title: Trends in cardiovascular health metrics and associations with all-cause and CVD mortality among US adults.
abstract: BACKGROUND
  Recent recommendations from the American Heart Association aim to improve cardiovascular health by encouraging the general population to meet 7 cardiovascular health metrics: not smoking; being physically active; having normal blood pressure, blood glucose and total cholesterol levels, and weight; and eating a healthy diet.
  
  
  OBJECTIVE
  To examine time trends in cardiovascular health metrics and to estimate joint associations and population-attributable fractions of these metrics in relation to all-cause and cardiovascular disease (CVD) mortality risk.
  
  
  METHODS
  Study of a nationally representative sample of 44,959 US adults (≥20 years), using data from the National Health and Nutrition Examination Survey (NHANES) 1988-1994, 1999-2004, and 2005-2010 and the NHANES III Linked Mortality File (through 2006).
  
  
  METHODS
  All-cause, CVD, and ischemic heart disease (IHD) mortality.
  
  
  RESULTS
  Few participants met all 7 cardiovascular health metrics (2.0% [95% CI, 1.5%-2.5%] in 1988-1994, 1.2% [95% CI, 0.8%-1.9%] in 2005-2010). Among NHANES III participants, 2673 all-cause, 1085 CVD, and 576 IHD deaths occurred (median follow-up, 14.5 years). Among participants who met 1 or fewer cardiovascular health metrics, age- and sex-standardized absolute risks were 14.8 (95% CI, 13.2-16.5) deaths per 1000 person-years for all-cause mortality, 6.5 (95% CI, 5.5-7.6) for CVD mortality, and 3.7 (95% CI, 2.8-4.5) for IHD mortality. Among those who met 6 or more metrics, corresponding risks were 5.4 (95% CI, 3.6-7.3) for all-cause mortality, 1.5 (95% CI, 0.5-2.5) for CVD mortality, and 1.1 (95% CI, 0.7-2.0) for IHD mortality. Adjusted hazard ratios were 0.49 (95% CI, 0.33-0.74) for all-cause mortality, 0.24 (95% CI, 0.13-0.47) for CVD mortality, and 0.30 (95% CI, 0.13-0.68) for IHD mortality, comparing participants who met 6 or more vs 1 or fewer cardiovascular health metrics. Adjusted population-attributable fractions were 59% (95% CI, 33%-76%) for all-cause mortality, 64% (95% CI, 28%-84%) for CVD mortality, and 63% (95% CI, 5%-89%) for IHD mortality.
  
  
  CONCLUSIONS
  Meeting a greater number of cardiovascular health metrics was associated with a lower risk of total and CVD mortality, but the prevalence of meeting all 7 cardiovascular health metrics was low in the study population.
authors.affiliation: Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, MS F-72, Atlanta, GA 30341, USA. qay0@cdc.gov
authors.forename: Quanhe
authors.initials: Q
authors.lastname: Yang
authors.forename: Mary E
authors.initials: ME
authors.lastname: Cogswell
authors.forename: W Dana
authors.initials: WD
authors.lastname: Flanders
authors.forename: Yuling
authors.initials: Y
authors.lastname: Hong
authors.forename: Zefeng
authors.initials: Z
authors.lastname: Zhang
authors.forename: Fleetwood
authors.initials: F
authors.lastname: Loustalot
authors.forename: Cathleen
authors.initials: C
authors.lastname: Gillespie
authors.forename: Robert
authors.initials: R
authors.lastname: Merritt
authors.forename: Frank B
authors.initials: FB
authors.lastname: Hu
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose; D001794:Blood Pressure; D001835:Body Weight; D002318:Cardiovascular Diseases / Q000401:mortality*; D002784:Cholesterol / Q000097:blood; D003430:Cross-Sectional Studies; D004032:Diet; D005260:Female; D015438:Health Behavior; D006305:Health Status Indicators; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D012306:Risk; D012907:Smoking / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D002784:Cholesterol