Ideal cardiovascular health and risk of cardiovascular events in the EPIC-Norfolk prospective population study.
The American Heart Association has prioritised seven cardiovascular health metrics to reduce the cardiovascular burden, including: body mass index, healthy diet, physical activity, smoking status, blood pressure, glycated haemoglobin A1c and total cholesterol. The aim of the current study was to assess the association between the American Heart Association-defined health metrics and the risk of cardiovascular events in the EPIC-Norfolk prospective study.



Prospective cohort study.



An overall cardiovascular health score was calculated based on the number of health metrics including ideal, intermediate or poor. Cox proportional hazards models were used to describe the association of the seven metrics separately and the overall health score with risk of coronary heart disease, stroke and cardiovascular disease. A total of 10,043 participants was included in the analysis (follow-up 1993-2008). For all individual health metrics a more ideal status was associated with a lower risk of cardiovascular events.



As for the overall cardiovascular health score, those in the highest (i.e. healthiest) category (score 12-14) had an adjusted hazard ratio for coronary heart disease of 0.07 (95% confidence interval (CI) 0.02-0.29, P < 0.001), for stroke of 0.16 (95% CI 0.02-1.37, P = 0.09) and for cardiovascular disease of 0.07 (95% CI 0.02-0.23, P < 0.001), compared to people in the lowest (i.e. unhealthiest) category (score 0-2). The overall cardiovascular health score was strongly and inversely associated with risk of coronary heart disease, stroke and cardiovascular disease. Our data suggest that even small improvements in modifiable risk factors may lead to substantial reductions in the risks of cardiovascular events.
Department of Cardiology, Academic Medical Centre, The Netherlands.
Sangeeta
S
Lachman
Department of Cardiology, Academic Medical Centre, The Netherlands.
Ron Jg
RJ
Peters
Department of Public Health and Primary Care, University of Cambridge, UK.
Marleen Ah
MA
Lentjes
Department of Public Health and Primary Care, University of Cambridge, UK.
Angela A
AA
Mulligan
Department of Public Health and Primary Care, University of Cambridge, UK.
Robert N
RN
Luben
Medical Research Council Epidemiology Unit, Cambridge, UK.
Nicholas J
NJ
Wareham
Department of Public Health and Primary Care, University of Cambridge, UK.
Kay-Tee
KT
Khaw
Department of Cardiology, Academic Medical Centre, The Netherlands s.m.boekholdt@amc.uva.nl.
S Matthijs
SM
Boekholdt
D000368:Aged; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D002784:Cholesterol / Q000097:blood; D000072001:Diet, Healthy; D004739:England / Q000453:epidemiology; D015444:Exercise; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006304:Health Status; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011322:Primary Prevention / Q000379:methods*; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012907:Smoking / Q000009:adverse effects; D016540:Smoking Cessation; D013997:Time Factors
D015415:Biomarkers; D002784:Cholesterol; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
Health metrics; cardiovascular diseases; primary prevention; risk factors