The CANHEART health index: a tool for monitoring the cardiovascular health of the Canadian population

Abstract

Background: To comprehensively examine the cardiovascular health of Canadians, we developed the Cardiovascular Health in Ambulatory Care Research Team (CANHEART) health index. We analyzed trends in health behaviours and factors to monitor the cardiovascular health of the Canadian population.

Methods: We used data from the Canadian Community Health Survey (2003-2011 [excluding 2005]; response rates 70%-81%) to examine trends in the prevalence of 6 cardiovascular health factors and behaviours (smoking, physical activity, fruit and vegetable consumption, overweight/obesity, diabetes and hypertension) among Canadian adults aged 20 or older. We defined ideal criteria for each of the 6 health metrics. The number of ideal metrics was summed to create the CANHEART health index; values range from 0 (worst) to 6 (best or ideal). A separate CANHEART index was developed for youth age 12-19 years; this index included 4 health factors and behaviours (smoking, physical activity, fruit and vegetable consumption and overweight/obesity). We determined the prevalence of ideal cardiovascular health and the mean CANHEART health index score, stratified by age, sex and province.

Results: During the study period, physical activity and fruit and vegetable consumption increased and smoking decreased among Canadian adults. The prevalence of overweight/obesity, hypertension and diabetes increased. In 2009-2010, 9.4% of Canadian adults were in ideal cardiovascular health, 53.3% were in intermediate health (4-5 healthy factors or behaviours), and 37.3% were in poor cardiovascular health (0-3 healthy factors or behaviours). Twice as many women as men were in ideal cardiovascular health (12.8% vs. 6.1%). Among youth, the prevalence of smoking decreased and the prevalence of overweight/obesity increased. In 2009-2010, 16.6% of Canadian youth were in ideal cardiovascular health, 33.7% were in intermediate health (3 healthy factors or behaviours), and 49.7% were in poor cardiovascular health (0-2 healthy factors or behaviours).

Interpretation: Fewer than 1 in 10 Canadian adults and 1 in 5 Canadian youth were in ideal cardiovascular health from 2003 to 2011. Intensive health promotion activities are needed to meet the Heart and Stroke Foundation of Canada's goal of improving the cardiovascular health of Canadians by 10% by 2020 as measured by the CANHEART health index.

Figure 1:

Trends in health factors and behaviours among Canadian adults aged 20 years and older. The beta (β) coefficients can be interpreted as the annual percentage change in each factor. Dashed lines indicate the regression line. Source: Canadian Community Health Survey 2001–2011.

Figure 2:

Trends in health behaviours and factors among Canadian youth aged 12–19 years. The beta (β) coefficients can be interpreted as the annual percentage change in each factor. Dashed lines indicate the regression line. Source: Canadian Community Health Survey 2001–2011.

Figure 3:

Prevalence of ideal cardiovascular health, by age group and sex. Error bars indicate 95% confidence intervals. Source: Canadian Community Health Survey 2009–2010.

Figure 4:

Mean CANHEART health index score among Canadian adults aged 20 years and older by province. Error bars indicate 95% confidence intervals. Source: Canadian Community Health Survey 2009–2010.

Figure 5:

Weighted prevalence of heart disease among adults age 20 and older by CANHEART health index score. Error bars indicate 95% confidence intervals. Among adults, ideal cardiovascular health is defined as the presence of all 6 ideal health factors and behaviours (smoking status, overweight/obesity, physical activity, fruit and vegetable consumption, hypertension, diabetes); intermediate cardiovascular health is defined as 4–5 ideal health factors or behaviours; and poor cardiovascular health is defined as the presence of 0–3 ideal health factors or behaviours. Source: Canadian Community Health Survey 2009–2010.