Cardiovascular Health Score and Lifetime Risk of Cardiovascular Disease

Abstract

C ardiovascular disease (CVD) remains the leading cause of death and a major cause of morbidity in the United States and globally. 1,2 Decades of epidemiological and clinical trial evidence have established the causal associations of several factors with increased risk of CVD, including hypertension, dyslip-idemia, diabetes mellitus, and cigarette smoking. 3 In 2010, the American Heart Association introduced the concept of cardiovascular health (CVH)-a comprehensive construct incorporating the simultaneous presence of 7 favorable health behaviors and factors. 4 These be-haviors/factors are modifiable and include the following metrics: smoking status, body mass index, physical activity , diet quality, total cholesterol, blood pressure (BP), and fasting glucose. Associations of overall CVH with numerous adverse health outcomes have been well-described in previous studies in diverse samples. 5-13 However, data are sparse regarding associations of CVH across the life course with longer term risk of adverse health outcomes, particularly CVD, in broad, representative populations. Furthermore , because the risks of noncardiovascular causes of death increase over longer time horizons, adjustment for these competing risks is crucial to accurately quantify the lifetime risk of CVD and avoid its overestima-tion. 14,15 A comprehensive analysis of CVH status across adulthood and lifetime risk of CVD, in the context of competing causes of death, can improve estimation of future population disease burden and call attention to the need to investigate strategies for maintaining and restoring high CVH throughout the life course. Tobacco smoking was defined as self-reported never, former, and current smoking. Body mass index was calculated as the weight in kilograms divided by height in meters squared. Physical activity was assessed according to cohort-specific quartiles of activity levels, constructed using Z scores estimated from the different physical activity questionnaires used within each cohort, according to ideal (quartile 4), intermediate (quartiles 2 and 3), and poor (quartile 1) categories. 13 Healthy diet was assessed according to cohort-specific quin-tiles of the Alternate Healthy Eating Index 2010 (range, 0-110 points), 25 based on self-reported diet composition according to ideal (quintile 5), intermediate (quintiles 3 and 4), and poor (quintiles 1 and 2) categories. 26 Total cholesterol, BP, and fasting glucose were measured according to standard protocols. The individual CVH metrics are each scored as ideal (2 points), WHAT IS KNOWN • The cardiovascular health (CVH) score integrates 7 of the most important risk factors for preventing cardiovascular disease (CVD), and previous studies show higher CVH is associated with lower risk of CVD. • However, data are sparse regarding associations of CVH across the life course with longer term risk of adverse health outcomes, particularly CVD, in broad, representative populations. WHAT THE STUDY ADDS • In this pooled cohort analysis of 30 447 US adults, those with high CVH had markedly lower lifetime risks for CVD events compared with individuals with moderate and low CVH. • The trend of lower lifetime risk for CVD among those with higher CVH was consistent across all age, sex, and race groups. • Persistent sex and race disparities in lifetime risks of CVD were observed and may be explained, in part, by corresponding disparities in levels of CVH metrics.