title: Ideal cardiovascular health predicts functional status independently of vascular events: the Northern Manhattan Study.
abstract: BACKGROUND
  We hypothesized that the American Heart Association's metric of ideal cardiovascular health (CVH) predicts improved long-term functional status after adjusting for incident stroke and myocardial infarction.
  
  
  RESULTS
  In the prospective, multiethnic Northern Manhattan Study, stroke-free individuals in northern Manhattan aged ≥40 years had annual assessments of the primary outcome of functional status with the Barthel index (BI), for a median of 13 years. Ideal CVH was calculated as a composite of 7 measures, each scored on a scale of 0 to 2. Primary predictors were (1) number of ideal CVH metrics, and (2) total score of all CVH metrics. Of 3219 participants, mean age was 69 years (SD 10), 63% were female, 21% were white, 25% were non-Hispanic black, and 54% were Hispanic. Twenty percent had 0 to 1 ideal CVH metrics, 32% had 2, 30% had 3, 14% had 4, and 4% had 5 to 7. Both number of ideal CVH categories and higher CVH metric scores were associated with higher mean BI scores at 5 and 10 years. 0047 Gradients persisted when results were adjusted for incident stroke and myocardial infarction, when mobility and nonmobility domains of the BI were analyzed separately, and when BI was analyzed dichotomously. At 10 years, in a fully adjusted model, differences in mean BI score were lower for poor versus ideal physical activity (3.48 points, P<0.0001) and fasting glucose (4.58 points, P<0.0001).
  
  
  CONCLUSIONS
  Ideal CVH predicts functional status, even after accounting for incident vascular events. Vascular functional impairment is an important outcome that can be reduced by optimizing vascular health.
authors: Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY (M.S.D.).
authors: Mandip S
authors: MS
authors: Dhamoon
authors: Department of Neurology, Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, FL (C.D., R.L.S.).
authors: Chuanhui
authors: C
authors: Dong
authors: Department of Neurology, College of Physicians and Surgeons, and Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.V.E.).
authors: Mitchell S V
authors: MS
authors: Elkind
authors: Department of Neurology, Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, FL (C.D., R.L.S.) Department of Public Health Sciences and Human Genetics, Miller School of Medicine, University of Miami, FL (R.L.S.).
authors: Ralph L
authors: RL
authors: Sacco
mesh_terms: D000328:Adult; D000368:Aged; D000572:American Heart Association; D001786:Blood Glucose / Q000032:analysis; D002318:Cardiovascular Diseases / Q000208:ethnology / Q000209:etiology*; D002319:Cardiovascular System / Q000473:pathology / Q000503:physiopathology; D005215:Fasting / Q000097:blood; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009519:New York City; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000208:ethnology / Q000209:etiology*; D014481:United States
chemical_list: D001786:Blood Glucose
keywords: cerebrovascular disorders; epidemiology; stroke