Ideal Cardiovascular Health and Incident Cardiovascular Disease: Heterogeneity Across Event Subtypes and Mediating Effect of Blood Biomarkers: The PRIME Study

Abstract

BackgroundThe aim of this study was to investigate whether the association between baseline cardiovascular health (CVH) and incident cardiovascular disease differs according to coronary heart disease (CHD) and stroke subtypes, and to assess the mediating effect of inflammatory and hemostatic blood biomarkers.Methods and ResultsThe association of ideal CVH with outcomes was derived in 9312 middle‐aged men from Northern Ireland and France (whole cohort) in multivariable Cox proportional hazards regression analysis. The mediating effect of baseline inflammatory and hemostatic blood biomarkers was evaluated in a case–control study nested within the cohort after 10 years of follow‐up. After a median follow‐up of 10 years, 614 first CHD events and 117 first stroke events were adjudicated. Compared with those with poor CVH, those with an ideal CVH profile at baseline had a 72% lower risk of CHD (hazard ratio=0.28; 95% confidence interval, 0.17; 0.46) and a 76% lower risk of stroke (hazard ratio =0.24; 95% confidence interval, 0.06; 0.98). The magnitude of the risk reductions was similar for incident angina and myocardial infarction, but was lower for ischemic stroke. In the controls, the mean concentrations of high‐sensitivity C‐reactive protein, IL‐6, and fibrinogen decreased with higher CVH status. Furthermore, the association of behavioral CVH with incident CHD was partly mediated by high‐sensitivity C‐reactive protein (16.69%), IL‐6 (8.52%), and fibrinogen (7.30%)ConclusionsOur study shows no clear heterogeneity in the association of baseline CVH with the main subtypes of cardiovascular disease. This supports a universal promotion of ideal CVH for all cardiovascular disease subtypes. Furthermore, our mediation analysis suggests that the lower risk of CHD associated with ideal CVH is partly mediated by lower inflammatory and hemostatic blood biomarkers.

Sex differences in the association between ideal cardiovascular health and biomarkers of cardiovascular disease among adults in the United States: a cross-sectional analysis from the multiethnic study of atherosclerosis

“…This may suggest that attaining ideal health behaviours such as ideal BMI may lead to more reductions in the biomarkers of CVD risk compared with ideal health factors. However, more elaborate studies would be needed to explore these findings so definite conclusions can be reached because of the importance of biomarkers such as hsCRP, fibrinogen and IL-6 in mediating the relationship between CVH and CVD 24. For example, in a prior study of over 9300 men followed for 10 years, individuals with ideal CVH had lower risk for all CVD subtypes examined and the lower risk of coronary heart disease was mediated in part through lower inflammatory and hemostatic factors 24…”

Frequent, short bouts of light-intensity exercises while standing decreases systolic blood pressure: Breaking Up Sitting Time after Stroke (BUST-Stroke) trial

“…14,15 In addition, long periods of sitting have been shown to increase plasma clotting factors, 16 which in turn increases the risk of ischemic stroke. 17,18 Engaging in at least 10 min bouts of regular exercise of at least moderate intensity can reduce resting blood pressure. Decreases in systolic blood pressure of 1.8-10.9 mmHg and diastolic blood pressure of 2.5-6.2 mmHg as a result of regular exercise of at least moderate intensity have been reported for healthy and hypertensive adults, with isometric resistance exercise being most beneficial.…”

“…14,15 In addition, long periods of sitting have been shown to increase plasma clotting factors, 16 which in turn increases the risk of ischemic stroke. 17,18…”

Cardiovascular health status and its associations with cardiovascular disease and ischemic heart disease prevalence in Australian adults

“…A total of 27 studies 12,27,29,30,35,36,42,63,69,84,85,91,105,113,[143][144][145][146][147][148][149][150][151][152][153][154][155] were included in our study and Table 3.3 listed the results of associations between number of ideal metrics and CVD related outcomes. In all studies, persons with higher numbers of ideal CVH metrics had a lower risk of overall CVD mortality, 27,30,35,84,113,143,144,146 incidence, 12,29,69,113,143,150 and prevalence 151 than did those with fewer ideal CVH metrics.…”

“…Several studies have explored the association between ideal CVH metrics number and IHD mortality, 30 IHD prevalence, 152 CHD incidence, 84,85,105,113 stroke incidence, 36,42,84,85,105,113,143 and stroke prevalence 148 and they all demonstrated an inverse association. Participants in the highest categories had 70%, 78% and 42%-73% reduced risk of IHD mortality, IHD prevalence, and CHD incidence compared with those in the lowest categories.…”