Twenty-Year Trends in the American Heart Association Cardiovascular Health Score and Impact on Subclinical and Clinical Cardiovascular Disease: The Framingham Offspring Study

Abstract

Background: Data on the temporal trends in ideal cardiovascular health (CVH) as well as on their association with subclinical/overt cardiovascular disease (CVD) and death are limited.

Methods and results: This study included 3460 participants attending ≥1 of 4 consecutive exams of the Framingham Heart Study (1991-2008, mean age 55.4 years, CVH score ranged 0-14). We created 4 groups describing changes in CVH score between examination cycles 5 and 8, using first and last exams attended (high-high: starting CVH score ≥8, last score of ≥8, referent; high-low: ≥8 start and ≤7 last; low-high: ≤7 start and ≥8 last; and low-low: ≤7 start and ≤7 last) and related them to subclinical CVD cross-sectionally, and incident CVD and death. Fewer people have ideal CVH scores over the past 20 years (8.5% for 1991-1995, 5.9% for 2005-2008, P=0.002), because of decreases in those with ideal status of body mass index, blood glucose, and serum cholesterol levels (P<0.05 for all). The odds of subclinical disease and risk of CVD and death were higher for all compared with the high-high group (428 CVD and 367 death events, median follow-up 5.1 years, hazard ratios for CVD: 1.39, 1.73, 1.9 and death: 1.12, 1.57, 1.4 and odds ratios for subclinical disease: 1.61, 1.98, 2.86 for high-low, low-high, and low-low, respectively).

Conclusions: The decreased presence of ideal CVH scores over the past 20 years resulted in increasing odds of subclinical disease and risk of CVD and death, emphasizing the importance of maintaining ideal CVH over the life course.

Keywords: American Heart Association; cardiovascular disease; ideal cardiovascular health; subclinical disease.

Figure 1

Sex‐specific and age‐adjusted trend of CVH score across exams. CVH indicates cardiovascular health. All numbers are percentages for Y axis.

Figure 2

Trends of each component* defining the CVH score across exams. *Physical activity is not presented because of how ideal, intermediate, and poor physical activity was defined. Y‐axis represents percentage at exam. P values are from age‐ and sex‐adjusted chi‐squared tests comparing ideal status in period 1991–1995 to ideal status in period 2005–2008. CVH indicates cardiovascular health.

Figure 3

A, Kaplan–Meier plot for incidence of cardiovascular disease (CVD). B, Kaplan–Meier plot for incidence of all‐cause mortality. CVH indicates cardiovascular health.