Lifestyle-based prediction model for the prevention of CVD: the Healthy Heart Score.
BACKGROUND
Clinical practice focuses on the primary prevention of cardiovascular (CV) disease (CVD) through the modification and pharmacological treatment of elevated risk factors. Prediction models based on established risk factors are available for use in the primary prevention setting. However, the prevention of risk factor development through healthy lifestyle behaviors, or primordial prevention, is of paramount importance to achieve optimal population-wide CV health and minimize long-term CVD risk.


RESULTS
We developed a lifestyle-based CVD prediction model among 61 025 women in the Nurses' Health Study and 34 478 men in the Health Professionals Follow-up Study, who were free of chronic disease in 1986 and followed for ≤24 years. Lifestyle factors were assessed by questionnaires in 1986. In the derivation step, we used the Bayes Information Criterion to create parsimonious 20-year risk prediction models among a random two thirds of participants in each cohort separately. The scores were validated in the remaining one third of participants in each cohort. Over 24 years, there were 3775 cases of CVD in women and 3506 cases in men. The Healthy Heart Score included age, smoking, body mass index, exercise, alcohol, and a composite diet score. In the validation cohort, the risk score demonstrated good discrimination (Harrell's C-index, 0.72; 95% confidence interval [CI], 0.71, 0.74 [women]; 0.77; 95% CI, 0.76, 0.79 [men]), fit, and calibration, particularly among individuals without baseline hypertension or hypercholesterolemia.


CONCLUSIONS
The Healthy Heart Score accurately identifies individuals at elevated risk for CVD and may serve as an important clinical and public health screening tool for the primordial prevention of CVD.
Department of Nutrition, Harvard School of Public Health, Boston, MA (S.E.C., W.C.W., E.B.R.) Center for Arrhythmia Prevention, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (S.E.C., C.M.A.) Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (S.E.C., N.R.C., K.M.R., C.M.A., J.A.E.M.).
Stephanie E
SE
Chiuve
Department of Epidemiology, Harvard School of Public Health, Boston, MA (N.R.C., J.A.E.M., W.C.W., E.B.R.) Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (S.E.C., N.R.C., K.M.R., C.M.A., J.A.E.M.).
Nancy R
NR
Cook
Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK (C.M.S.).
Christina M
CM
Shay
Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (S.E.C., N.R.C., K.M.R., C.M.A., J.A.E.M.).
Kathryn M
KM
Rexrode
Center for Arrhythmia Prevention, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (S.E.C., C.M.A.) Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (S.E.C., N.R.C., K.M.R., C.M.A., J.A.E.M.) Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (C.M.A.).
Christine M
CM
Albert
Department of Epidemiology, Harvard School of Public Health, Boston, MA (N.R.C., J.A.E.M., W.C.W., E.B.R.) Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (S.E.C., N.R.C., K.M.R., C.M.A., J.A.E.M.).
JoAnn E
JE
Manson
Department of Nutrition, Harvard School of Public Health, Boston, MA (S.E.C., W.C.W., E.B.R.) Department of Epidemiology, Harvard School of Public Health, Boston, MA (N.R.C., J.A.E.M., W.C.W., E.B.R.) The Channing Division for Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (W.C.W., E.B.R.).
Walter C
WC
Willett
Department of Nutrition, Harvard School of Public Health, Boston, MA (S.E.C., W.C.W., E.B.R.) Department of Epidemiology, Harvard School of Public Health, Boston, MA (N.R.C., J.A.E.M., W.C.W., E.B.R.) The Channing Division for Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (W.C.W., E.B.R.).
Eric B
EB
Rimm
D000328:Adult; D000367:Age Factors; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology; D001499:Bayes Theorem; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D004032:Diet / Q000009:adverse effects; D015444:Exercise; D005260:Female; D006304:Health Status; D006305:Health Status Indicators; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D011314:Preventive Health Services / Q000379:methods*; D065840:Protective Factors; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D057185:Sedentary Behavior; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D016540:Smoking Cessation; D000074606:Smoking Prevention; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States / Q000453:epidemiology
epidemiology; lifestyle; nutrition; prevention; risk assessment