Vanessa Xanthakis1, Danielle M Enserro2, Joanne M Murabito2, Joseph F Polak2, Kai C Wollert2, James L Januzzi2, Thomas J Wang2, Geoffrey Tofler2, Ramachandran S Vasan2. 1. From the Framingham Heart Study, Framingham, MA (V.X., J.M.M., R.S.V.); Department of Biostatistics, Boston University School of Public Health, Boston, MA (V.X., D.M.E.); Section of Preventive Medicine and Epidemiology (V.X., R.S.V.) and Section of General Internal Medicine, Department of Medicine (J.M.M.), Boston University School of Medicine, Boston, MA; Department of Radiology, Tufts University Medical Center, Boston, MA (J.F.P.); Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany (K.C.W.); Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (J.L.J.); Cardiology Division, Vanderbilt University Medical Center, Nashville, TN (T.J.W.); and Royal North Shore Hospital University of Sydney, Sydney, Australia (G.T.). vanessax@bu.edu. 2. From the Framingham Heart Study, Framingham, MA (V.X., J.M.M., R.S.V.); Department of Biostatistics, Boston University School of Public Health, Boston, MA (V.X., D.M.E.); Section of Preventive Medicine and Epidemiology (V.X., R.S.V.) and Section of General Internal Medicine, Department of Medicine (J.M.M.), Boston University School of Medicine, Boston, MA; Department of Radiology, Tufts University Medical Center, Boston, MA (J.F.P.); Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany (K.C.W.); Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (J.L.J.); Cardiology Division, Vanderbilt University Medical Center, Nashville, TN (T.J.W.); and Royal North Shore Hospital University of Sydney, Sydney, Australia (G.T.).
Abstract
BACKGROUND: The American Heart Association Cardiovascular Health score (CVH score) is inversely associated with cardiovascular disease (CVD) incidence, but the mechanisms underlying this association warrant exploration. METHODS AND RESULTS: We related the CVH score to circulating biomarkers and prevalent subclinical CVD (defined as ≥1 of the following: increased carotid intima-media thickness or stenosis, left ventricular hypertrophy [by ECG or echocardiography], left ventricular systolic dysfunction, microalbuminuria, and a reduced ankle-brachial index) in 2680 Framingham Study participants (mean age, 58 years; 55% women). After adjustment for age and sex, an ideal CVH score (nonsmoking status, ideal body mass index, regular physical activity, healthy diet, and an optimal profile of serum cholesterol, blood pressure, and glucose; 1 point for each) was associated with higher circulating concentrations of natriuretic peptides (N-terminal pro-atrial natriuretic peptide and B-type natriuretic peptide) and lower blood concentrations of plasminogen activator inhibitor-1, aldosterone, C-reactive protein, D-dimer, fibrinogen, homocysteine, and growth differentiation factor-15 levels (P<0.001 for all), as well as lower odds of subclinical disease (odds ratio, 0.74 per 1-unit increase in CVH score; 95% confidence interval, 0.68-0.80). The incidence of CVD (267 events over 16 years) was inversely associated with the CVH score in age- and sex-adjusted models (hazard ratio, 0.77 per 1-unit increase in CVH score; 95% confidence interval, 0.70-0.86), which was slightly attenuated upon adjustment for biomarkers and subclinical disease (hazard ratio, 0.87; 95% confidence interval, 0.78-0.97). CONCLUSION: In our prospective community-based study, the inverse association between an ideal cardiovascular health score and CVD incidence was partly attributable to its favorable impact on CVD biomarker levels and subclinical disease.
