Seven key measures of heart health may offer a way to predict future risk of cardiovascular disease.
A new study in JAMA Network Open identifies five patterns of how well people did or did not do on the measures over time. For example, people who consistently scored well had a lower chance of cardiovascular disease than those who did not. Further, improving the metrics related to a lower risk of cardiovascular disease (CVD) in the future.
The findings suggest that people can help influence their risk, says Xiang Gao, associate professor of nutritional sciences and director of the Nutritional Epidemiology Lab at Penn State.
“In our study population, and probably across the world, there are many people who have suboptimal or poor heart health,” Gao says. “But, even though most people don’t meet the ideal criteria for all seven metrics, if we can work to improve those measures, the future risk of CVD can still decrease.”
The American Heart Association identified the seven health metrics as the most important predictors of heart health. These include four behaviors that people have control over and three biometrics that should be kept at healthy levels.
The modifiable behaviors include not smoking, maintaining a healthy weight, a healthy diet, and staying physically active. The biometrics include blood pressure, cholesterol, and blood sugar.
Each metric has a poor, intermediate, or ideal score. For example, smoking regularly gets a “poor” rating; smoking within the past 12 months an “intermediate” rating; and never smoking or quitting more than a year ago an “ideal” rating.
Combining the score for all seven metrics—0 for poor, 1 for intermediate, and 2 for ideal—results in an overall “cardiovascular health score,” or CHS.
“Only about 2 percent of people in the United States and other countries meet all the ideal requirements for these seven factors,” Gao says. “This raises the question of whether improving these metrics is related to lower future risk of CVD. It should, but no one had the data to support this idea.”
Researchers used data from 74,701 Chinese adults from the Kailuan Study. At the beginning of the study, participants completed questionnaires about their health, and underwent clinical exams and lab tests three times in the first four years. Across the following five years, the researchers kept track of any new onset CVD cases in the participants.
After they gathered the information, the researchers analyzed the data to see how CHS during the first four years associated with whether or not the participants developed CVD. They found five distinct patterns—or trajectories—that people followed throughout the four years.
These trajectories included maintaining high, medium, or low CHS, as well as increasing and decreasing CHS over time. These different trajectories associated with different risks for developing CVD in the future, Gao says.
“For example, about 19 percent of participants were able to maintain a better cardiovascular health score over the four years. We found that those people had a 79 percent lower chance of developing heart disease in the future than people who maintained a low cardiovascular health score.”
The researchers found similar results when they analyzed risk for stroke and myocardial infarction—commonly referred to as a heart attack.
“We also examined whether improving cardiovascular health score over time affected future risk of CVD,” Gao says. “We found that improvement of overall cardiovascular health over time related to lower future CVD in this population, even for those with poor cardiovascular health status at the beginning of the study.”
The researchers were also curious about whether one health measure was more important than the others. They ran repeated tests, removing a different, single health measure each time. They found that the scores still predicted future CVD risk in similar ways.
“This suggests that overall cardiovascular health is still the most important thing and that one factor isn’t more important than the others,” Gao says. “It also helps confirm that these seven metrics are valid and a very useful tool for developing a strategy for cardiovascular disease prevention.”
Additional coauthors are from Penn State, Tufts University, Harvard T.H. Chan School of Public Health, Kailuan General Hospital, and Han Dan Central Hospital. The Penn State CyberScience Seed Grant Program helped support the work.
Source: Penn State