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. 2015 Nov 24;132(21):1979-89.
doi: 10.1161/CIRCULATIONAHA.115.017882. Epub 2015 Sep 8.

Ideal Cardiovascular Health During Adult Life and Cardiovascular Structure and Function Among the Elderly

Amil M Shah  1 , Brian Claggett  2 , Aaron R Folsom  2 , Pamela L Lutsey  2 , Christie M Ballantyne  2 , Gerardo Heiss  2 , Scott D Solomon  2
Affiliations

Ideal Cardiovascular Health During Adult Life and Cardiovascular Structure and Function Among the Elderly

Amil M Shah et al. Circulation. .

Abstract

Background: A higher American Heart Association cardiovascular health score (CVHS) predicts a lower incidence of cardiovascular disease (CVD). However, the relationship of CVHS attainment through midlife to late life with CVD prevalence and cardiovascular structure and function in late life is not well described.

Methods and results: The following 6 ideal cardiovascular health metrics were assessed in the Atherosclerosis Risk in Communities (ARIC) study participants at 5 examination visits between 1987 and 2013: nonsmoking, body mass index <25 kg/m(2), untreated total cholesterol <200 mg/dL, untreated blood pressure <120/<80 mm Hg, fasting blood glucose <100 mg/dL, and ideal physical activity. Attainment over time was assessed as the percentage of maximum possible CVHS metrics achieved at visits 1 through 5, the slope of change in CVHS per decade of follow-up, and CVHS trajectory through follow-up. At visit 5, participant groups were characterized with respect to CVD prevalence (n=6520) and echocardiographic measures of cardiac structure and function (n=5903 free of CVD). CVHS was low at baseline and declined with age. Both greater CVHS attainment and improvement in CVHS during follow-up were associated with a lower prevalence of CVD and better left ventricular structure and systolic and diastolic function at visit 5.

Conclusions: Greater attainment of, and improvements in, ideal cardiovascular health through midlife to late life are associated with lower CVD prevalence and better cardiovascular structure and function when elderly. These findings highlight the importance of consistent primordial and primary prevention efforts throughout midlife to late life as a potential intervention to decrease the burden of CVD among the elderly.

Keywords: aging; cardiovascular diseases; echocardiography; epidemiology; risk factors.

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Figures

Figure 1
Figure 1
Consort diagram of study population.
Figure 2
Figure 2
Panels A and B illustrate the mean (±S.D.) number of ideal cardiovascular health indicators attained at each of 5 ARIC visits between 1987 and 2013, in the study cohort overall and stratified by gender (Panel A) and race (Panel B). Panels C and D show the distribution of percent ideal cardiovascular health score (CVHS) attained by gender (Panel C) and by race (Panel D). P value for men versus women was 0.11. P value for whites versus black participants was <0.001.
Figure 2
Figure 2
Panels A and B illustrate the mean (±S.D.) number of ideal cardiovascular health indicators attained at each of 5 ARIC visits between 1987 and 2013, in the study cohort overall and stratified by gender (Panel A) and race (Panel B). Panels C and D show the distribution of percent ideal cardiovascular health score (CVHS) attained by gender (Panel C) and by race (Panel D). P value for men versus women was 0.11. P value for whites versus black participants was <0.001.
Figure 2
Figure 2
Panels A and B illustrate the mean (±S.D.) number of ideal cardiovascular health indicators attained at each of 5 ARIC visits between 1987 and 2013, in the study cohort overall and stratified by gender (Panel A) and race (Panel B). Panels C and D show the distribution of percent ideal cardiovascular health score (CVHS) attained by gender (Panel C) and by race (Panel D). P value for men versus women was 0.11. P value for whites versus black participants was <0.001.
Figure 2
Figure 2
Panels A and B illustrate the mean (±S.D.) number of ideal cardiovascular health indicators attained at each of 5 ARIC visits between 1987 and 2013, in the study cohort overall and stratified by gender (Panel A) and race (Panel B). Panels C and D show the distribution of percent ideal cardiovascular health score (CVHS) attained by gender (Panel C) and by race (Panel D). P value for men versus women was 0.11. P value for whites versus black participants was <0.001.
Figure 3
Figure 3
Prevalence of cardiovascular diseases by categories of percent cardiovascular health score (CVHS) attained through mid-life and late-life (Panel A) and by categories of change in CVHS per decade follow-up (Panel B). Prevalence estimates and P values are adjusted for age, gender, race, and Field Center.
Figure 3
Figure 3
Prevalence of cardiovascular diseases by categories of percent cardiovascular health score (CVHS) attained through mid-life and late-life (Panel A) and by categories of change in CVHS per decade follow-up (Panel B). Prevalence estimates and P values are adjusted for age, gender, race, and Field Center.
Figure 4
Figure 4
(A) Trajectories of CVHS over the 25 year period of the ARIC study. Percentages in the figure legend refer to population prevalence. (B) Prevalence of cardiovascular diseases by trajectory of CVHS. Prevalence estimates and P values are adjusted for age, gender, race, and Field Center.
Figure 4
Figure 4
(A) Trajectories of CVHS over the 25 year period of the ARIC study. Percentages in the figure legend refer to population prevalence. (B) Prevalence of cardiovascular diseases by trajectory of CVHS. Prevalence estimates and P values are adjusted for age, gender, race, and Field Center.
Figure 5
Figure 5
Mean and SEM of echocardiographic measures at Visit 5 of (A) LV structure [mass], (B) LV systolic function [longitudinal strain], and (C) LV diastolic function [TDI e’] by CVHS trajectory. Values and P values are adjusted for age, gender, race, and Field Center. * - trajectory 5 vs 3 p <0.05 and 5 vs 2 p NS. # - trajectory 5 vs 1 p <0.5.
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