Ideal Cardiovascular Health Predicts Lower Risks of Myocardial Infarction, Stroke, and Vascular Death Across Whites, Blacks, and Hispanics

Dong, Chuanhui; Rundek, Tatjana; Wright, Clinton B.; Anwar, Zane; Elkind, Mitchell S.V.; Sacco, Ralph L.

doi:10.1161/circulationaha.111.081083

Cited by 312 publications

(373 citation statements)

References 28 publications

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“…Numerous studies have demonstrated that better CVH is associated greater longevity and lower cardiovascular incidence, cardiovascular mortality, and all‐cause mortality across racial/ethnic groups 7, 8, 9…”

Section: Introductionmentioning

confidence: 99%

Trends in Racial/Ethnic Disparities in Cardiovascular Health Among US Adults From 1999–2012

Pool

Ning

Lloyd‐Jones

et al. 2017

JAHA

156

105

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BackgroundIn the United States, there are persistent racial and ethnic disparities in cardiovascular disease morbidity and mortality. National efforts have focused on reducing these disparities; however, little is known about the long‐term trends in racial/ethnic disparities in cardiovascular health (CVH).Methods and ResultsWe included 11 285 adults aged ≥20 years from the National Health and Nutrition Examination Surveys survey cycles 1999/2000 through 2011/2012. CVH includes 7 health factors and behaviors—diet, physical activity, smoking status, body mass index, blood pressure, blood glucose, and total cholesterol—each scored as ideal (2 points), intermediate (1 point), or poor (0 points). Overall CVH is a summation of these scores (range, 0–14) points. Age‐adjusted mean CVH scores were calculated by race/ethnicity (non‐Hispanic black, non‐Hispanic white, or Mexican American) and sex for each survey cycle. Non‐Hispanic black women had significantly lower mean CVH scores as compared with non‐Hispanic white women at each survey cycle (difference=0.93; P=0.001 in 2011/2012) and Mexican‐American women had significantly lower mean score as compared with non‐Hispanic white women at almost all survey cycles (difference=0.71; P=0.02 in 2011/2012). Differences between racial/ethnic groups were smaller for men and were mostly nonsignificant.ConclusionsFrom 1999/2000 to 2011/2012, there were enduring disparities in CVH for non‐Hispanic black and Mexican‐American women as compared with non‐Hispanic white women. Disparities that were present in 1999/2000 were present in 2011/2012, though no racial/ethnic differences became more pronounced over time. These findings provide US nationally representative data to evaluate health factors and behaviors of particular concern regarding racial/ethnic disparities in cardiovascular health.

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Section: Introductionmentioning

confidence: 99%

Trends in Racial/Ethnic Disparities in Cardiovascular Health Among US Adults From 1999–2012

Pool

Ning

Lloyd‐Jones

et al. 2017

JAHA

156

105

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“…Attainment of these ideal health metrics has been associated with lower incidence of cardiovascular disease, including coronary heart disease, myocardial infarction, heart failure,10, 11, 12, 13, 14 stroke,15 and retinopathy,16 in addition to noncardiovascular conditions, such as cancer 11, 17. Greater attainment of ideal cardiovascular health through midlife to late life is associated with both a lower prevalence of cardiovascular disease in late life and better cardiac structure and function in late life among people free of prevalent cardiovascular disease 18.…”

Section: Introductionmentioning

confidence: 99%

Ideal Cardiovascular Health and the Prevalence and Severity of Aortic Stenosis in Elderly Patients

