title: Association Between a Healthy Heart Score and the Development of Clinical Cardiovascular Risk Factors Among Women: Potential Role for Primordial Prevention.
abstract: BACKGROUND
  The prevailing efforts for cardiovascular disease (CVD) prevention focused on treatment of common CVD risk factors rather than primordial prevention of risk factors through health behaviors. The previously validated Healthy Heart Score effectively predicted the 20-year risk of CVD in midadulthood; however, it is unknown whether this risk score is associated with clinically relevant CVD risk factors.
  
  
  RESULTS
  We analyzed the association between the Healthy Heart Score and the incidence of clinical CVD risk factors, including diabetes mellitus, hypertension, and hypercholesterolemia among 69 505 US women in the Nurses' Health Study II (NHSII; 1991-2011). The Healthy Heart Score estimates the 20-year CVD risk based on 9 lifestyle factors; thus, a higher score reflected a higher predictive CVD risk. During 20 years, we documented 3275 incident cases of diabetes mellitus, 17 420 of hypertension, and 24 385 of hypercholesterolemia. Women with higher predicted CVD risk based on the Healthy Heart Score (highest quintile versus lowest quintile) had significantly greater risk of each clinical risk factor individually (hazard ratios: 18.1 [95% confidence interval, 14.4-22.7] for diabetes mellitus, 5.10 [4.66-5.57] for hypertension, and 2.57 [2.40-2.75] for hypercholesterolemia). The hazard ratio for developing the high-CVD profile was 52.5 (33.6-82.1). These associations were most pronounced among women who were younger, were nonsmokers, or had optimal weight.
  
  
  CONCLUSIONS
  An absolute 20-year risk of CVD, estimated by the Healthy Heart Score, was strongly associated with the development of CVD clinically relevant risk factors. This risk score may serve as the first step for CVD risk assessment in primordial prevention.
authors.affiliation: From the Departments of Nutrition (M.S.-P., J.M., F.B.H., E.B.R., W.C.W., S.E.C.) and Epidemiology (F.B.H., E.B.R., W.C.W., A.H.E., S.E.C.), Harvard T.H. Chan School of Public Health, Boston, MA; Channing Division of Network Medicine (F.B.H., E.B.R., W.C.W., A.H.E.) and Division of Preventive Medicine, Department of Medicine (S.E.C.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington (A.K.C.). msotosp@hsph.harvard.edu.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Sotos-Prieto
authors.affiliation: From the Departments of Nutrition (M.S.-P., J.M., F.B.H., E.B.R., W.C.W., S.E.C.) and Epidemiology (F.B.H., E.B.R., W.C.W., A.H.E., S.E.C.), Harvard T.H. Chan School of Public Health, Boston, MA; Channing Division of Network Medicine (F.B.H., E.B.R., W.C.W., A.H.E.) and Division of Preventive Medicine, Department of Medicine (S.E.C.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington (A.K.C.).
authors.forename: Josiemer
authors.initials: J
authors.lastname: Mattei
authors.affiliation: From the Departments of Nutrition (M.S.-P., J.M., F.B.H., E.B.R., W.C.W., S.E.C.) and Epidemiology (F.B.H., E.B.R., W.C.W., A.H.E., S.E.C.), Harvard T.H. Chan School of Public Health, Boston, MA; Channing Division of Network Medicine (F.B.H., E.B.R., W.C.W., A.H.E.) and Division of Preventive Medicine, Department of Medicine (S.E.C.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington (A.K.C.).
authors.forename: Frank B
authors.initials: FB
authors.lastname: Hu
authors.affiliation: From the Departments of Nutrition (M.S.-P., J.M., F.B.H., E.B.R., W.C.W., S.E.C.) and Epidemiology (F.B.H., E.B.R., W.C.W., A.H.E., S.E.C.), Harvard T.H. Chan School of Public Health, Boston, MA; Channing Division of Network Medicine (F.B.H., E.B.R., W.C.W., A.H.E.) and Division of Preventive Medicine, Department of Medicine (S.E.C.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington (A.K.C.).
authors.forename: Andrea K
authors.initials: AK
authors.lastname: Chomistek
authors.affiliation: From the Departments of Nutrition (M.S.-P., J.M., F.B.H., E.B.R., W.C.W., S.E.C.) and Epidemiology (F.B.H., E.B.R., W.C.W., A.H.E., S.E.C.), Harvard T.H. Chan School of Public Health, Boston, MA; Channing Division of Network Medicine (F.B.H., E.B.R., W.C.W., A.H.E.) and Division of Preventive Medicine, Department of Medicine (S.E.C.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington (A.K.C.).
authors.forename: Eric B
authors.initials: EB
authors.lastname: Rimm
authors.affiliation: From the Departments of Nutrition (M.S.-P., J.M., F.B.H., E.B.R., W.C.W., S.E.C.) and Epidemiology (F.B.H., E.B.R., W.C.W., A.H.E., S.E.C.), Harvard T.H. Chan School of Public Health, Boston, MA; Channing Division of Network Medicine (F.B.H., E.B.R., W.C.W., A.H.E.) and Division of Preventive Medicine, Department of Medicine (S.E.C.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington (A.K.C.).
authors.forename: Walter C
authors.initials: WC
authors.lastname: Willett
authors.affiliation: From the Departments of Nutrition (M.S.-P., J.M., F.B.H., E.B.R., W.C.W., S.E.C.) and Epidemiology (F.B.H., E.B.R., W.C.W., A.H.E., S.E.C.), Harvard T.H. Chan School of Public Health, Boston, MA; Channing Division of Network Medicine (F.B.H., E.B.R., W.C.W., A.H.E.) and Division of Preventive Medicine, Department of Medicine (S.E.C.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington (A.K.C.).
authors.forename: A Heather
authors.initials: AH
authors.lastname: Eliassen
authors.affiliation: From the Departments of Nutrition (M.S.-P., J.M., F.B.H., E.B.R., W.C.W., S.E.C.) and Epidemiology (F.B.H., E.B.R., W.C.W., A.H.E., S.E.C.), Harvard T.H. Chan School of Public Health, Boston, MA; Channing Division of Network Medicine (F.B.H., E.B.R., W.C.W., A.H.E.) and Division of Preventive Medicine, Department of Medicine (S.E.C.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington (A.K.C.).
authors.forename: Stephanie E
authors.initials: SE
authors.lastname: Chiuve
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000517:prevention & control; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008019:Life Style; D011322:Primary Prevention; D011446:Prospective Studies; D012307:Risk Factors
keywords: cardiovascular diseases; epidemiology; lifestyle; prevention and control; women