title: Cardiovascular Health and Incident Cardiovascular Disease and Cancer: The Women's Health Initiative.
abstract: BACKGROUND
  The American Heart Association's "Simple 7" offers a practical public health conceptualization of cardiovascular health (CVH). CVH predicts incident cardiovascular disease (CVD) in younger populations, but has not been studied in a large, diverse population of aging postmenopausal women. The extent to which CVH predicts cancer in postmenopausal women is unknown.
  
  
  METHODS
  Multivariable Cox regression estimated hazard ratios and 95% CIs for the association between CVH and incident CVD, any cancer, and cancer subtypes (lung, colorectal, and breast) among 161,809 Women's Health Initiative observational study and clinical trial participants followed from 1993 through 2010. Data were analyzed in 2013. CVH score was characterized as the number (0 [worst] to 7 [best]) of the American Heart Association's ideal CVH behaviors and factors at baseline: smoking, BMI, physical activity, diet, total cholesterol, blood pressure, and fasting glucose.
  
  
  RESULTS
  Median follow-up was approximately 13 years. Fewer minorities and less educated women achieved ideal CVH, a common benchmark. In adjusted models, compared with women with the highest (best) CVH scores, those with the lowest (worst) CVH scores had nearly seven times the hazard of incident CVD (6.83, 95% CI=5.83, 8.00) and 52% greater risk of incident cancer (1.52, 95% CI=1.35, 1.72). Ideal CVH was most strongly inversely associated with lung cancer, then colorectal cancer, and then breast cancer.
  
  
  CONCLUSIONS
  Lower ideal CVH is more common among minority and less educated postmenopausal women and predicts increased risk of CVD and cancer in this population, emphasizing the importance of prevention efforts among vulnerable older adults.
authors.affiliation: Division of Epidemiology, The Ohio State University, Columbus, Ohio. Electronic address: rforaker@cph.osu.edu.
authors.forename: Randi E
authors.initials: RE
authors.lastname: Foraker
authors.affiliation: Center for Biostatistics, The Ohio State University, Columbus, Ohio.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Abdel-Rasoul
authors.affiliation: Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Lewis H
authors.initials: LH
authors.lastname: Kuller
authors.affiliation: Department of Internal Medicine, The Ohio State University, Columbus, Ohio.
authors.forename: Rebecca D
authors.initials: RD
authors.lastname: Jackson
authors.affiliation: Department of Preventive Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Linda
authors.initials: L
authors.lastname: Van Horn
authors.affiliation: Division of Nutritional Sciences, Cornell University, Ithaca, New York.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Seguin
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Monika M
authors.initials: MM
authors.lastname: Safford
authors.affiliation: Department of Epidemiology, The University of Iowa, Iowa City, Iowa.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Wallace
authors.affiliation: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Kucharska-Newton
authors.affiliation: Department of Epidemiology, The University of Iowa, Iowa City, Iowa.
authors.forename: Jennifer G
authors.initials: JG
authors.lastname: Robinson
authors.affiliation: Department of Medicine, The George Washington University, Washington, District of Columbia.
authors.forename: Lisa W
authors.initials: LW
authors.lastname: Martin
authors.affiliation: Department of Environmental Health, Harvard University, Cambridge, Massachusetts;
authors.forename: Golareh
authors.initials: G
authors.lastname: Agha
authors.affiliation: Department of Preventive Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Lifang
authors.initials: L
authors.lastname: Hou
authors.affiliation: Department of Preventive Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Norrina B
authors.initials: NB
authors.lastname: Allen
authors.affiliation: Department of Medicine, Vanderbilt University, Nashville, Tennessee.
authors.forename: Hilary A
authors.initials: HA
authors.lastname: Tindle
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose; D001794:Blood Pressure; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002784:Cholesterol / Q000097:blood; D004032:Diet; D015444:Exercise; D005260:Female; D015438:Health Behavior; D006304:Health Status; D006801:Humans; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012307:Risk Factors; D012907:Smoking; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D016387:Women's Health
chemical_list: D001786:Blood Glucose; D002784:Cholesterol