title: Ideal cardiovascular health: associations with biomarkers and subclinical disease and impact on incidence of cardiovascular disease in the Framingham Offspring Study.
abstract: BACKGROUND
  The American Heart Association Cardiovascular Health score (CVH score) is inversely associated with cardiovascular disease (CVD) incidence, but the mechanisms underlying this association warrant exploration.
  
  
  RESULTS
  We related the CVH score to circulating biomarkers and prevalent subclinical CVD (defined as ≥1 of the following: increased carotid intima-media thickness or stenosis, left ventricular hypertrophy [by ECG or echocardiography], left ventricular systolic dysfunction, microalbuminuria, and a reduced ankle-brachial index) in 2680 Framingham Study participants (mean age, 58 years; 55% women). After adjustment for age and sex, an ideal CVH score (nonsmoking status, ideal body mass index, regular physical activity, healthy diet, and an optimal profile of serum cholesterol, blood pressure, and glucose; 1 point for each) was associated with higher circulating concentrations of natriuretic peptides (N-terminal pro-atrial natriuretic peptide and B-type natriuretic peptide) and lower blood concentrations of plasminogen activator inhibitor-1, aldosterone, C-reactive protein, D-dimer, fibrinogen, homocysteine, and growth differentiation factor-15 levels (P<0.001 for all), as well as lower odds of subclinical disease (odds ratio, 0.74 per 1-unit increase in CVH score; 95% confidence interval, 0.68-0.80). The incidence of CVD (267 events over 16 years) was inversely associated with the CVH score in age- and sex-adjusted models (hazard ratio, 0.77 per 1-unit increase in CVH score; 95% confidence interval, 0.70-0.86), which was slightly attenuated upon adjustment for biomarkers and subclinical disease (hazard ratio, 0.87; 95% confidence interval, 0.78-0.97).
  
  
  CONCLUSIONS
  In our prospective community-based study, the inverse association between an ideal cardiovascular health score and CVD incidence was partly attributable to its favorable impact on CVD biomarker levels and subclinical disease.
authors.affiliation: From the Framingham Heart Study, Framingham, MA (V.X., J.M.M., R.S.V.); Department of Biostatistics, Boston University School of Public Health, Boston, MA (V.X., D.M.E.); Section of Preventive Medicine and Epidemiology (V.X., R.S.V.) and Section of General Internal Medicine, Department of Medicine (J.M.M.), Boston University School of Medicine, Boston, MA; Department of Radiology, Tufts University Medical Center, Boston, MA (J.F.P.); Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany (K.C.W.); Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (J.L.J.); Cardiology Division, Vanderbilt University Medical Center, Nashville, TN (T.J.W.); and Royal North Shore Hospital University of Sydney, Sydney, Australia (G.T.). vanessax@bu.edu.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Xanthakis
authors.affiliation: From the Framingham Heart Study, Framingham, MA (V.X., J.M.M., R.S.V.); Department of Biostatistics, Boston University School of Public Health, Boston, MA (V.X., D.M.E.); Section of Preventive Medicine and Epidemiology (V.X., R.S.V.) and Section of General Internal Medicine, Department of Medicine (J.M.M.), Boston University School of Medicine, Boston, MA; Department of Radiology, Tufts University Medical Center, Boston, MA (J.F.P.); Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany (K.C.W.); Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (J.L.J.); Cardiology Division, Vanderbilt University Medical Center, Nashville, TN (T.J.W.); and Royal North Shore Hospital University of Sydney, Sydney, Australia (G.T.).
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Enserro
authors.affiliation: From the Framingham Heart Study, Framingham, MA (V.X., J.M.M., R.S.V.); Department of Biostatistics, Boston University School of Public Health, Boston, MA (V.X., D.M.E.); Section of Preventive Medicine and Epidemiology (V.X., R.S.V.) and Section of General Internal Medicine, Department of Medicine (J.M.M.), Boston University School of Medicine, Boston, MA; Department of Radiology, Tufts University Medical Center, Boston, MA (J.F.P.); Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany (K.C.W.); Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (J.L.J.); Cardiology Division, Vanderbilt University Medical Center, Nashville, TN (T.J.W.); and Royal North Shore Hospital University of Sydney, Sydney, Australia (G.T.).
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Murabito
authors.affiliation: From the Framingham Heart Study, Framingham, MA (V.X., J.M.M., R.S.V.); Department of Biostatistics, Boston University School of Public Health, Boston, MA (V.X., D.M.E.); Section of Preventive Medicine and Epidemiology (V.X., R.S.V.) and Section of General Internal Medicine, Department of Medicine (J.M.M.), Boston University School of Medicine, Boston, MA; Department of Radiology, Tufts University Medical Center, Boston, MA (J.F.P.); Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany (K.C.W.); Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (J.L.J.); Cardiology Division, Vanderbilt University Medical Center, Nashville, TN (T.J.W.); and Royal North Shore Hospital University of Sydney, Sydney, Australia (G.T.).
