Tomi T Laitinen1, Katja Pahkala2, Costan G Magnussen3, Mervi Oikonen4, Jorma S A Viikari5, Matthew A Sabin6, Stephen R Daniels7, Olli J Heinonen8, Leena Taittonen9, Olli Hartiala4, Vera Mikkilä10, Nina Hutri-Kähönen11, Tomi Laitinen12, Mika Kähönen13, Olli T Raitakari14, Markus Juonala15. 1. Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland. Electronic address: tomi.laitinen@utu.fi. 2. Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Paavo Nurmi Centre, Sports & Exercise Medicine Unit, Department of Physical Activity and Health University of Turku, Turku, Finland. 3. Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia. 4. Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland. 5. Department of Medicine, University of Turku and Division of Medicine, Turku University Hospital, Turku, Finland. 6. Murdoch Childrens Research Institute, Royal Children's Hospital and University of Melbourne, Parkville, Victoria, Australia. 7. Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, USA. 8. Paavo Nurmi Centre, Sports & Exercise Medicine Unit, Department of Physical activity and Health, University of Turku, Turku, Finlad. 9. Department of Pediatrics, University of Oulu, Vaasa, Finland; Vaasa Central Hospital, Vaasa, Finland. 10. Department of Food and Environmental Sciences, University of Helsinki, Finland. 11. Department of Pediatrics, University of Tampere and Tampere University Hospital, Tampere, Finland. 12. Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland. 13. Department of Clinical Physiology, University of Tampere and Tampere University Hospital, Tampere, Finland. 14. Research Centre of Applied and Preventive Cardiovascular, University of Turku, Turku, Finland; Department of Clinical Physiology, Turku University Hospital, Turku, Finland. 15. Department of Medicine, University of Turku and Division of Medicine, Turku University Hospital, Turku, Finland; Murdoch Childrens Research Institute, Parkville, Victoria, Australia.
Abstract
BACKGROUND: The American Heart Association recently defined 7 ideal health behaviors and factors that can be used to monitor ideal cardiovascular health (ICH) over time. These relate to smoking, physical activity, diet, body mass index (BMI), blood pressure, blood glucose and total cholesterol. Associations between repeated measures of ICH across the life-course with outcomes of subclinical atherosclerosis in adult life have not been reported. METHODS AND RESULTS: The sample comprised 1465 children and young adults aged 12 to 24 years (mean age 17.5 years) from the Cardiovascular Risk in Young Finns Study cohort. Participants were followed-up for 21 years since baseline (1986) and had complete ICH data available at baseline and follow-up. Average lifetime ICH index was associated with reduced risk of coronary artery calcification (CAC) (P=0.0004), high-risk carotid intima-media thickness (IMT) (P=0.0005) and high-risk carotid distensibility (<0.0001) in middle age. Participants with persistently low ICH status (lower than the median), as compared with persons with persistently high ICH status (higher than the median), had an increased risk of CAC (P=0.02), high-risk IMT (P=0.02), and high-risk distensibility (P<0.0001). Participants who improved their ICH status from low to high did not have a different risk of CAC (P=0.90), high-risk IMT (P=0.25), or high-risk distensibility (P=0.80) than participants who always had high ICH status. CONCLUSIONS: The results show that ICH can be lost and regained, and importantly that regaining of ICH has a beneficial effect on cardiometabolic health. Health care providers should work to improve health behaviors especially in those who have lost ICH.
BACKGROUND: The American Heart Association recently defined 7 ideal health behaviors and factors that can be used to monitor ideal cardiovascular health (ICH) over time. These relate to smoking, physical activity, diet, body mass index (BMI), blood pressure, blood glucose and total cholesterol. Associations between repeated measures of ICH across the life-course with outcomes of subclinical atherosclerosis in adult life have not been reported. METHODS AND RESULTS: The sample comprised 1465 children and young adults aged 12 to 24 years (mean age 17.5 years) from the Cardiovascular Risk in Young Finns Study cohort. Participants were followed-up for 21 years since baseline (1986) and had complete ICH data available at baseline and follow-up. Average lifetime ICH index was associated with reduced risk of coronary artery calcification (CAC) (P=0.0004), high-risk carotid intima-media thickness (IMT) (P=0.0005) and high-risk carotid distensibility (<0.0001) in middle age. Participants with persistently low ICH status (lower than the median), as compared with persons with persistently high ICH status (higher than the median), had an increased risk of CAC (P=0.02), high-risk IMT (P=0.02), and high-risk distensibility (P<0.0001). Participants who improved their ICH status from low to high did not have a different risk of CAC (P=0.90), high-risk IMT (P=0.25), or high-risk distensibility (P=0.80) than participants who always had high ICH status. CONCLUSIONS: The results show that ICH can be lost and regained, and importantly that regaining of ICH has a beneficial effect on cardiometabolic health. Health care providers should work to improve health behaviors especially in those who have lost ICH.
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