Dynamic Change of Cardiovascular Health Metrics and Long‐Term Risk of Sudden Cardiac Death: The ARIC Study

Abstract

Background The change of cardiovascular health (CVH) status has been associated with risk of cardiovascular disease. However, no studies have explored the change patterns of CVH in relation to risk of sudden cardiac death (SCD). We aim to examine the link between baseline CVH and change of CVH over time with the risk of SCD. Methods and Results Analyses were conducted in the prospective cohort ARIC (Atherosclerosis Risk in Communities) study, started in 1987 to 1989. ARIC enrolled 15 792 individuals 45 to 64 years of age from 4 US communities (Forsyth County, North Carolina; Jackson, Mississippi; suburbs of Minneapolis, Minnesota; and Washington County, Maryland). Subjects with 0 to 2, 3 to 4, and 5 to 7 ideal metrics of CVH were categorized as having poor, intermediate, or ideal CVH, respectively. Change in CVH over 6 years between 1987 to 1989 and 1993 to 1995 was considered. The primary study outcome was physician adjudicated SCD. The study population consisted of 15 026 subjects, of whom 12 207 had data about CVH change. Over a median follow‐up of 23.0 years, 583 cases of SCD were recorded. There was a strong inverse association between baseline CVH metrics and time varying CVH metrics with risk of SCD. Compared with subjects with consistently poor CVH, risk of SCD was lower in those changed from poor to intermediate/ideal (hazard ratio [HR], 0.67 [95% CI, 0.48–0.94]), intermediate to poor (HR, 0.73 [95% CI, 0.54–0.99]), intermediate to ideal (HR, 0.49 [95% CI, 0.24–0.99]), ideal to poor/intermediate CVH (HR, 0.23 [95% CI, 0.10–0.52]), or those with consistently intermediate (HR, 0.49 [95% CI, 0.36–0.66]) or consistently ideal CVH (HR, 0.31 [95% CI, 0.13–0.76]). Similar results were also observed for non‐SCD. Conclusions Compared with consistently poor CVH, other patterns of change in CVH were associated with lower risk of SCD. These findings highlight the importance of promotion of ideal CVH in the primordial prevention of SCD.

Association of Spousal Diabetes Status and Ideal Cardiovascular Health Metrics With Risk of Incident Diabetes Among Chinese Adults

“…To reduce CVD morbidity and mortality, the AHA defined 7 components of ideal cardiovascular health in 2010 and updated the ICVHM to 8 components recently, named Life’s Essential 8. The ARIC study defined participants with 0 to 2, 3 to 4, and 5 or more ICVHMs as having poor, intermediate, and ideal cardiovascular health, respectively . It was suggested in multiple studies that these metrics were associated with lower diabetes incidence .…”

Association of change in cardiovascular health based on life's essential 8 with incident cardiovascular disease

“…The associations between absolute change in CVH score and incident cardiovascular events have also been evaluated in some previous studies, and all the results showed that both per 1 additional ideal metric and per 1-point increase in CVH score were associated with a decreased risk of cardiovascular events[ 9 , 10 , 13 , 14 , 21 ]. Lee et al found that per 1-point increase in the CVH score based on LS7 (total 14 points) was associated with a 21 % decrease in the risk of premature cardiovascular events [10] , and Yang et al showed that per 1 additional ideal metric based on LS7 was associated with a 13 % decrease in the risk of total stroke [13] .…”

“…However, limited empirical evidence exists on the association between CVH change and incident cardiovascular events. Most studies have indicated that improvement of CVH from low to moderate/high status is associated with a decreased risk of cardiovascular events, such as sudden cardiac death [14] , stroke [12] , and premature cardiovascular events [10] . Compared with the consistent low group, Gaye et al showed that the risk of CVD was statistically decreased in the low to moderate/high group [20] , whereas van Sloten et al found that the risk of CVD was not significantly changed in the low to moderate and low to high groups [9] .…”

“…Notably, even for LS7, studies on the change in CVH and subsequent cardiovascular events are limited, and their findings are inconsistent [9] , [10] , [11] . Nevertheless, changes in CVH are very common in the real world [12] , [13] , [14] . For example, individuals with poor CVH at baseline are often recommended to improve CVH in the future.…”

Associations of Renal Function Trajectories and Long‐Term Cardiovascular Risks Among a Population Without Chronic Kidney Disease

“…The proportional hazards assumption was checked by plotting the log (−log [survival]) versus log (survival time) and by using Schoenfeld residuals. 21 , 23 No evidence was suggestive of potential violation for any exposure‐outcome associations.…”