-7 metrics in ideal range), intermediate (3 metrics in ideal range), or unfavorable (0-2 metrics in ideal range).…”

Section: See Article By Saleem Et Almentioning

confidence: 99%

“…Furthermore, it is evident that young adults adopting healthy lifestyle changes at an early age are significantly less likely to develop subclinical atherosclerosis assessed 20 years later. 20 In summary, although achieving ICH metrics remain one of the most important public health goal, studies like the one by Saleem et al 10 leave us with more questions, such as can we accurately classify CVD health as ideal in the presence of early subclinical damage? Although a provocative and untested concept, these findings provide enough substance for us to at least start deliberating whether there is any value in broadening our scope to embrace subclinical disease testing to assess true CVD health status.…”

Section: See Article By Saleem Et Almentioning

confidence: 99%

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Disparities Between Ideal Cardiovascular Health Metrics and Subclinical Atherosclerotic Burden

Nasir¹,

Blankstein

2015

Circ: Cardiovascular Imaging

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4I n 2010, the American Heart Association proposed an important and welcoming paradigm shift from our decades old emphasis on reduction of cardiovascular disease (CVD) to a national goal of attaining cardiovascular health.1 This framework paved the way for an ideal cardiovascular health (ICH) metric, on the basis of simple, reproducible, and easily measurable determinants of CV health, which have been proven to have a favorable effect on long-term cardiovascular morbidity and mortality. Broadly, the focus is on 4 lifestyle factors (smoking, body weight, physical activity, and optimal diet) and 3 established risk factors (blood cholesterol, blood glucose, and blood pressure levels). Since the first formal definition of ICH, extensive investigations have conclusively demonstrated that (1) a small proportion of our population has optimal CV health status as defined by presence of ≥6 to 7 ICH metrics, (2) as a society we fare poorly on the diet, physical activity, and body mass index metrics, and (3) those who demonstrate higher frequency of ICH metrics have a substantially lower CVD and all-cause mortality. 2-5 See Article by Saleem et alIn recent years, there has been a significant interest in exploring associations between ICH metrics and subclinical CVD, a proposed link between healthy risk factor/lifestyle profile and improved CVD outcomes. Aatola et al 6 demonstrated that arterial stiffness measured as pulse wave velocity decreased by 0.09 m/s per unit increase in patients with ideal CV health score, whereas Crichton et al 7 noted that mean pulse wave velocity was significantly lower among subjects with ≥5 ICH metrics when compared with those with ≤2. A similar inverse relationship was observed between favorable CV health status and carotid intima-media thickness, a marker of atherosclerotic disease. 8 Results from the Framingham offspring cohort convincingly revealed that with each additional ideal CV health metric, there was a 23% reduction in the probability of having a abnormal marker of subclinical CVD (defined as any combination of left ventricular hypertrophy, enlarged left ventricular end-systolic diameter, increased carotid intima-media thickness, peripheral arterial disease, and the presence of microalbuminuria). 9In this issue of Circulation: Cardiovascular Imaging, Saleem et al 10 add to the current literature by examining association between ICH metrics with the presence and burden of coronary artery calcification (CAC), arguably one of the most robust marker of subclinical CVD and prognosis. In a large sample of self-referred individuals (n=3121), the investigators categorized cardiovascular health status as favorable (4-7 metrics in ideal range), intermediate (3 metrics in ideal range), or unfavorable (0-2 metrics in ideal range). Despite the limitations that the study focused on a nonrepresentative population whose objectives were not intended to assess metrics of ideal health, the distribution of these metrics was still consistent with national estimates from multiple prospective studies. As e...

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Section: See Article By Saleem Et Alsupporting

confidence: 93%

Section: See Article By Saleem Et Almentioning

confidence: 99%

Section: See Article By Saleem Et Almentioning

confidence: 99%

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Disparities Between Ideal Cardiovascular Health Metrics and Subclinical Atherosclerotic Burden

Nasir¹,

Blankstein

2015

Circ: Cardiovascular Imaging

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“…[40][41][42] This may be helpful as surrogate endpoints for intervention studies, as well as potentially add to global CVD risk assessment and guide treatment decisions. [43][44][45][46][47] Subclinical atherosclerosis is commonly assessed by carotid intima-media thickness (cIMT), coronary artery calcium score (CACS), coronary computed tomography angiography (CCTA) and cardiac magnetic resonance imaging (CMR).…”

