Association Between a Healthy Heart Score and the Development of Clinical Cardiovascular Risk Factors Among Women

Sotos-Prieto, Mercedes; Mattei, Josiemer; Hu, Frank B.; Chomistek, Andrea K.; Rimm, Eric B.; Willett, Walter C.; Eliassen, A. Heather; Chiuve, Stephanie E.

doi:10.1161/circoutcomes.115.002372

Cited by 18 publications

(10 citation statements)

References 49 publications

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“…When we assessed the separate effect of the three different blocks of the MEDLIFE, the dimension that captured physical activity, social interaction, rest and conviviality was the only one showing statistically significant results, mainly due to physical activity, collective and non-collective sports. Despite the wide supporting evidence of the benefits of physical activity on cardiovascular health and mortality [ 52 – 60 ], we cannot rule out positive effects of other components such as napping, social interaction, or eating in company that are not usually included in other previously published scores [ 22 , 25 , 61 ]. Our findings may highlight the importance of those components in the context of a healthy Mediterranean dietary pattern.…”

Section: Discussionmentioning

confidence: 99%

Association between the Mediterranean lifestyle, metabolic syndrome and mortality: a whole-country cohort in Spain

Sotos-Prieto

Ortolá²,

Ruiz‐Canela

et al. 2021

Cardiovasc Diabetol

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Background Evidence is limited about the joint health effects of the Mediterranean lifestyle on cardiometabolic health and mortality. The aim of this study was to evaluate the association of the Mediterranean lifestyle with the frequency of the metabolic syndrome (MS) and the risk of all-cause and cardiovascular mortality in Spain. Methods Data were taken from ENRICA study, a prospective cohort of 11,090 individuals aged 18+ years, representative of the population of Spain, who were free of cardiovascular disease (CVD) and diabetes at 2008–2010 and were followed-up to 2017. The Mediterranean lifestyle was assessed at baseline with the 27-item MEDLIFE index (with higher score representing better adherence). Results Compared to participants in the lowest quartile of MEDLIFE, those in the highest quartile had a multivariable-adjusted odds ratio 0.73 (95% confidence interval (CI) 0.5, 0.93) for MS, 0.63. (0.51, 0.80) for abdominal obesity, and 0.76 (0.63, 0.90) for low HDL-cholesterol. Similarly, a higher MELDIFE score was associated with lower HOMA-IR and highly-sensitivity C-reactive protein (P-trend < 0.001). During a mean follow-up of 8.7 years, 330 total deaths (74 CVD deaths) were ascertained. When comparing those in highest vs. lowest quartile of MEDLIFE, the multivariable-adjusted hazard ratio (95% CI) was 0.58 (0.37, 0.90) for total mortality and 0.33 (0.11, 1.02) for cardiovascular mortality. Conclusions The Mediterranean lifestyle was associated with lower frequency of MS and reduced all-cause mortality in Spain. Future studies should determine if this also applies to other Mediterranean countries, and also improve cardiovascular health outside the Mediterranean basin.

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Section: Discussionmentioning

confidence: 99%

Association between the Mediterranean lifestyle, metabolic syndrome and mortality: a whole-country cohort in Spain

Sotos-Prieto

Ortolá²,

Ruiz‐Canela

et al. 2021

Cardiovasc Diabetol

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“…At the same time, the HHS results showed that the participants still significantly improved their HHS at week 4. The HHS is associated with many clinical disease risks, such as diabetes mellitus, hypertension, and hypercholesterolemia [ 37 ]. In other words, studies report that patients with higher HHS show higher incidences of such diseases [ 37 , 38 ].…”

Section: Discussionmentioning

confidence: 99%

“…The HHS is associated with many clinical disease risks, such as diabetes mellitus, hypertension, and hypercholesterolemia [ 37 ]. In other words, studies report that patients with higher HHS show higher incidences of such diseases [ 37 , 38 ]. When we converted the HHS to 20-year CVD risk, the participants’ initial risk resulted in 100%.…”

Section: Discussionmentioning

confidence: 99%

Improving Heart Disease Risk Through Quality-Focused Diet Logging: Pre-Post Study of a Diet Quality Tracking App

