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Abstract

Background

The American Heart Association has prioritised seven cardiovascular health metrics to reduce the cardiovascular burden, including: body mass index, healthy diet, physical activity, smoking status, blood pressure, glycated haemoglobin A1c and total cholesterol. The aim of the current study was to assess the association between the American Heart Association-defined health metrics and the risk of cardiovascular events in the EPIC-Norfolk prospective study.

Design

Prospective cohort study.

Methods

An overall cardiovascular health score was calculated based on the number of health metrics including ideal, intermediate or poor. Cox proportional hazards models were used to describe the association of the seven metrics separately and the overall health score with risk of coronary heart disease, stroke and cardiovascular disease. A total of 10,043 participants was included in the analysis (follow-up 1993–2008). For all individual health metrics a more ideal status was associated with a lower risk of cardiovascular events.

Results and conclusion

As for the overall cardiovascular health score, those in the highest (i.e. healthiest) category (score 12–14) had an adjusted hazard ratio for coronary heart disease of 0.07 (95% confidence interval (CI) 0.02–0.29, P < 0.001), for stroke of 0.16 (95% CI 0.02–1.37, P = 0.09) and for cardiovascular disease of 0.07 (95% CI 0.02–0.23, P < 0.001), compared to people in the lowest (i.e. unhealthiest) category (score 0–2). The overall cardiovascular health score was strongly and inversely associated with risk of coronary heart disease, stroke and cardiovascular disease. Our data suggest that even small improvements in modifiable risk factors may lead to substantial reductions in the risks of cardiovascular events.

Keywords

Health metrics risk factors primary prevention cardiovascular diseases

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References

Lozano

Naghavi

Foreman

. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380(9859): 2095–2128.

Yusuf

Hawken

Ounpuu

. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): Case-control study. Lancet 2004; 364(9438): 937–952.

Iestra

Kromhout

van der Schouw

. Effect size estimates of lifestyle and dietary changes on all-cause mortality in coronary artery disease patients: A systematic review. Circulation 2005; 112(6): 924–934.

Eckel

Jakicic

Ard

. 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. Circulation 2014; 129(25 Suppl 2): S76–99.

Perk

Gohlke

. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012): The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Atherosclerosis 2012; 223(1): 1–68.

Folsom

Yatsuya

Nettleton

. Community prevalence of ideal cardiovascular health, by the American Heart Association definition, and relationship with cardiovascular disease incidence. J Am Coll Cardiol 2011; 57(16): 1690–1696.

Kotseva

Wood

. Cardiovascular prevention guidelines in daily practice: A comparison of EUROASPIRE I, II, and III surveys in eight European countries. Lancet 2009; 373(9667): 929–940.

Lloyd-Jones

Hong

Labarthe

. Defining and setting national goals for cardiovascular health promotion and disease reduction: The American Heart Association’s strategic Impact Goal through 2020 and beyond. Circulation 2010; 121(4): 586–613.

Day

Oakes

Luben

. EPIC-Norfolk: Study design and characteristics of the cohort. European Prospective Investigation of Cancer. Br J Cancer 1999; 80(Suppl 1): 95–103.

10.

Bingham

Welch

McTaggart

. Nutritional methods in the European Prospective Investigation of Cancer in Norfolk. Public Health Nutr 2001; 4(3): 847–858.

11.

Wareham

Jakes

Rennie

. Validity and repeatability of a simple index derived from the short physical activity questionnaire used in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Public Health Nutr 2003; 6(4): 407–413.

12.

Khaw

Wareham

Bingham

. Combined impact of health behaviours and mortality in men and women: The EPIC-Norfolk prospective population study. PLoSMed 2008; 5(1): e12–e12.

13.

Ford

Greenlund

Hong

. Ideal cardiovascular health and mortality from all causes and diseases of the circulatory system among adults in the United States. Circulation 2012; 125(8): 987–995.

14.

Huang

Yang

. Prevalence of ideal cardiovascular health and its relationship with the 4-year cardiovascular events in a northern Chinese industrial city. Circ Cardiovasc Qual Outcomes 2012; 5(4): 487–493.

15.

Ludt

Wensing

Campbell

. The challenge of cardiovascular prevention in primary care: Implications of a European observational study in 8928 patients at different risk levels. Eur J Prev Cardiol 2014; 21(2): 203–213.

16.

Espana-Romero

Golubic

Martin

. Comparison of the EPIC Physical Activity Questionnaire with combined heart rate and movement sensing in a nationally representative sample of older British adults. PLoSOne 2014; 9(2): e87085–e87085.

17.

Knoops

Groot de

Fidanza

. Comparison of three different dietary scores in relation to 10-year mortality in elderly European subjects: The HALE project. Eur J Clin Nutr 2006; 60(6): 746–755.

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Ideal cardiovascular health and risk of cardiovascular events in the EPIC-Norfolk prospective population study