Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Apr:198:180-188.
doi: 10.1016/j.ahj.2017.10.026. Epub 2017 Nov 11.

Factors of health in the protection against death and cardiovascular disease among adults with subclinical atherosclerosis

Mahmoud Al Rifai  1 , Philip Greenland  2 , Michael J Blaha  3 , Erin D Michos  3 , Khurram Nasir  4 , Michael D Miedema  5 , Joseph Yeboah  6 , Veit Sandfort  7 , Alexis C Frazier-Wood  8 , Steven Shea  9 , Joao Ac Lima  10 , Moyses Szklo  11 , Wendy S Post  3 , Roger S Blumenthal  3 , John W McEvoy  12
Affiliations

Factors of health in the protection against death and cardiovascular disease among adults with subclinical atherosclerosis

Mahmoud Al Rifai et al. Am Heart J. 2018 Apr.

Abstract

Background: Although cardiovascular disease (CVD) prevention traditionally emphasizes risk factor control, recent evidence also supports the promotion of "health factors" associated with cardiovascular wellness. However, whether such health factors exist among adults with advanced subclinical atherosclerosis is unknown. We aimed to study the association between health factors and events among persons with elevated coronary artery calcium (CAC).

Methods: Self-reported health-factors studied included nonsmoking, physical activity, Mediterranean-style diet, sleep quality, emotional support, low stress burden, and absence of depression. Measured health-factors included optimal weight, blood pressure, lipids, and glucose. Multivariable-adjusted Cox models examined the association between health factors and incident CVD or mortality, independent of risk factor treatment. Accelerated failure time models assessed whether health factors were associated with relative time delays in disease onset.

Results: Among 1,601 Multi-Ethnic Study of Atherosclerosis participants with CAC >100 without baseline clinical atherosclerotic CVD, mean age was 69 (±9) years, 64% were male, and median CAC score was 332 Agatston units. Over 12 years of follow-up, nonsmoking, high-density lipoprotein cholesterol levels >40 mg/dL for men and >50 mg/dL for women, and low stress burden were inversely associated with ASCVD (hazard ratios ranging from 0.58 to 0.71, all P<.05). Nonsmoking, glucose levels <100 mg/dL, regular physical activity, and low stress burden were inversely associated with mortality (hazard ratios ranging from 0.40 to 0.77, all P<.05). Each of these factors was also associated with delays in onset of clinical disease, as was absence of depression.

Conclusions: Adults with elevated CAC appear to have healthy lifestyle options to lower risk and delay onset of CVD, over and above standard preventive therapies.

Trial registration: ClinicalTrials.gov NCT00005487.

PubMed Disclaimer

Figures

Figure 1
Figure 1
a. Kaplan Meier survival estimates of incident hard ASCVD events by tertile of health factor score b. Kaplan Meier survival estimates of incident mortality events by tertile of health factor score
Figure 1
Figure 1
a. Kaplan Meier survival estimates of incident hard ASCVD events by tertile of health factor score b. Kaplan Meier survival estimates of incident mortality events by tertile of health factor score
See this image and copyright information in PMC

References

    1. Kannel WB, Dawber TR, Kagan A, Revotskie N, Stokes J. Factors of risk in the development of coronary heart disease–six year follow-up experience. The Framingham Study. Ann Intern Med. 1961;55:33–50. - PubMed
    1. Goff DC, Lloyd-Jones DM, Bennett G, Coady S, D’Agostino RB, Gibbons R, Greenland P, Lackland DT, Levy D, O’Donnell CJ, Robinson JG, Schwartz JS, Shero ST, Smith SC, Sorlie P, Stone NJ, Wilson PWF. 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. (Journal of the American College of Cardiology).J Am Coll Cardiol. 2014;63:2935–2959. - PMC - PubMed
    1. Lloyd-Jones DM, Hong Y, Labarthe D, Mozaffarian D, Appel LJ, Van Horn L, Greenlund K, Daniels S, Nichol G, Tomaselli GF, Arnett DK, Fonarow GC, Ho PM, Lauer MS, Masoudi FA, Robertson RM, Roger V, Schwamm LH, Sorlie P, Yancy CW, Rosamond WD. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic Impact Goal through 2020 and beyond. Circulation. 2010;121:586–613. - PubMed
    1. Labarthe DR, Kubzansky LD, Boehm JK, Lloyd-Jones DM, Berry JD, Seligman MEP. Positive Cardiovascular Health. J Am Coll Cardiol. 2016;68:860–867. - PubMed
    1. Knapper JT, Ghasemzadeh N, Khayata M, Patel SP, Quyyumi AA, Mendis S, Mensah GA, Taubert K, Sperling LS. Time to Change Our Focus: Defining, Promoting, and Impacting Cardiovascular Population Health. J Am Coll Cardiol. 2015;66:960–971. - PubMed

Publication types

MeSH terms

Associated data