Section: Cardiovascular Imagingmentioning

confidence: 99%

Determinants of future cardiovascular health in women with a history of preeclampsia

et al. 2015

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Please cite this article as: Zoet Gerbrand A, Koster Maria PH, Velthuis Birgitta K, de Groot Christianne JM, Maas Angela HEM, Fauser Bart CJM, Franx Arie, Rijn Bas B.van.Determinants of future cardiovascular health in women with a history of preeclampsia.Maturitas http://dx.doi.org/10.1016/j.maturitas. 2015.07.004 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Keywords:Preeclampsia, cardiovascular disease, risk assessment, screening, prevention Highlights  Female-specific risk factors, among which preeclampsia, may have additional value in cardiovascular screening.  Non-invasive imaging techniques can be helpful to detect early-stage cardiovascular lesions as a sign of subclinical atherosclerotic disease.  Preliminary studies show positive effects of short-term lifestyle interventions following preeclampsia.  There is a need for clinical practice guidelines that provide long-term strategies in women after preeclampsia in pregnancy to improve cardiovascular health. AbstractWomen who develop preeclampsia have an increased risk of cardiovascular disease (CVD) later in life.However, current guidelines on cardiovascular risk assessment and prevention are unclear on how and when to screen these women postpartum, and about the role of a positive history of preeclampsia in later-life CVD risk management. The aim of this review is to discuss the present knowledge on commonly used cardiovascular screening modalities available to women with a history of preeclampsia, and to discuss recent developments in early detection of CVD using cardiovascular imaging.Furthermore, we explore how female-specific risk factors may have additional value in cardiovascular screening, in particular in relatively young women, although their implementation in clinical practice is challenged by inconsistent results and lack of long-term outcome data. Non-invasive imaging techniques, e.g. coronary artery intima-media thickness (CIMT), can be helpful to detect subclinical atherosclerotic disease, and coronary artery calcium scoring (CACS) has shown to be effective in early detection of cardiovascular damage. However, whilst more short-term and long-term follow-up studies are becoming available, few studies have investigated women with a history of preeclampsia in the fourth and fifth decade of life, when early signs of premature CVD are most likely to become apparent.Further studies are needed to inform new and improved clinical practice guidelines, and provide longterm strategies to effectively prevent CVD, specifically targeted at women with a history of preeclampsia. Additionally, evaluation of feasibility, cost-effectiveness ...

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“…[28][29][30][31] Lower CCA-IMT has also been associated with the number of ideal CVH metrics among adolescents 26 and among young adults in the United States, Finland, and Australia. 30 To the best of our knowledge, only 2 previous studies have specifically examined the association of CVH with CCA-IMT among adults.…”

Section: Ideal Cvh and Carotid Structurementioning

confidence: 99%

Ideal Cardiovascular Health and Subclinical Markers of Carotid Structure and Function

Gaye

Mustafić

Laurent

et al. 2016

ATVB

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Objective— We hypothesized that subclinical markers of vascular structure and function, which are independent predictors of cardiovascular disease, would be less frequent in subjects with ideal than poor cardiovascular health (CVH) as defined by the American Heart Association (AHA). Approach and Results— Carotid parameters were measured using high-precision echotracking device in 9155 nonreferred participants attending a health checkup in a large health center in Paris (France) between 2008 and 2012. According to the AHA, participants with 0 to 2, 3 to 4, and 5 to 7 metrics (smoking, physical activity, body mass index, diet, blood glucose and total cholesterol, blood pressure) at the ideal level were categorized as having poor, intermediate, and ideal CVH. Carotid parameters were dichotomized according to their median value, and multivariable logistic regression analysis was performed. Mean age was 59.5 (SD 6.3) years; 39% were females, and ideal CVH was present in 10.11% of the study participants. After adjustment for age, sex, education, and living alone and compared with a poor CVH, an ideal CVH was associated with lower common carotid artery intima–media thickness (odds ratio=1.64; 95% confidence interval 1.40, 1.93), absence of carotid plaques (odds ratio=2.14; 95% confidence interval 1.60, 2.87), lower Young’s elastic modulus (odds ratio=2.43; 95% confidence interval 2.07, 2.84), and higher carotid distensibility coefficient (odds ratio=2.90; 95% confidence interval 2.47, 3.41). Conclusions— In community subjects aged 50 to 75 years, ideal CVH was associated with substantially less arterial stiffness and thickness. These associations might contribute to the lower risk of cardiovascular diseases in subjects with ideal CVH.

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Association of a Favorable Cardiovascular Health Profile With the Presence of Coronary Artery Calcification

Cited by 47 publications

References 33 publications

Disparities Between Ideal Cardiovascular Health Metrics and Subclinical Atherosclerotic Burden

Disparities Between Ideal Cardiovascular Health Metrics and Subclinical Atherosclerotic Burden

Determinants of future cardiovascular health in women with a history of preeclampsia

Ideal Cardiovascular Health and Subclinical Markers of Carotid Structure and Function

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