BACKGROUND: The American Heart Association Cardiovascular Health score (CVH score) is inversely associated with cardiovascular disease (CVD) incidence, but the mechanisms underlying this association warrant exploration. METHODS AND RESULTS: We related the CVH score to circulating biomarkers and prevalent subclinical CVD (defined as ≥1 of the following: increased carotid intima-media thickness or stenosis, left ventricular hypertrophy [by ECG or echocardiography], left ventricular systolic dysfunction, microalbuminuria, and a reduced ankle-brachial index) in 2680 Framingham Study participants (mean age, 58 years; 55% women). After adjustment for age and sex, an ideal CVH score (nonsmoking status, ideal body mass index, regular physical activity, healthy diet, and an optimal profile of serum cholesterol, blood pressure, and glucose; 1 point for each) was associated with higher circulating concentrations of natriuretic peptides (N-terminal pro-atrial natriuretic peptide and B-type natriuretic peptide) and lower blood concentrations of plasminogen activator inhibitor-1, aldosterone, C-reactive protein, D-dimer, fibrinogen, homocysteine, and growth differentiation factor-15 levels (P<0.001 for all), as well as lower odds of subclinical disease (odds ratio, 0.74 per 1-unit increase in CVH score; 95% confidence interval, 0.68-0.80). The incidence of CVD (267 events over 16 years) was inversely associated with the CVH score in age- and sex-adjusted models (hazard ratio, 0.77 per 1-unit increase in CVH score; 95% confidence interval, 0.70-0.86), which was slightly attenuated upon adjustment for biomarkers and subclinical disease (hazard ratio, 0.87; 95% confidence interval, 0.78-0.97). CONCLUSION: In our prospective community-based study, the inverse association between an ideal cardiovascular health score and CVD incidence was partly attributable to its favorable impact on CVD biomarker levels and subclinical disease.
Authors: Maria Vassilaki; Jeremiah A Aakre; Ruth H Cha; Walter K Kremers; Jennifer L St Sauver; Michelle M Mielke; Yonas E Geda; Mary M Machulda; David S Knopman; Ronald C Petersen; Rosebud O Roberts Journal: J Am Geriatr Soc Date: 2015-08-27 Impact factor: 5.562
Authors: Omar Bayomy; Ajay D Rao; Rajesh Garg; Anand Vaidya; Alyssa R Kotin; Beata Reiber; Stephanie Nijmeijer; Marcelo F Di Carli; Michael Jerosch-Herold; Raymond Y Kwong; Gail K Adler Journal: Metab Syndr Relat Disord Date: 2017-05-15 Impact factor: 1.894
Authors: Wendy Y Zhang; Elif Seda Selamet Tierney; Angela C Chen; Albee Y Ling; Raquel R Fleischmann; Valerie L Baker Journal: J Pediatr Date: 2019-08-20 Impact factor: 4.406
Authors: P Seron; V Irazola; A Rubinstein; M Calandrelli; J Ponzo; H Olivera; L Gutierrez; N Elorriaga; R Poggio; F Lanas Journal: Public Health Date: 2018-02-20 Impact factor: 2.427
Authors: Matthew J Feinstein; June-Ho Kim; Prossy Bibangambah; Ruth Sentongo; Jeffrey N Martin; Alexander C Tsai; David R Bangsberg; Linda Hemphill; Virginia A Triant; Yap Boum; Peter W Hunt; Samson Okello; Mark J Siedner Journal: AIDS Res Hum Retroviruses Date: 2016-09-07 Impact factor: 2.205
Authors: Rene Baudrand; Luminita H Pojoga; Anand Vaidya; Amanda E Garza; Paul A Vöhringer; Xavier Jeunemaitre; Paul N Hopkins; Tham M Yao; Jonathan Williams; Gail K Adler; Gordon H Williams Journal: Circulation Date: 2015-10-02 Impact factor: 29.690
Authors: Megan M Marron; Jatinder Singh; Robert M Boudreau; Kaare Christensen; Stephanie Cosentino; Mary F Feitosa; Ryan L Minster; Thomas Perls; Nicole Schupf; Paola Sebastiani; Svetlana Ukraintseva; Mary K Wojczynski; Anne B Newman Journal: J Hypertens Date: 2018-01 Impact factor: 4.844
Authors: Abbi D Lane-Cordova; Kiarri Kershaw; Kiang Liu; David Herrington; Donald M Lloyd-Jones Journal: Am J Hypertens Date: 2017-08-01 Impact factor: 2.689
Authors: Aaron R Folsom; Alvaro Alonso; Kristen M George; Nicholas S Roetker; Weihong Tang; Mary Cushman Journal: Thromb Res Date: 2015-08-28 Impact factor: 3.944