Ideal Cardiovascular Health During Adult Life and Cardiovascular Structure and Function Among the Elderly.
BACKGROUND
A higher American Heart Association cardiovascular health score (CVHS) predicts a lower incidence of cardiovascular disease (CVD). However, the relationship of CVHS attainment through midlife to late life with CVD prevalence and cardiovascular structure and function in late life is not well described.


RESULTS
The following 6 ideal cardiovascular health metrics were assessed in the Atherosclerosis Risk in Communities (ARIC) study participants at 5 examination visits between 1987 and 2013: nonsmoking, body mass index <25 kg/m(2), untreated total cholesterol <200 mg/dL, untreated blood pressure <120/<80 mm Hg, fasting blood glucose <100 mg/dL, and ideal physical activity. Attainment over time was assessed as the percentage of maximum possible CVHS metrics achieved at visits 1 through 5, the slope of change in CVHS per decade of follow-up, and CVHS trajectory through follow-up. At visit 5, participant groups were characterized with respect to CVD prevalence (n=6520) and echocardiographic measures of cardiac structure and function (n=5903 free of CVD). CVHS was low at baseline and declined with age. Both greater CVHS attainment and improvement in CVHS during follow-up were associated with a lower prevalence of CVD and better left ventricular structure and systolic and diastolic function at visit 5.


CONCLUSIONS
Greater attainment of, and improvements in, ideal cardiovascular health through midlife to late life are associated with lower CVD prevalence and better cardiovascular structure and function when elderly. These findings highlight the importance of consistent primordial and primary prevention efforts throughout midlife to late life as a potential intervention to decrease the burden of CVD among the elderly.
From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., S.D.S.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.R.F., P.L.L.); Section of Cardiology, Baylor College of Medicine and Methodist DeBakey Heart and Vascular Center, Houston, TX (C.M.B.); and University of North Carolina Gillings School of Global Public Health, Chapel Hill (G.H.). ashah11@partners.org.
Amil M
AM
Shah
From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., S.D.S.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.R.F., P.L.L.); Section of Cardiology, Baylor College of Medicine and Methodist DeBakey Heart and Vascular Center, Houston, TX (C.M.B.); and University of North Carolina Gillings School of Global Public Health, Chapel Hill (G.H.).
Brian
B
Claggett
From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., S.D.S.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.R.F., P.L.L.); Section of Cardiology, Baylor College of Medicine and Methodist DeBakey Heart and Vascular Center, Houston, TX (C.M.B.); and University of North Carolina Gillings School of Global Public Health, Chapel Hill (G.H.).
Aaron R
AR
Folsom
From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., S.D.S.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.R.F., P.L.L.); Section of Cardiology, Baylor College of Medicine and Methodist DeBakey Heart and Vascular Center, Houston, TX (C.M.B.); and University of North Carolina Gillings School of Global Public Health, Chapel Hill (G.H.).
Pamela L
PL
Lutsey
From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., S.D.S.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.R.F., P.L.L.); Section of Cardiology, Baylor College of Medicine and Methodist DeBakey Heart and Vascular Center, Houston, TX (C.M.B.); and University of North Carolina Gillings School of Global Public Health, Chapel Hill (G.H.).
Christie M
CM
Ballantyne
From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., S.D.S.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.R.F., P.L.L.); Section of Cardiology, Baylor College of Medicine and Methodist DeBakey Heart and Vascular Center, Houston, TX (C.M.B.); and University of North Carolina Gillings School of Global Public Health, Chapel Hill (G.H.).
Gerardo
G
Heiss
From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., S.D.S.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.R.F., P.L.L.); Section of Cardiology, Baylor College of Medicine and Methodist DeBakey Heart and Vascular Center, Houston, TX (C.M.B.); and University of North Carolina Gillings School of Global Public Health, Chapel Hill (G.H.).
Scott D
SD
Solomon
D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D000572:American Heart Association; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D006305:Health Status Indicators; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D008875:Middle Aged; D009043:Motor Activity; D050177:Overweight / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D063177:Pulse Wave Analysis; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D014463:Ultrasonography; D014481:United States
D001786:Blood Glucose
aging; cardiovascular diseases; echocardiography; epidemiology; risk factors