Ideal Cardiovascular Health: Associations with Biomarkers and Subclinical Disease, and Impact on Incidence of Cardiovascular Disease in the Framingham Offspring Study
Background—The American Heart Association Cardiovascular Health score (CVH score) is inversely associated with cardiovascular disease (CVD) incidence but the mechanisms underlying this association warrant exploration.
Methods and Results—We related the CVH score to circulating biomarkers and prevalent subclinical CVD (defined as ≥1 of the following:increased carotid intima-media thickness or stenosis; left ventricular hypertrophy (by ECG or echocardiography); left ventricular systolic dysfunction; microalbuminuria; and a reduced ankle-brachial index) in 2680 Framingham Study participants (mean age 58 years, 55% women). Adjusting for age & sex, an ideal CVH score (non-smoking status, ideal body mass index, regular physical activity, healthy diet, and an optimal profile of serum cholesterol, blood pressure, and glucose; 1 point for each) was associated with: a. higher circulating concentrations of natriuretic peptides (NT-proANP & B-type natriuretic peptide) and lower blood concentrations of plasminogen activator inhibitor-1, aldosterone, C-reactive protein, D-dimer, fibrinogen, homocysteine, and growth differentiation factor-15 levels (p<0.001 for all);and b. lower odds of subclinical disease (Odds Ratio 0.74 per unit increase in CVH score, 95% CI 0.68, 0.80). The incidence of CVD (267 events over 16 years) was inversely associated with the CVH score in age-, sex-adjusted models (Hazards ratio [HR] 0.77 per unit-increase in CVH score, 95% CI 0.70, 0.86) that was slightly attenuated upon adjustment for biomarkers and subclinical disease (HR 0.87, 95% CI 0.78, 0.97).
Conclusions—In our prospective community-based study, the inverse association between an ideal cardiovascular health score and CVD incidence was partly attributable to its favorable impact on CVD biomarker levels and subclinical disease.
- AHA 2020 goals
- Ideal Cardiovascular health
- subclinical atherosclerosis risk factor
- cardiovascular disease prevention
- cardiovascular disease risk factors
- Received February 4, 2014.
- Revision received July 17, 2014.
- Accepted August 19, 2014.