Ideal Cardiovascular Health During Mid- and Late-Life
Does an improved cardiovascular health score (CVHS) attained through mid- to late-life reduce cardiovascular disease (CVD) prevalence and relate to CV structure and function in late life?
Six ideal CV health metrics (equally weighted) were assessed in ARIC (Atherosclerosis Risk in Communities) study participants at five visits between 1987 and 2013. They included: nonsmoking, body mass index (BMI) <25 kg/m2, untreated total cholesterol <200 mg/dl, untreated blood pressure <120/<80 mm Hg, fasting blood glucose <100 mg/dl, and ideal physical activity. Attainment over time was assessed as the percent of maximum possible CVHS metrics achieved at visits 1-5, the slope of change in CVHS per decade of follow-up, and CVHS trajectory through follow-up. At visit 5, participant groups were characterized with respect to CVD prevalence (n = 6,520) and echo measures of cardiac structure and function (n = 5,903 free of CVD).
The mean number of ideal health measures (maximal 6) was 2.9 at baseline and 2.2 at the fifth visit. The average CVHS decreased by 0.4 per decade, although values ranged from a decrease of 2.8 per decade to an increase of 1.9 per decade. CVHS was low at baseline and declined with age, with the most prominent decreases in health attainment noted for blood pressure, glucose, and cholesterol. Both greater CVHS attainment and improvement in CVHS during follow-up (slope) were associated with a lower prevalence of CVD and better left ventricular structure, systolic function, and diastolic function at visit 5. Worse CVHS was associated with younger age, males, and blacks who demonstrated significantly worse health attainment at each time point, but with a similar rate of decline over time as whites. The greatest decrease in CVHS was between the fourth and fifth visits. Greater health attainment through mid-life and late-life was not only associated with less prevalent CVD when elderly, but among those without prevalent CVD, was also associated with better measures of CV structure and function when elderly.
Greater attainment of, and improvements in, ideal CV health through mid- to late-life are associated with lower CVD prevalence and better CV structure and function when elderly. These findings highlight the importance of consistent primordial and primary prevention efforts throughout mid- to late-life as a potential intervention to decrease the burden of CVD among the elderly.
The findings are of vital import to those involved in public health and cost of health care. It will be interesting to see an analysis that provides a weighting for the risk factors that contribute to the reduction in CV events and CV structure and function among the elderly. For example, does a trend to reduce BMI to <25 kg/m2 or change in fasting blood sugar with a 100 mg/dl cutpoint provide an equivalent benefit to achieving optimal blood pressure without treatment, improved physical activity, and smoking cessation?
Keywords: Atherosclerosis, Blood Glucose, Blood Pressure, Body Mass Index, Cardiovascular Diseases, Cholesterol, Geriatrics, Motor Activity, Primary Prevention, Risk Factors, Smoking Cessation
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