Key Points Question Are trajectories of overall cardiovascular health over time, as assessed by the cardiovascular health score repeatedly in 2006, 2008, and 2010, associated with subsequent risk of cardiovascular disease? Findings In this population-based study of 74 701 Chinese adults, 5 cardiovascular health score trajectories were identified. Relative to the lowest measured trajectory, the highest measured trajectory was associated with a 79% lower subsequent risk of cardiovascular disease after adjusting for age, sex, educational level, income, occupation, alcohol intake, and serum high-sensitivity C-reactive protein concentrations at baseline. Meaning Long-term cardiovascular health trajectories may be associated with subsequent cardiovascular disease morbidity.

Background and AimsThe American Heart Association has recently established seven ideal cardiovascular health metrics for cardiovascular health promotion and disease reduction (i.e., non-smoking, normal body mass index, physically active, healthy diet, and normal levels of cholesterol, blood pressure and fasting blood glucose). The present study seeks to evaluate how well these metrics predict mortality from all causes and cardiovascular diseases in adult Chinese living in a northern industrial city.Methods and ResultsData of 95,429 adults who participated in the Kailuan cohort study from June 2006 to October 2007 was analyzed. All participants underwent questionnaire assessment, clinical examination, laboratory assessments and were followed up biannually. During a median follow-up of 4.02 years, 1,843 deaths occurred, with 597 deaths resulting from cardiovascular diseases. Lower mortality rates from all causes and cardiovascular diseases were observed among the subjects who met a higher number of the ideal health metrics. Compared to the participants who met none or one ideal health metric, those meeting ≥5 ideal health metrics had a lower risk of all-cause mortality by 30% (adjusted hazard ratio, 0.70; 95% confidence interval, 0.56–0.88) and a lower risk of mortality from cardiovascular diseases by 39% (adjusted hazard ratio, 0.61; 95% confidence interval, 0.41–0.89) . Four metrics (smoking status, physical activity, blood pressure and fasting blood glucose) were significantly associated with all-cause mortality. Three metrics (physical activity, blood pressure and fasting blood glucose) were significantly associated with mortality from cardiovascular diseases.ConclusionThe number of ideal health metrics is negatively associated with mortality rates from all causes and cardiovascular diseases among adults in a Northern Chinese industrial city. The data supports the AHA recommendation of ideal health metrics for adults from Northern China.

Exposure to higher cumCVH can prevent the increase in baPWV and reduce the incidence of arterial stiffness.

Increased levels of the inflammatory biomarker high-sensitivity C-reactive protein (hs-CRP) are associated with increased risk of cardiovascular disease. However, ideal cardiovascular health indicates lower risk of cardiovascular disease. This study aimed to investigate the effect of ideal cardiovascular health behaviors and health factors on hs-CRP levels among a hypertensive population. From 2006 to 2007, a cross-sectional study was conducted to survey 41,476 hypertensive subjects among the employees of Kailuan Corporation. Data from unified questionnaires and blood biochemical examinations were collected. The effects of ideal cardiovascular health behaviors and health factors on hs-CRP levels were evaluated through multivariate logistic regression analysis. A negative correlation was observed between hs-CRP levels and the number of ideal cardiovascular health metrics. The mean hs-CRP levels of subjects with zero to one, two, three, and four to six ideal cardiovascular health metrics were 1.11, 0.96, 0.90, and 0.80 mg/L, respectively (P<0.01). Multivariate logistic regression analysis revealed that after adjustment for sex, age, triglyceride, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and other risk factors, the risks for subjects with two, three, and four to six ideal health metrics with serum hs-CRP >3 mg/L were lower than those with zero to one ideal health metrics, with corresponding odd ratios of 0.86 (95%CI: 0.79–0.93, P<0.01), 0.76 (95%CI: 0.69–0.83, P<0.01), and 0.68 (95%CI: 0.64–0.75, P<0.01), respectively. This finding suggests that ideal cardiovascular health behaviors and health factors were related to decreased hs-CRP levels in a hypertensive population.Clinical Trial RegistrationUnique identifier: ChiCTR-TNC-11001489.

