title: Association between ideal cardiovascular health and carotid intima-media thickness: a twin study.
abstract: BACKGROUND
  The American Heart Association (AHA) recently developed the Cardiovascular Health Index (CVHI), a health metric consisting of 7 modifiable risk factors. The relationship of the CVHI with preclinical markers, such as carotid intima-media thickness (CIMT) has not been assessed.
  
  
  METHODS
  We examined 490 male monozygotic and dizygotic twins without overt cardiovascular disease. CIMT was measured using B-mode ultrasonography. Each of the 7 CVHI components (blood pressure, fasting glucose, total cholesterol, body mass index, physical activity, healthy diet, and smoking) was given a point score of 0, 1, or 2 to represent poor, intermediate, or ideal health, respectively. A CVHI summation score was computed (range 0 to 14) and categorized as inadequate (0 to 4), average (5 to 9), or optimum (10 to 14) cardiovascular health. Mixed-model regression was used to examine the association of the CVHI with CIMT.
  
  
  RESULTS
  The mean age of the twins was 55.4 years, and 61% were monozygotic. The mean CIMT was 0.75 (± 0.11) mm and the mean CVHI score was 7.7 (± 2.1). There was an inverse correlation between CVHI and CIMT (Spearman r=-0.22, P<0.01). For every 5-unit increase in overall CVHI score (indicating better cardiovascular health category), CIMT decreased by 0.045 mm (P<0.001) after adjusting for demographic variables and other confounders. Within monozygotic twin pairs, a 5-unit increment in CVHI score was associated with a 0.05 mm lower CIMT (P<0.001).
  
  
  CONCLUSIONS
  The CVHI is independently associated with CIMT and the association is not confounded by shared genetic and other familial factors.
authors.affiliation: Department of Epidemiology, Emory University School of Public Health, Atlanta, GA.
authors.forename: Ambar
authors.initials: A
authors.lastname: Kulshreshtha
authors.forename: Abhinav
authors.initials: A
authors.lastname: Goyal
authors.forename: Emir
authors.initials: E
authors.lastname: Veledar
authors.forename: William
authors.initials: W
authors.lastname: McClellan
authors.forename: Suzanne
authors.initials: S
authors.lastname: Judd
authors.forename: Silvia C
authors.initials: SC
authors.lastname: Eufinger
authors.forename: J Douglas
authors.initials: JD
authors.lastname: Bremner
authors.forename: Jack
authors.initials: J
authors.lastname: Goldberg
authors.forename: Viola
authors.initials: V
authors.lastname: Vaccarino
mesh_terms: D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000235:genetics*; D059168:Carotid Intima-Media Thickness; D020022:Genetic Predisposition to Disease; D005845:Georgia / Q000453:epidemiology; D006304:Health Status; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012042:Registries; D012307:Risk Factors; D014429:Twins, Dizygotic / Q000235:genetics*; D014430:Twins, Monozygotic / Q000235:genetics*; D014728:Veterans
keywords: epidemiology; prevention; risk factors