Ideal Cardiovascular Health
Start Young, Finish Strong
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Landmark developments during the second half of the 20th century established that smoking, hypertension, and hypercholesterolemia constituted cardinal risk factors for cardiovascular morbidity and mortality.1 These insights proved critical in reversing decades of increases in the mortality rate from coronary heart disease in the United States starting in the late 1960s. As knowledge concerning the pathogenesis and pathophysiology of cardiovascular disease evolved rapidly during ensuing decades, research tended to focus on how much risk for adverse cardiovascular events increased in function of levels of risk factors (high-risk emphasis). However, this paradigm has shifted as research increasingly emphasized that low-risk cardiovascular risk factor profiles were associated with large reductions in cardiovascular mortality and improvements in other outcomes (low-risk emphasis).2 Thus, the conceptual framework for preventing cardiovascular disease that had been anchored largely in primary prevention increasingly embraced primordial prevention.3
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In 2010, the American Heart Association released a set of 7 cardiovascular health metrics for adults and children that put cardiovascular health, as opposed to cardiovascular disease, front and center.4 These metrics were divided into 4 health behaviors (smoking, weight, physical activity, and diet) and 3 health factors (blood pressure, total cholesterol, and glycemia). For each health metric, 3 levels of cardiovascular health were defined: poor, intermediate, and ideal cardiovascular health. Although the choice of the metrics and the definition of levels of cardiovascular health for each metric rested on sound science, the utility of these metrics when combined into an index had not been previously tested. Recent studies have substantiated the AHA cardiovascular health metrics in adults.5,6 Hitherto, information about the utility of these metrics in children and adolescents was lacking.
In this issue of Circulation, Laitinen and colleagues7 report the results of a study that examined the …