Influential Periods in Longitudinal Clinical Cardiovascular Health Scores

Abstract

The prevalence of ideal cardiovascular health (CVH) among adults in the United States is low and decreases with age. Our objective was to identify specific age windows when the loss of CVH accelerates, to ascertain preventive opportunities for intervention. Data were pooled from 5 longitudinal cohorts (Project Heartbeat!, Cardiovascular Risk in Young Finns Study, The Bogalusa Heart Study, Coronary Artery Risk Development in Young Adults, Special Turku Coronary Risk Factor Intervention Project) from the United States and Finland from 1973 to 2012. Individuals with clinical CVH factors (i.e., body mass index, blood pressure, cholesterol, blood glucose) measured from ages 8 to 55 years were included. These factors were categorized and summed into a clinical CVH score ranging from 0 (worst) to 8 (best). Adjusted, segmented, linear mixed models were used to estimate the change in CVH over time. Among the 18,343 participants, 9,461 (52%) were female and 12,346 (67%) were White. The baseline mean (standard deviation) clinical CVH score was 6.9 (1.2) at an average age of 17.6 (8.1) years. Two inflection points were estimated: at 16.9 years (95% confidence interval: 16.4, 17.4) and at 37.2 years (95% confidence interval: 32.4, 41.9). Late adolescence and early middle age appear to be influential periods during which the loss of CVH accelerates.

Keywords: adolescence; cardiovascular epidemiology; cardiovascular health; cohort studies; longitudinal studies; prevention; risk factors.

Figure 1

Plots of unadjusted segmented mixed models (fixed effects only), cardiovascular health (CVH) pooled cohort, 1973–2012. A) Overall model (change points: 17.3 and 35.1; 95% confidence intervals (CIs): 16.8, 17.8 and 32.3, 37.9, respectively). Stratified models: B) males (change points: 17.1 and 37.2; 95% CIs: 16.9, 18.3 and 33.7, 40.6, respectively) and C) females (change points: 16.8 and 35.6; 95% CIs: 16.1, 17.6 and 34.3, 36.9, respectively). (For illustrative purposes, data points from 50 randomly selected participants are shown).

Figure 2

Adjusted segmented mixed model, by sex, cardiovascular health (CVH) pooled cohort, 1973–2012. The reference group, Black males and females from Bogalusa Heart Study (1973–2010), is shown here. Dashed vertical lines indicate the knots at 17 and 37 years. Clinical CVH score ranges from 0 to 8, with 8 being the most ideal.)