Trends in Cardiovascular Health Metrics and Associations With All-Cause and CVD Mortality Among US Adults

Yang, Quanhe; Cogswell, Mary E.; Flanders, W. Dana; Hong, Yuling; Zhang, Zefeng; Loustalot, Fleetwood; Gillespie, Cathleen; Merritt, Robert; Hu, Frank B.

doi:10.1001/jama.2012.339

Cited by 691 publications

(712 citation statements)

References 54 publications

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“…We also observed that the prevalence of ideal cardiovascular health among obese people was extremely low over the past 3 decades, remaining consistently <2%, and that very few adult obese participants met the criteria for ideal blood cholesterol health (<5%). These results are consistent with previously reported very low prevalence of meeting cardiovascular health among the general adult population in the United States 33. Consistent with a previous report on the prevalence of CVD risk factors in US adults from 1960 to 2000,16 our results indicated that blood glucose health continued to deteriorate in obese people during the period 1988–2014.…”

Section: Discussionsupporting

confidence: 93%

Trends in Cardiovascular Health Metrics in Obese Adults: National Health and Nutrition Examination Survey (NHANES), 1988–2014

Guo

Garvey

2016

JAHA

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BackgroundNo study has quantified trends in the prevalence of cardiovascular disease risk factors and cardiovascular health metrics among obese people in the United States in recent years.Methods and ResultsWe examined the secular changes in cardiovascular health metrics and key cardiovascular disease risk factors among obese adults (aged ≥20 years) in the United States. We included 18 626 obese adults (body mass index ≥30) from the National Health and Nutrition Examination Survey (NHANES) III and NHANES 1999–2014. Among those obese adults, there were decreases in mean systolic blood pressure, diastolic blood pressure, and total cholesterol levels and increases in mean high‐density lipoprotein cholesterol levels and mean hemoglobin A1c levels. Prevalence of blood pressure health and lipid health remained stable during the period 1988–2014, whereas prevalence of blood glucose health decreased significantly during this period. Prevalence of freedom from cardiovascular disease risk factors remained stable at ≈15% among the adult obese population during the period 1988–2014, whereas prevalence of presence of all 3 risk factors increased from 16.4% to 22.4% during this period, commensurate with a decline in those with 1 to 2 risk factors (from 69.6% to 62.4%).ConclusionsDuring the past 3 decades, blood pressure health and blood lipid health remained stable or improved, whereas blood glucose health deteriorated among adult obese population. This resulted in an overall decrease in cardiovascular health status among obese adults and greater risk of type 2 diabetes mellitus. The data argue for interventions targeted to those obese persons who are metabolically unhealthy to stem rising rates of diabetes mellitus.

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Section: Discussionsupporting

confidence: 93%

Trends in Cardiovascular Health Metrics in Obese Adults: National Health and Nutrition Examination Survey (NHANES), 1988–2014

Guo

Garvey

2016

JAHA

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“…For dietary patterns in Life's Simple 7, some investigators raised a concern that adherence to the 5 AHA dietary recommendations is challenging 25. In fact, in our study as well as previous ones, the prevalence of ideal diet patterns is low (<1%–6%) 17, 18, 26, 27, 28. This might partially explain no significant association, even with incident MI, an analysis with much higher statistical power than the analysis after incident MI.…”

Section: Discussioncontrasting

confidence: 50%

American Heart Association's Life's Simple 7 at Middle Age and Prognosis After Myocardial Infarction in Later Life

