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- Title
Association of Trajectory of Cardiovascular Health Score and Incident Cardiovascular Disease.
- Authors
Wu, Shouling; An, Shasha; Li, Weijuan; Lichtenstein, Alice H.; Gao, Jingsheng; Kris-Etherton, Penny M.; Wu, Yuntao; Jin, Cheng; Huang, Shue; Hu, Frank B.; Gao, Xiang
- Abstract
Key Points: Question: Are trajectories of overall cardiovascular health over time, as assessed by the cardiovascular health score repeatedly in 2006, 2008, and 2010, associated with subsequent risk of cardiovascular disease? Findings: In this population-based study of 74 701 Chinese adults, 5 cardiovascular health score trajectories were identified. Relative to the lowest measured trajectory, the highest measured trajectory was associated with a 79% lower subsequent risk of cardiovascular disease after adjusting for age, sex, educational level, income, occupation, alcohol intake, and serum high-sensitivity C-reactive protein concentrations at baseline. Meaning: Long-term cardiovascular health trajectories may be associated with subsequent cardiovascular disease morbidity. Importance: The American Heart Association 2020 Strategic Impact Goals target an improvement in overall cardiovascular health, as assessed by 7 health metrics (smoking, body weight, physical activity, diet, plasma glucose level, plasma cholesterol level, and blood pressure). Objective: To examine whether trajectories of overall cardiovascular health over time, as assessed by the cardiovascular health score (CHS) in 2006, 2008, and 2010, are associated with subsequent risk of CVD. Design, Setting, and Participants: The Kailuan study is a prospective, population-based study that began in 2006. The cohort included 74 701 Chinese adults free of myocardial infarction, stroke, and cancer in or before 2010. In the present study, CHS trajectories were developed from 2006 to 2010 to predict CVD risk from 2010 to 2015. Data analysis was performed from January 1, 2006, to December 31, 2015. Exposures: The CHS trajectories during 2006-2010 were identified using latent mixture models. Main Outcomes and Measures: Incident CVD events (myocardial infarction and stroke) during 2010-2015 were confirmed by review of medical records. The CHS trajectories were determined using 7 cardiovascular health metrics scored as poor (0 points), intermediate (1 point), and ideal (2 points); total score ranges from 0 (worst) to 14 (best). Based on the baseline CHS and patterns over time, 5 trajectories were categorized (low-stable, moderate-increasing, moderate-decreasing, high-stable I, and high-stable II). Results: Of the 74 701 adults included in the study (mean [SD] age at baseline, 49.6 [11.8] years), 58 216 (77.9%) were men and 16 485 (22.1%) were women. Five CHS trajectories were identified from 2006 to 2010: low-stable (n = 4393; range, 4.6-5.2), moderate-increasing (n = 4643; mean increase from 5.4 to 7.8), moderate-decreasing (n = 14 853; mean decrease from 7.4 to 6.3), high-stable I (n = 36 352; range, 8.8-9.0), and high-stable II (n = 14 461; range, 10.9-11.0). During 5 years of follow-up, 1852 incident CVD cases were identified. Relative to the low-stable trajectory, the high-stable II trajectory was associated with a lower subsequent risk of CVD (adjusted hazard ratio, 0.21; 95% CI, 0.16-0.26, after adjusting for age, sex, educational level, income, occupation, alcohol intake, and serum high-sensitivity C-reactive protein concentration at baseline). Conclusions and Relevance: Cardiovascular health trajectories may be associated with subsequent CVD risk. This population-based study examines changes in cardiovascular health status assessed by the Cardiovascular Health Score of Chinese adults over 5 years.
- Subjects
CHINA; AGE distribution; C-reactive protein; CARDIOVASCULAR diseases; CARDIOVASCULAR diseases risk factors; CONFIDENCE intervals; EMPLOYMENT; HEALTH status indicators; INCOME; LONGITUDINAL method; RESEARCH funding; RISK assessment; SEX distribution; EDUCATIONAL attainment; PROPORTIONAL hazards models; DATA analysis software; DESCRIPTIVE statistics
- Publication
JAMA Network Open, 2019, Vol 2, Issue 5, pe194758
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2019.4758