Hypertension is a well established cause of chronic kidney disease (CKD). However, the effect of prehypertension on risk of CKD is controversial. The aim of this study is to determine whether prehypertension increases the risk of CKD events in the Chinese population. We enrolled 20,034 with prehypertension and 12,351 with ideal blood pressure in this prospective study. CKD was defined as an estimated glomerular filtration rate (eGFR) <60 ml/min 1.73m2. The new occurrences of CKD events were collected during follow-up. Cumulative survival and freedom for the occurrence of new CKD events was analyzed using the Kaplan-Meier approach. Multivariate Cox Regression was used to analyze the effect of prehypertension on CKD. The median follow-up time was 47 (interquartile range 44–51) months. 601 new onset CKD events occurred during the follow-up period. The cumulative incidence of new CKD events was higher in the prehypertensive population than that in the ideal blood pressure population (2.10% vs 1.46%, P = 0.0001). Multivariate Cox Regression showed that relative risks (RRs) for the new onset CKD events in the prehypertensive population were 1.69 (95% confidence intervals (CI): 1.41~2.04, P = 0.001) higher than those in the ideal blood pressure population. Similarly, the risks were 1.68 (95% CI: 1.33~2.13 P = 0.001) times higher in females and 2.14 (95% CI: 1.58~2.91 P = 0.001) times higher in males by adjustment for traditional CV risk factors. Our findings demonstrated prehypertension is an independent risk factor for the occurrence of new CKD events in the Chinese population.

Objective. Hyperuricemia has been shown to be associated with increased risks of gout and cardiovascular diseases. We prospectively investigated the association between the American Heart Association (AHA) ideal cardiovascular health metrics, including smoking, body mass index, dietary intake, physical activity, blood pressure, total cholesterol, and fasting blood glucose, and the risk of developing hyperuricemia. Methods. We included 77,787 Chinese adults, ages ‡18 years (60,951 men and 16,836 women), without hyperuricemia at the baseline (2006) in this study. Information on the cardiovascular health metrics at baseline was collected. Incident hyperuricemia cases were identified by elevated serum uric acid concentrations, which were repeatedly assessed in 2006, 2008, 2010, and 2012, respectively. Cox regression was used to calculate the hazard ratios (HRs) and 95% confidence intervals (95% CIs) for incident hyperuricemia according to the baseline ideal cardiovascular health metrics. Results. We observed an inverse relation between the greater numbers of ideal cardiovascular health metrics at baseline and lower risks of developing hyperuricemia during 6 years of followup. After adjusting for age, sex, alcohol consumption, and other potential confounders, the HRs for incident hyperuricemia were 0.95, 0.84, 0.72, and 0.64 (95% CIs 0.58-0.70, P for trend < 0.0001) for participants who met 2, 3, 4, and 5-7 metrics, respectively, compared with those who met 0-1 cardiovascular health metrics. Conclusion. Greater cardiovascular health metrics were associated with lower risk of hyperuricemia in this Chinese population, suggesting that the modifiable construct defined by the AHA could be of significance in reducing the risk of developing hyperuricemia-related diseases, such as gout.

Ideal cardiovascular health behaviors and factors are protective factors to prevent the progression from prehypertension to hypertension.

ObjectiveTo identify long-term fasting blood glucose trajectories and to assess the association between the trajectories and the risk of arterial stiffness in individuals without diabetes.MethodsWe enrolled 16,454 non-diabetic participants from Kailuan cohort. Fasting blood glucose concentrations were measured in 2006, 2008, and 2010 survey. Brachial-ankle pulse wave velocities were measured during 2011 to 2016. Multivariate regression model was used to estimate the difference of brachial-ankle pulse wave velocity levels and logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (95%CIs) of arterial stiffness risk, according to the fasting blood glucose trajectories.ResultsWe identified five distinct fasting blood glucose trajectories and each of the trajectories was labeled according to its range and change over 2006–2010 survey: elevated-stable pattern (5.0% of participants), elevated-decreasing pattern (6.6%), moderate-increasing pattern (10.9%), moderate-stable pattern (59.3%), and low-stable pattern (18.2%). After adjustment for potential confounders, individuals with elevated-stable pattern had a 42.6 cm/s (95%CI: 24.7 to 60.6 cm/s) higher brachial-ankle pulse wave velocity level and a 37% (OR 1.37, 95%CI: 1.14 to 1.66) higher arterial stiffness risk, and individuals with moderate-increasing pattern had a 19.6 cm/s (95%CI: 6.9 to 32.3 cm/s) higher brachial-ankle pulse wave velocity level and a 17% (OR 1.17, 95%CI: 1.03 to 1.33) higher arterial stiffness risk, related to individuals with moderate-stable pattern. We did not find significant associations of the elevated-decreasing or low-stable patterns with arterial stiffness. Consistently, the cumulative average, variability, and increased rate of fasting blood glucose during 2006–2010 survey were significantly associated with the arterial stiffness risk.ConclusionDiscrete fasting blood glucose trajectories were associated with the arterial stiffness risk in non-diabetic individuals.