Kwon

VanDam

Chiuve

et al. 2020

JMIR Mhealth Uhealth

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Background Diet-tracking mobile apps have gained increased interest from both academic and clinical fields. However, quantity-focused diet tracking (eg, calorie counting) can be time-consuming and tedious, leading to unsustained adoption. Diet quality—focusing on high-quality dietary patterns rather than quantifying diet into calories—has shown effectiveness in improving heart disease risk. The Healthy Heart Score (HHS) predicts 20-year cardiovascular risks based on the consumption of foods from quality-focused food categories, rather than detailed serving sizes. No studies have examined how mobile health (mHealth) apps focusing on diet quality can bring promising results in health outcomes and ease of adoption. Objective This study aims to design a mobile app to support the HHS-informed quality-focused dietary approach by enabling users to log simplified diet quality and view its real-time impact on future heart disease risks. Users were asked to log food categories that are the main predictors of the HHS. We measured the app’s feasibility and efficacy in improving individuals’ clinical and behavioral factors that affect future heart disease risks and app use. Methods We recruited 38 participants who were overweight or obese with high heart disease risk and who used the app for 5 weeks and measured weight, blood sugar, blood pressure, HHS, and diet score (DS)—the measurement for diet quality—at baseline and week 5 of the intervention. Results Most participants (30/38, 79%) used the app every week and showed significant improvements in DS (baseline: mean 1.31, SD 1.14; week 5: mean 2.36, SD 2.48; 2-tailed t test t29=−2.85; P=.008) and HHS (baseline: mean 22.94, SD 18.86; week 4: mean 22.15, SD 18.58; t29=2.41; P=.02) at week 5, although only 10 participants (10/38, 26%) checked their HHS risk scores more than once. Other outcomes, including weight, blood sugar, and blood pressure, did not show significant changes. Conclusions Our study showed that our logging tool significantly improved dietary choices. Participants were not interested in seeing the HHS and perceived logging diet categories irrelevant to improving the HHS as important. We discuss the complexities of addressing health risks and quantity- versus quality-based health monitoring and incorporating secondary behavior change goals that matter to users when designing mHealth apps.

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“…The model has been validated [7] with data from large cohorts that consist primarily of non-Hispanic white, middleaged women and men and performs best among individuals without baseline CVD risk factors. Previous findings using the Healthy Heart Score showed that women in the highest quintile (poorest behaviour's) of the Healthy Heart Score had a predicted 18.01 (14.39-22.72 [20]. Researchers are currently collecting qualitative data to better understand the clinical utility of a lifestyle-only risk assessment tool with goal of adding clinical value when used in combination with short term risk models.…”

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confidence: 99%

The Value of Primordial Prevention in the Obesity Epidemic and Related Comorbidities

Buls¹,

Sotos‐Prieto²

2017

J Obes Eat Disord

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Despite an overall increase in public health awareness, the prevalence of obesity remains epidemically high. Worldwide, over half a billion people are currently classified as obese (body mass index [BMI] ≥ 30 kg/m 2 ), and it is estimated that over 40% of the U.S population will be obese by the year 2030 [1]. These statistics are of serious concern because of the recognized relationship between obesity and chronic disease, specifically cardiovascular disease (CVD) being the number one cause of death in the United States [2].Even in the absence of other cardiac related comorbidities, excess adipose tissue often induces dyslipidaemia, hypertension and glucose intolerance, all indicative of metabolic syndrome [3]. While each of these components is known to increase CVD risk independently, the combination of these markers and the presence of metabolic syndrome itself is associated with a significant long-term risk of CVD [4].Strong evidence suggests that healthy lifestyle habits can influence CVD risk factors [5]. For example, when observing more than 80,000 nurses, over 90% of diabetes mellitus cases, 57% of hypertension cases, and 40% of hypercholesterolemia cases were attributed to poor lifestyle factors [6]. Research has also showed that a combination of at least three low risk lifestyle factors and a BMI between 18.5-22.4 is associated with the lowest risk of CVD (0.37, 0.29 to 0.46) mortality, when compared with those with a BMI between 22.5-24.9 and none of the four low-risk lifestyle factors [7]. This emphasizes the importance of maintaining a healthy weight and the prevention of clinical risk factor development, recognizing the value of primordial prevention.Primordial prevention is defined as the prevention of the risk factors themselves, before the individual is negatively affected by the symptoms [8]. This is often thought of as radical, especially in young patients who don't currently exhibit concerning biomarkers. Primordial prevention differs from primary prevention in that the emphasis is on early dietary and lifestyle modifications to prevent the risk factors in the first place. If these risk factors are proven to lead to the onset of disease, why would health providers not want to prevent them from occurring in the first place? This is especially true when considering the alarming long-term risk that the obese population faces for developing CVD despite a perceived low short-term risk [4].Currently, there are numerous risk prediction tools that include in their assessment clinical risk factors such as blood pressure, and blood lipids to estimate an individual's short term (i.e., 10-years) risk of CVD. For individuals with a high risk based on these factors, it is common practice to attempt to decrease risk pharmacologically [9]. However, individuals with a low short term risk but elevated long term risk may benefit from alternative methods of risk factor management. In addition, the fact that drug therapy is usually prescribed when short term risk is high (>7.5% over 10 years) has led to hypertens...

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Association Between a Healthy Heart Score and the Development of Clinical Cardiovascular Risk Factors Among Women

Cited by 18 publications

References 49 publications

Association between the Mediterranean lifestyle, metabolic syndrome and mortality: a whole-country cohort in Spain

Association between the Mediterranean lifestyle, metabolic syndrome and mortality: a whole-country cohort in Spain

Improving Heart Disease Risk Through Quality-Focused Diet Logging: Pre-Post Study of a Diet Quality Tracking App

The Value of Primordial Prevention in the Obesity Epidemic and Related Comorbidities

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