Cardiovascular Health and Incident Cardiovascular Disease and Cancer: The Women's Health Initiative

Abstract

Introduction: The American Heart Association's "Simple 7" offers a practical public health conceptualization of cardiovascular health (CVH). CVH predicts incident cardiovascular disease (CVD) in younger populations, but has not been studied in a large, diverse population of aging postmenopausal women. The extent to which CVH predicts cancer in postmenopausal women is unknown.

Methods: Multivariable Cox regression estimated hazard ratios and 95% CIs for the association between CVH and incident CVD, any cancer, and cancer subtypes (lung, colorectal, and breast) among 161,809 Women's Health Initiative observational study and clinical trial participants followed from 1993 through 2010. Data were analyzed in 2013. CVH score was characterized as the number (0 [worst] to 7 [best]) of the American Heart Association's ideal CVH behaviors and factors at baseline: smoking, BMI, physical activity, diet, total cholesterol, blood pressure, and fasting glucose.

Results: Median follow-up was approximately 13 years. Fewer minorities and less educated women achieved ideal CVH, a common benchmark. In adjusted models, compared with women with the highest (best) CVH scores, those with the lowest (worst) CVH scores had nearly seven times the hazard of incident CVD (6.83, 95% CI=5.83, 8.00) and 52% greater risk of incident cancer (1.52, 95% CI=1.35, 1.72). Ideal CVH was most strongly inversely associated with lung cancer, then colorectal cancer, and then breast cancer.

Conclusions: Lower ideal CVH is more common among minority and less educated postmenopausal women and predicts increased risk of CVD and cancer in this population, emphasizing the importance of prevention efforts among vulnerable older adults.

Figure 1

Age-adjusted incidence rate (per 100 women) of CVD (left) and cancer (right), according to the number of ideal CVH factors (total cholesterol, blood pressure, glucose) and behaviors (smoking, BMI, physical activity, healthy diet score): WHI study participants.

Figure 2

Multivariable-adjusted hazard ratios and 95% CI for incident CVD and cancer (left), and cancer subtypes (right), including death, by ideal CVH score: WHI study participants. Full models are adjusted for OS/CT enrollment, age, race/ethnicity, marital status, education, and family history of CVD or cancer, respectively.