Mok

Sang

Ballew

et al. 2018

JAHA

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BackgroundThe American Heart Association recommends focusing on 7 health factors (Life's Simple 7) for primordial prevention of cardiovascular health. However, whether greater adherence to Life's Simple 7 in midlife improves prognosis after myocardial infarction (MI) in later life is unknown.Methods and ResultsIn 1277 participants who developed MI during the ARIC (Atherosclerosis Risk in Communities) Study follow‐up, a 14‐point score of Life's Simple 7 was constructed according to the status (2 points for ideal, 1 point for intermediate, and 0 points for poor) of each of 7 factors (smoking, adiposity, physical activity, diet, total cholesterol, blood pressure, and fasting glucose) at baseline (1987–1989). Hazard ratios for composite and individual adverse outcomes of all‐cause mortality, cardiovascular mortality, recurrent MI, heart failure, and stroke were calculated according to Life's Simple 7 score. During a median follow‐up of 3.3 years, 918 participants (72%) had subsequent adverse outcomes after MI. Life's Simple 7 score at middle age was inversely associated with adverse outcomes after MI (adjusted hazard ratios of composite outcome, 0.57 [95% confidence interval, 0.39–0.84] if score is ≥10, 0.78 [95% confidence interval, 0.57–1.07] if score is 7–9, and 0.82 [95% confidence interval, 0.60–1.11] if score is 4–6 versus ≤3). The association was largely independent of access to care and MI severity. Individual factors related to better prognosis after MI were ideal nonsmoking, body mass index, blood pressure, and fasting glucose.ConclusionsOptimal Life's Simple 7 at middle age was associated with better prognosis after MI in later life. Our findings suggest a secondary prevention benefit of having better cardiovascular health status in midlife.

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“…Attainment of these ideal health metrics has been associated with lower incidence of cardiovascular disease, including coronary heart disease, myocardial infarction, heart failure,10, 11, 12, 13, 14 stroke,15 and retinopathy,16 in addition to noncardiovascular conditions, such as cancer 11, 17. Greater attainment of ideal cardiovascular health through midlife to late life is associated with both a lower prevalence of cardiovascular disease in late life and better cardiac structure and function in late life among people free of prevalent cardiovascular disease 18.…”

Section: Introductionmentioning

confidence: 99%

Ideal Cardiovascular Health and the Prevalence and Severity of Aortic Stenosis in Elderly Patients

Sengeløv

Cheng

Biering‐Sørensen

et al. 2018

JAHA

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BackgroundThe relationship between ideal cardiovascular health reflected in the cardiovascular health score (CVHS) and valvular heart disease is not known. The purpose of this study was to determine the association of CVHS attainment through midlife to late life with aortic stenosis prevalence and severity in late life.Methods and ResultsThe following 6 ideal cardiovascular health metrics were assessed in ARIC (Atherosclerosis Risk in Communities) Study participants at 5 examination visits between 1987 and 2013 (visits 1–4 in 1987–1998 and visit 5 in 2011–2013): smoking, body mass index, total cholesterol, blood pressure, physical activity, and blood glucose. Percentage attained CVHS was calculated in 6034 participants as the sum of CVHS at each visit/the maximum possible score. Aortic stenosis was assessed by echocardiography at visit 5 on the basis of the peak aortic valve velocity. Aortic stenosis was categorized sclerosis, mild stenosis, and moderate‐to‐severe stenosis. Mean age was 76±5 years, 42% were men, and 22% were black. Mean percentage attained CVHS was 63±14%, and the prevalence of aortic stenosis stages were 15.9% for sclerosis, 4.3% for mild stenosis, and 0.7% for moderate‐to‐severe stenosis. Worse percentage attained CVHS was associated with higher prevalence of aortic sclerosis (P<0.001 for trend), mild stenosis (P<0.001), and moderate‐to‐severe stenosis (P=0.002), adjusting for age, sex, and race.ConclusionsGreater attainment of ideal cardiovascular health in midlife to late life is associated with a lower prevalence of aortic sclerosis and stenosis in late life in a large cohort of older adults.

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Trends in Cardiovascular Health Metrics and Associations With All-Cause and CVD Mortality Among US Adults

Cited by 691 publications

References 54 publications

Trends in Cardiovascular Health Metrics in Obese Adults: National Health and Nutrition Examination Survey (NHANES), 1988–2014

Trends in Cardiovascular Health Metrics in Obese Adults: National Health and Nutrition Examination Survey (NHANES), 1988–2014

American Heart Association's Life's Simple 7 at Middle Age and Prognosis After Myocardial Infarction in Later Life

Ideal Cardiovascular Health and the Prevalence and Severity of Aortic Stenosis in Elderly Patients

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