Association of Cardiovascular Health With Subclinical Disease and Incident Events: The Multi-Ethnic Study of Atherosclerosis.
BACKGROUND
Few adults have ideal cardiovascular health (CVH). We studied associations of an overall CVH score with subclinical cardiovascular disease and events. We assessed whether associations varied by race/ethnicity.


RESULTS
Among 5961 participants in the Multi-Ethnic Study of Atherosclerosis, components of CVH were measured at baseline, 2000-2002: systolic blood pressure, total cholesterol, fasting glucose, smoking, physical activity, diet, and body mass index. Levels were classified as ideal (2 points), intermediate (1 point), and poor (0 points) according to American Heart Association definitions. Points were summed to produce a CVH score (0-7 low, 8-11 moderate, 12-14 high). Coronary artery calcium, carotid intima-media thickness, and left ventricular mass were measured at baseline. Cardiovascular disease was defined as myocardial infarction, coronary heart disease death, resuscitated cardiac arrest, stroke, heart failure, or peripheral artery disease. Follow-up was 10.3 years. Regression models were used to examine associations of the CVH score with subclinical disease and events, adjusting for age, sex, and education. Analyses were stratified by race/ethnicity. Adults with high or moderate CVH scores had significantly lower odds of coronary artery calcium and lower carotid intima-media thickness and left ventricular mass than adults with low CVH scores. Adults with high or moderate CVH scores were 67% (95%CI 41% to 82%) and 37% (95%CI 22% to 49%) less likely, respectively, to experience a cardiovascular disease event than adults with low scores. There was no interaction with race/ethnicity.


CONCLUSIONS
There is a graded inverse association between CVH scores and measures of subclinical and overt cardiovascular disease that is similar across race/ethnic groups.
Department of Medicine, University of Chicago, IL tpolonsky@medicine.bsd.uchicago.edu.
Tamar S
TS
Polonsky
Department of Preventive Medicine, Northwestern University, Chicago, IL.
Hongyan
H
Ning
Institute for Minority Health Research, University of Illinois at Chicago, IL.
Martha L
ML
Daviglus
Department of Preventive Medicine, Northwestern University, Chicago, IL.
Kiang
K
Liu
Department of Public Health Sciences, Wake Forest University, Winston Salem, NC.
Gregory L
GL
Burke
Departments of Medicine and Pathology & Laboratory Medicine, University of Vermont, Colchester, VT.
Mary
M
Cushman
Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD.
John
J
Eng
Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN.
Aaron R
AR
Folsom
Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN.
Pamela L
PL
Lutsey
Health Science Center, Division of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas, Houston, TX.
Jennifer A
JA
Nettleton
Department of Medicine, Johns Hopkins University, Baltimore, MD.
Wendy S
WS
Post
Department of Neurology, University of Miami, FL.
Ralph L
RL
Sacco
Department of Epidemiology, Johns Hopkins University, Baltimore, MD.
Moyses
M
Szklo
Department of Preventive Medicine, Northwestern University, Chicago, IL.
Donald M
DM
Lloyd-Jones
D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism*; D001794:Blood Pressure; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality; D059168:Carotid Intima-Media Thickness; D002784:Cholesterol / Q000097:blood*; D003324:Coronary Artery Disease / Q000453:epidemiology*; D003327:Coronary Disease / Q000401:mortality; D004032:Diet; D005006:Ethnicity / Q000706:statistics & numerical data; D015444:Exercise; D005215:Fasting; D005260:Female; D006304:Health Status; D006323:Heart Arrest / Q000453:epidemiology; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D058729:Peripheral Arterial Disease / Q000453:epidemiology; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology*; D020521:Stroke / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D061205:Vascular Calcification / Q000453:epidemiology*
D001786:Blood Glucose; D002784:Cholesterol
cardiovascular disease prevention; disparities; subclinical atherosclerosis risk factor