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Polak
authors.affiliation: From the Framingham Heart Study, Framingham, MA (V.X., J.M.M., R.S.V.); Department of Biostatistics, Boston University School of Public Health, Boston, MA (V.X., D.M.E.); Section of Preventive Medicine and Epidemiology (V.X., R.S.V.) and Section of General Internal Medicine, Department of Medicine (J.M.M.), Boston University School of Medicine, Boston, MA; Department of Radiology, Tufts University Medical Center, Boston, MA (J.F.P.); Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany (K.C.W.); Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (J.L.J.); Cardiology Division, Vanderbilt University Medical Center, Nashville, TN (T.J.W.); and Royal North Shore Hospital University of Sydney, Sydney, Australia (G.T.).
authors.forename: Kai C
authors.initials: KC
authors.lastname: Wollert
authors.affiliation: From the Framingham Heart Study, Framingham, MA (V.X., J.M.M., R.S.V.); Department of Biostatistics, Boston University School of Public Health, Boston, MA (V.X., D.M.E.); Section of Preventive Medicine and Epidemiology (V.X., R.S.V.) and Section of General Internal Medicine, Department of Medicine (J.M.M.), Boston University School of Medicine, Boston, MA; Department of Radiology, Tufts University Medical Center, Boston, MA (J.F.P.); Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany (K.C.W.); Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (J.L.J.); Cardiology Division, Vanderbilt University Medical Center, Nashville, TN (T.J.W.); and Royal North Shore Hospital University of Sydney, Sydney, Australia (G.T.).
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
authors.affiliation: From the Framingham Heart Study, Framingham, MA (V.X., J.M.M., R.S.V.); Department of Biostatistics, Boston University School of Public Health, Boston, MA (V.X., D.M.E.); Section of Preventive Medicine and Epidemiology (V.X., R.S.V.) and Section of General Internal Medicine, Department of Medicine (J.M.M.), Boston University School of Medicine, Boston, MA; Department of Radiology, Tufts University Medical Center, Boston, MA (J.F.P.); Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany (K.C.W.); Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (J.L.J.); Cardiology Division, Vanderbilt University Medical Center, Nashville, TN (T.J.W.); and Royal North Shore Hospital University of Sydney, Sydney, Australia (G.T.).
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Wang
authors.affiliation: From the Framingham Heart Study, Framingham, MA (V.X., J.M.M., R.S.V.); Department of Biostatistics, Boston University School of Public Health, Boston, MA (V.X., D.M.E.); Section of Preventive Medicine and Epidemiology (V.X., R.S.V.) and Section of General Internal Medicine, Department of Medicine (J.M.M.), Boston University School of Medicine, Boston, MA; Department of Radiology, Tufts University Medical Center, Boston, MA (J.F.P.); Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany (K.C.W.); Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (J.L.J.); Cardiology Division, Vanderbilt University Medical Center, Nashville, TN (T.J.W.); and Royal North Shore Hospital University of Sydney, Sydney, Australia (G.T.).
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Tofler
authors.affiliation: From the Framingham Heart Study, Framingham, MA (V.X., J.M.M., R.S.V.); Department of Biostatistics, Boston University School of Public Health, Boston, MA (V.X., D.M.E.); Section of Preventive Medicine and Epidemiology (V.X., R.S.V.) and Section of General Internal Medicine, Department of Medicine (J.M.M.), Boston University School of Medicine, Boston, MA; Department of Radiology, Tufts University Medical Center, Boston, MA (J.F.P.); Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany (K.C.W.); Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (J.L.J.); Cardiology Division, Vanderbilt University Medical Center, Nashville, TN (T.J.W.); and Royal North Shore Hospital University of Sydney, Sydney, Australia (G.T.).
authors.forename: Ramachandran S
authors.initials: RS
authors.lastname: Vasan
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood* / Q000453:epidemiology*; D059168:Carotid Intima-Media Thickness / Q000706:statistics & numerical data; D016893:Carotid Stenosis / Q000097:blood / Q000453:epidemiology; D016241:Child of Impaired Parents / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000097:blood / Q000453:epidemiology; D015994:Incidence; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000453:epidemiology
chemical_list: D015415:Biomarkers
keywords: American Heart Association; biological markers; cardiovascular diseases; risk