Cardiovascular Health Score Associated with Subsequent Risk of CVD

A recent study, involving more than 70,000 individuals in China, has found that cardiovascular health trajectories are associated with subsequent risk of cardiovascular disease (CVD).

Investigators examined whether trajectories of cardiovascular health, defined by cardiovascular health score (CHS), from 2006 to 2010 was associated with risk of subsequent CVD between 2010 and 2015.

"In our study population, and probably across the world, there are many people who have suboptimal or poor heart health," explained Xiang Gao, MD, PhD, associate professor of nutritional sciences and director of the Nutritional Epidemiology Lab at Penn State. "But, even though most people don't meet the ideal criteria for all seven metrics, if we can work to improve those measures, the future risk of CVD can still decrease."

Based on the American Heart Association published 2020 Strategic Impact Goals to improve cardiovascular health, investigators sought to determine an association between cardiovascular health scores in 2006, 2008, and 2010 and subsequent risk of CVD. Investigators developed CHS trajectories from 2006 to 2010 to predict CVD risk from 2010 to 2015.

The AHA proposed a concept that included the presence of 7 favorable metrics and the absence of CVD, and investigators used this to create an individual-level composite of all 7 measures to evaluate overall cardiovascular health. The 7 measurements include 4 health behaviors (smoking, body weight, physical activity, and diet) and 3 health factors (blood pressure, plasma glucose level, and cholesterol level).

"Only about 2 percent of people in the United States and other countries meet all the ideal requirements for these seven factors," Gao said. ”This raises the question of whether improving these metrics is related to lower future risk of CVD. It should, but no one had the data to support this idea."

Investigators included a total of 74,701 participants in the Kailuan community in Tangshan, Republic of China and developed CHS trajectories that ranged from 0 (worst) to 14 (best). Based on baseline CHS and patterns, 5 trajectories were categorized (low-stable, moderate-increasing, moderate-decreasing, highstable 1, and high-stable 2).

The main outcomes of the study were incident CVD events. To identify potential CVD events, investigators reviewed discharge lists from the 11 hospitals examined during the study from 2006 to 2016 and a biennial interview. Cox proportional hazards regression ws used to calculate hazard ratios and 95% confidence intervals of risk of developing CVD during 2010 to 2015 across CHS trajectories.

After analyses, investigators found 5 patterns accord got both baseline CHS and patterns over time. Investigators noted the following population levels and CHS changes in the 5 categories: low-stable (n=4393; mean CHS range, 4.6-5.2 during 2006-2010), moderate-increasing (n=4643, mean CHS increased from 5.4 in 2006 to 7.8 in 2010), moderate-decreasing (n=14,853, mean CHS decreased from 7.4 in 2006 to 6.3 in 2010), high-stable 1 (n=36 352, mean CHS range, 8.8-9.0 during 2006-2010), and high-stable 2 (n=14,461, mean CHS range, 10.9-11.0 during 2006-2010).

Between 2010 and 2015, investigators identified 1842 incidents CVD events (1401 stroke cases, 429 m myocardial infarction cases, and 22 stroke and myocardial infarction cases). Additionally, compared to the low-stable trajectory, the high-stable 2 trajectory was associated with a lower subsequent risk of CVD (aHR, 0.21; 95% CI, 0.16-0.26, after multivariable adjustment for age, sex, educational level, income, occupation, alcohol intake, and serum high-sensitivity C-reactive protein concentration at baseline).

Based on the results of their analyses, investigators concluded that CHS trajectories and an improvement in cardiovascular health status might be associated with risk of CVD morbidity in a large population. Investigators noted that their results suggest implementation of preventive strategies to optimize cardiovascular health behaviors and risk factors could improve cardiovascular health — they called for additional studies with information on diet and physical activity to attempt to replicate their observations.

This study, titled “Association of Trajectory of Cardiovascular Health Score and Incident Cardiovascular Disease,” was published in JAMA Cardiology.