title: Cardiovascular Health Status and Incidence of Heart Failure in the Framingham Offspring Study.
abstract: BACKGROUND
  The American Heart Association Cardiovascular Health (CVH) score is inversely associated with cardiovascular disease, but its relations to cardiac remodeling traits and heart failure (HF) incidence have not been examined.
  
  
  RESULTS
  A 14-point score was constructed for each participant based on the presence of poor, intermediate, or ideal status on each of the 7 CVH metrics (ideal score=14). We related the CVH score to echocardiographic traits cross-sectionally and to HF incidence prospectively in the Framingham Offspring Study. In age- and sex-adjusted models, a higher CVH score was associated with lower left ventricular (LV) mass, LV wall thickness, LV diastolic dimension, and left atrial dimension (P<0.01 for all; n=2392; mean age, 58 years; 56% women), and with a 12% to 15% lower odds of prevalent LV concentric remodeling and concentric hypertrophy, respectively (P<0.0001 for both). On follow-up (mean, 12.3 years), 188 incident HF events were observed in 3201 participants (mean age, 59 years; 53% women). In age- and sex-adjusted Cox proportional hazard models, the CVH score was inversely associated with HF incidence (hazard ratio per 1-point higher CVH score, 0.77; 95% confidence interval, 0.72-0.83). This association was partially attenuated upon adjustment for LV mass and interim myocardial infarction (hazard ratio, 0.84; 95% confidence interval, 0.76-0.93), and it was consistent for HF with preserved and reduced ejection fractions.
  
  
  CONCLUSIONS
  In our community-based sample, comprised predominantly of middle-aged white individuals of European descent, better CVH was associated with lower HF incidence, in part due to a lower prevalence of adverse cardiac remodeling.
authors.affiliation: From the Framingham Heart Study, MA (M.N., R.S.V., V.X.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (M.N.); Departments of Biostatistics (D.M.E., V.X.), Epidemiology (R.S.V., V.X.), and Sections of Preventive Medicine and Epidemiology and Cardiology, Department of Medicine (R.S.V., V.X.), Boston University School of Public Health, MA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Nayor
authors.affiliation: From the Framingham Heart Study, MA (M.N., R.S.V., V.X.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (M.N.); Departments of Biostatistics (D.M.E., V.X.), Epidemiology (R.S.V., V.X.), and Sections of Preventive Medicine and Epidemiology and Cardiology, Department of Medicine (R.S.V., V.X.), Boston University School of Public Health, MA.
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Enserro
authors.affiliation: From the Framingham Heart Study, MA (M.N., R.S.V., V.X.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (M.N.); Departments of Biostatistics (D.M.E., V.X.), Epidemiology (R.S.V., V.X.), and Sections of Preventive Medicine and Epidemiology and Cardiology, Department of Medicine (R.S.V., V.X.), Boston University School of Public Health, MA.
authors.forename: Ramachandran S
authors.initials: RS
authors.lastname: Vasan
authors.affiliation: From the Framingham Heart Study, MA (M.N., R.S.V., V.X.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (M.N.); Departments of Biostatistics (D.M.E., V.X.), Epidemiology (R.S.V., V.X.), and Sections of Preventive Medicine and Epidemiology and Cardiology, Department of Medicine (R.S.V., V.X.), Boston University School of Public Health, MA. vanessax@bu.edu.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Xanthakis
mesh_terms: D000368:Aged; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006305:Health Status Indicators; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control; D015994:Incidence; D008019:Life Style; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D065840:Protective Factors; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
keywords: American Heart Association; cardiac remodelling; diastole; heart failure; life style; myocardial infarction