Ideal Cardiovascular Health and Lifetime Risk of Cardiovascular Disease: the Cardiovascular Disease Lifetime Risk Pooling Project
Circulation(2019)
摘要
Introduction: Ideal cardiovascular health (CVH) is associated with lower risk of cardiovascular disease (CVD) compared with intermediate and poor CVH. Quantifying the associations of ideal, intermediate, and poor CVH with lifetime risk of CVD can improve estimation of future population disease burden. Hypothesis: Individuals with ideal CVH have lower lifetime risk of CVD compared with individuals with intermediate and poor CVH. Methods: We pooled individual-level data from 7 US cohort studies (n=34027) that are included in the Lifetime Risk Pooling Project. We defined CVH based on levels of 7 health factors: smoking status, body mass index, physical activity, dietary pattern, total cholesterol, blood pressure, and diabetes mellitus. Each factor is scored as ideal (2 points), intermediate (1 point), or poor (0 points). The total CVH score was used to define overall CVH according to categories of ideal (12-14 points), intermediate (9-11 points), or poor (0-8 points). We used a modified Kaplan-Meier analysis, accounting for the competing risk of death, to assess the lifetime risk of CVD (CVD deaths, myocardial infarction, stroke, heart failure) separately in men and women free of CVD at index age categories of <40, 40-59, and ≥60 years. Results: Over 553379 person-years of follow-up, we observed 6858 CVD events (103 events in ideal, 1514 in intermediate, and 5241 in poor CVH categories). Men had higher lifetime risk of CVD than women across all CVH categories. In the 40-59 years index age group (Figure), participants with ideal CVH had lower lifetime risk of CVD (men, 14.3%; women, 12.0%) compared with intermediate (men, 21.9%; women, 16.9%) and poor (men, 42.7%; women, 33.8%) CVH. Patterns were similar for the <40 and ≥60 years index age groups. Conclusions: Ideal CVH is associated with substantially lower lifetime risk of CVD in US men and women. Further research is warranted to investigate strategies for maintaining and restoring ideal CVH throughout the life course to prevent associated risk of CVD.
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