Sengeløv

Cheng

Biering‐Sørensen

et al. 2018

JAHA

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BackgroundThe relationship between ideal cardiovascular health reflected in the cardiovascular health score (CVHS) and valvular heart disease is not known. The purpose of this study was to determine the association of CVHS attainment through midlife to late life with aortic stenosis prevalence and severity in late life.Methods and ResultsThe following 6 ideal cardiovascular health metrics were assessed in ARIC (Atherosclerosis Risk in Communities) Study participants at 5 examination visits between 1987 and 2013 (visits 1–4 in 1987–1998 and visit 5 in 2011–2013): smoking, body mass index, total cholesterol, blood pressure, physical activity, and blood glucose. Percentage attained CVHS was calculated in 6034 participants as the sum of CVHS at each visit/the maximum possible score. Aortic stenosis was assessed by echocardiography at visit 5 on the basis of the peak aortic valve velocity. Aortic stenosis was categorized sclerosis, mild stenosis, and moderate‐to‐severe stenosis. Mean age was 76±5 years, 42% were men, and 22% were black. Mean percentage attained CVHS was 63±14%, and the prevalence of aortic stenosis stages were 15.9% for sclerosis, 4.3% for mild stenosis, and 0.7% for moderate‐to‐severe stenosis. Worse percentage attained CVHS was associated with higher prevalence of aortic sclerosis (P<0.001 for trend), mild stenosis (P<0.001), and moderate‐to‐severe stenosis (P=0.002), adjusting for age, sex, and race.ConclusionsGreater attainment of ideal cardiovascular health in midlife to late life is associated with a lower prevalence of aortic sclerosis and stenosis in late life in a large cohort of older adults.

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“…Attainment of ideal cardiovascular health has been associated with a reduced incidence of coronary heart disease, stroke, and heart failure (HF) 2, 3, 4, 5, 6…”

mentioning

confidence: 99%

American Heart Association's Life Simple 7 and Risk of Atrial Fibrillation in a Population Without Known Cardiovascular Disease: The ARIC (Atherosclerosis Risk in Communities) Study

Garg

O’Neal

Chen

et al. 2018

JAHA

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BackgroundThe American Heart Association has defined metrics of ideal cardiovascular health known as Life's Simple 7 (LS7) to prevent cardiovascular disease. We examined the association between LS7 and incident atrial fibrillation (AF) in a biracial cohort of middle‐ and older‐aged adults without known cardiovascular disease.Methods and ResultsThis analysis included 13 182 ARIC (Atherosclerosis Risk in Communities) study participants (mean baseline age=54±5.7 years; 56% women; 25% black) free of AF and cardiovascular disease. An overall LS7 score was calculated as the sum of the LS7 component scores and classified as inadequate (0‐4), average (5‐9), or optimal (10‐14) cardiovascular health. The primary outcome was incident AF, identified primarily by ECG and hospital discharge coding of AF through December 31, 2014. A total of 2266 (17%) incident AF cases were detected over a median follow‐up of 25.1 years. Compared with the inadequate category (n=1057), participants in the average (n=8629) and optimal (n=3496) categories each had a lower risk of developing AF in a multivariable Cox proportional hazards model (hazard ratio 0.59, 95% confidence interval 0.51, 0.67 for average; and hazard ratio 0.38, 95% confidence interval 0.32, 0.44 for optimal). In a similar model, a 1‐point‐higher LS7 score was associated with a 12% lower risk of incident AF (hazard ratio 0.88, 95% confidence interval 0.86, 0.89).ConclusionsA higher LS7 score is strongly associated with a lower risk of AF in individuals without baseline cardiovascular disease. Determining whether interventions that improve the population's cardiovascular health also reduce AF incidence is needed.

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Ideal Cardiovascular Health Predicts Lower Risks of Myocardial Infarction, Stroke, and Vascular Death Across Whites, Blacks, and Hispanics

Cited by 312 publications

References 28 publications

Trends in Racial/Ethnic Disparities in Cardiovascular Health Among US Adults From 1999–2012

Trends in Racial/Ethnic Disparities in Cardiovascular Health Among US Adults From 1999–2012

Ideal Cardiovascular Health and the Prevalence and Severity of Aortic Stenosis in Elderly Patients

American Heart Association's Life Simple 7 and Risk of Atrial Fibrillation in a Population Without Known Cardiovascular Disease: The ARIC (Atherosclerosis Risk in Communities) Study

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