Ideal Cardiovascular Health, Mortality, and Vascular Events

Jun 22, 2017
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Authors:
Gaye B, Canonico M, Perier MC, et al.
Citation:
Ideal Cardiovascular Health, Mortality, and Vascular Events in Elderly Subjects: The Three-City Study. J Am Coll Cardiol 2017;69:3015-3026.
Summary By:
Melvyn Rubenfire, MD, FACC

Study Questions:

What is the association of ideal cardiovascular health (CVH) metrics with mortality, incident coronary heart disease (CHD), and stroke events in elderly individuals from the community?

Methods:

Between 1999 and 2001, 9,294 men and women ≥65 years and noninstitutionalized were examined, and followed-up for the occurrence of vascular events and mortality within the Three-City Study conducted in France. Hazard ratios (HRs) were estimated by Cox proportional hazard model and compared subjects with 3-4 and subjects with 5-7 ideal metrics (limited to baseline) with those with 0-2 ideal metrics, respectively.

Results:

Mean age was 73.8 years (standard deviation, 5.3) and 36.7% were men. Only 5% of the participants had ≥5 metrics at the ideal level. After a median follow-up of 10.9 years and 8.6 years, respectively, 1,987 deaths and 680 adjudicated CHD or stroke events had occurred. In multivariate analysis, the risk of mortality and of vascular events decreased across the categories of ideal metrics. In particular, in subjects with ≥5 metrics at the ideal level (compared to those with ≤2), there was a 29% (HR, 0.71; 95% CI, 0.55-0.90) decreased risk of all-cause mortality and 67% (HR, 0.33; 95% CI, 0.19-0.57) for CHD and stroke combined (p for trend < 0.001).

Conclusions:

Even in the elderly, higher CVH status is highly beneficial regarding mortality and vascular event risks.

Perspective:

Preventing the development of cardiovascular risk factors is the concept of primordial prevention, which is applied to the entire population. The benefit of high CVH status has been demonstrated previously in middle-aged persons. The metrics include the American Heart Association recommended simplified 7-item tool in which each is equally weighted: body mass index (<25 kg/m2), smoking status (none for 12 months), diet, physical activity, blood pressure (<120/80 mm Hg), blood cholesterol (<200 mg/dl), and euglycemia (<100 mg/dl).

Keywords: Blood Pressure, Body Mass Index, Cholesterol, Coronary Artery Disease, Diet, Exercise, Geriatrics, Health Status, Primary Prevention, Risk Factors, Smoking, Stroke, Vascular Diseases


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