Association of trajectory of cardiovascular health score and incident cardiovascular disease

Authors: WU, SHOULING - Kailuan Hospital; AN, SHASHA - Handan Central Hospital; LI, WEIJUAN - Vanderbilt University; LICHTENSTEIN, ALICE - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; GAO, JINGSHENG - Kailuan Hospital; KRIS-ETHERTON, PENNY - Pennsylvania State University; WU, YUNTAO - Kailuan Hospital; JIN, CHENG - Kailuan Hospital; HUANG, SHUE - Pennsylvania State University; HU, FRANK - Harvard University; GAO, XIANG - Pennsylvania State University

Submitted to: JAMA Network Open
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/8/2019
Publication Date: 5/31/2019
Citation: Wu, S., An, S., Li, W., Lichtenstein, A.H., Gao, J., Kris-Etherton, P.M., Wu, Y., Jin, C., Huang, S., Hu, F., Gao, X. 2019. Association of trajectory of cardiovascular health score and incident cardiovascular disease. JAMA Network Open. 2(5):e194758. https://doi.org/10.1001/jamanetworkopen.2019.4758.
DOI: https://doi.org/10.1001/jamanetworkopen.2019.4758

Interpretive Summary: The American Heart Association 2020 Strategic Impact Goals targets a 20% improvement in overall cardiovascular health. Whether this goal is met will be determined by assessing four lifestyle behaviors - smoking, body weight, physical activity, diet; two blood measures - glucose and cholesterol concentrations; and blood pressure. The sum of these factors is referred to as the cardiovascular health score (CHS). Higher scores are associated with lower rates of cardiovascular disease (CVD) and all-cause mortality. Our aim was to determine whether changes in the CHS over time altered the risk of CVD outcomes and all-cause mortality in a large population. To accomplish this we included 64,525 Chinese adults (50,557 men and 13,968 women) free of CVD and cancer at the time they entered the study. Data for the components of the CHS was collected in 2006 and 2008. The change in CHS between those years was calculated. During the 7 year of follow-up period, there were 2,199 CVD events and 2,720 deaths. Improvement, as indicated by an increase in the CHS, was associated with a lower risk of CVD events, CVD mortality, and all-cause mortality, after adjusting for other risk factors. These findings indicate that an improvement in the overall cardiovascular health status by improving cardiovascular health behaviors and factors, including smoking, body weight, physical activity, diet; blood glucose and cholesterol concentrations and blood pressure, can result in improved health outcomes, particularly CVD, in this cohort.

Technical Abstract: IMPORTANCE: The American Heart Association 2020 Strategic Impact Goals target an improvement in overall cardiovascular health, as assessed by 7 health metrics (smoking, body weight, physical activity, diet, plasma glucose level, plasma cholesterol level, and blood pressure). OBJECTIVE: To examine whether trajectories of overall cardiovascular health over time, as assessed by the cardiovascular health score (CHS) in 2006, 2008, and 2010, are associated with subsequent risk of CVD. DESIGN, SETTING, AND PARTICIPANTS: The Kailuan study is a prospective, population-based study that began in 2006. The cohort included 74 701 Chinese adults free of myocardial infarction, stroke, and cancer in or before 2010. In the present study, CHS trajectories were developed from 2006 to 2010 to predict CVD risk from 2010 to 2015. Data analysis was performed from January 1, 2006, to December 31, 2015. EXPOSURES: The CHS trajectories during 2006-2010 were identified using latent mixture models. MAIN OUTCOMES AND MEASURES: Incident CVD events (myocardial infarction and stroke) during 2010-2015 were confirmed by review of medical records. The CHS trajectories were determined using 7 cardiovascular health metrics scored as poor (0 points), intermediate (1 point), and ideal (2 points); total score ranges from 0 (worst) to 14 (best). Based on the baseline CHS and patterns over time, 5 trajectories were categorized (low-stable, moderate-increasing, moderate-decreasing, highstable I, and high-stable II). RESULTS: Of the 74 701 adults included in the study (mean [SD] age at baseline, 49.6 [11.8] years), 58 216 (77.9%) were men and 16 485 (22.1%) were women. Five CHS trajectories were identified from 2006 to 2010: low-stable (n = 4393; range, 4.6-5.2), moderate-increasing (n = 4643; mean increase from 5.4 to 7.8), moderate-decreasing (n = 14 853; mean decrease from 7.4 to 6.3), highstable I (n = 36 352; range, 8.8-9.0), and high-stable II (n = 14 461; range, 10.9-11.0). During 5 years of follow-up, 1852 incident CVD cases were identified. Relative to the low-stable trajectory, the highstable II trajectory was associated with a lower subsequent risk of CVD (adjusted hazard ratio, 0.21; 95%CI, 0.16-0.26, after adjusting for age, sex, educational level, income, occupation, alcohol intake, and serum high-sensitivity C-reactive protein concentration at baseline). CONCLUSIONS AND RELEVANCE: Cardiovascular health trajectories may be associated with subsequent CVD risk.