Dataset Information

Twenty-Year Trends in the American Heart Association Cardiovascular Health Score and Impact on Subclinical and Clinical Cardiovascular Disease: The Framingham Offspring Study.

ABSTRACT: BACKGROUND:Data on the temporal trends in ideal cardiovascular health (CVH) as well as on their association with subclinical/overt cardiovascular disease (CVD) and death are limited. METHODS AND RESULTS:This study included 3460 participants attending ?1 of 4 consecutive exams of the Framingham Heart Study (1991-2008, mean age 55.4 years, CVH score ranged 0-14). We created 4 groups describing changes in CVH score between examination cycles 5 and 8, using first and last exams attended (high-high: starting CVH score ?8, last score of ?8, referent; high-low: ?8 start and ?7 last; low-high: ?7 start and ?8 last; and low-low: ?7 start and ?7 last) and related them to subclinical CVD cross-sectionally, and incident CVD and death. Fewer people have ideal CVH scores over the past 20 years (8.5% for 1991-1995, 5.9% for 2005-2008, P=0.002), because of decreases in those with ideal status of body mass index, blood glucose, and serum cholesterol levels (P<0.05 for all). The odds of subclinical disease and risk of CVD and death were higher for all compared with the high-high group (428 CVD and 367 death events, median follow-up 5.1 years, hazard ratios for CVD: 1.39, 1.73, 1.9 and death: 1.12, 1.57, 1.4 and odds ratios for subclinical disease: 1.61, 1.98, 2.86 for high-low, low-high, and low-low, respectively). CONCLUSIONS:The decreased presence of ideal CVH scores over the past 20 years resulted in increasing odds of subclinical disease and risk of CVD and death, emphasizing the importance of maintaining ideal CVH over the life course.

SUBMITTER: Enserro DM

PROVIDER: S-EPMC6015351 | biostudies-literature | 2018 May

REPOSITORIES: biostudies-literature

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Twenty-Year Trends in the American Heart Association Cardiovascular Health Score and Impact on Subclinical and Clinical Cardiovascular Disease: The Framingham Offspring Study.

Enserro Danielle M DM Vasan Ramachandran S RS Xanthakis Vanessa V

Journal of the American Heart Association 20180517 11

<h4>Background</h4>Data on the temporal trends in ideal cardiovascular health (CVH) as well as on their association with subclinical/overt cardiovascular disease (CVD) and death are limited.<h4>Methods and results</h4>This study included 3460 participants attending ≥1 of 4 consecutive exams of the Framingham Heart Study (1991-2008, mean age 55.4 years, CVH score ranged 0-14). We created 4 groups describing changes in CVH score between examination cycles 5 and 8, using first and last exams attend ...[more]

PMID: 29773573

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Project description:Several biomarkers have been individually associated with vascular brain injury, but no prior study has explored the simultaneous association of a biologically plausible panel of biomarkers with the incidence of stroke/transient ischemic attack and the prevalence of subclinical brain injury.In 3127 stroke-free Framingham offspring (age, 59±10 years; 54% female), we related a panel of 8 biomarkers assessing inflammation (C-reactive protein), hemostasis (D-dimer and plasminogen activator inhibitor-1), neurohormonal activity (aldosterone-to-renin ratio, B-type natriuretic peptide, and N-terminal proatrial natriuretic peptides), and endothelial function (homocysteine and urinary albumin/creatinine ratio) measured at the sixth examination (1995-1998) to risk of incident stroke/transient ischemic attack. In a subset of 1901 participants with available brain magnetic resonance imaging (1999-2005), we further related these biomarkers to total cerebral brain volume, covert brain infarcts, and large white-matter hyperintensity volume. During a median follow-up of 9.2 years, 130 participants experienced incident stroke/transient ischemic attack. In multivariable analyses adjusted for stroke risk factors, the biomarker panel was associated with incident stroke/transient ischemic attack and with total cerebral brain volume (P<0.05 for both) but not with covert brain infarcts or white-matter hyperintensity volume (P>0.05). In backward elimination analyses, higher log-B-type natriuretic peptide (hazard ratio, 1.39 per 1-SD increment; P=0.002) and log-urinary albumin/creatinine ratio (hazard ratio, 1.31 per 1-SD increment; P=0.004) were associated with increased risk of stroke/transient ischemic attack and improved risk prediction compared with the Framingham Stroke Risk Profile alone; when the <5%, 5% to 15%, or >15% 10-year risk category was used, the net reclassification index was 0.109 (P=0.037). Higher C-reactive protein (?=-0.21 per 1-SD increment; P=0.008), D-dimer (?=-0.18 per 1-SD increment; P=0.041), total homocysteine (?=-0.21 per 1-SD increment; P=0.005), and urinary albumin/creatinine ratio (?=-0.15 per 1-SD increment; P=0.042) were associated with lower total cerebral brain volume.In a middle-aged community sample, we identified multiple biomarkers that were associated with clinical and subclinical vascular brain injury and could improve risk stratification.

Dataset Information

Twenty-Year Trends in the American Heart Association Cardiovascular Health Score and Impact on Subclinical and Clinical Cardiovascular Disease: The Framingham Offspring Study.

Publications

Twenty-Year Trends in the American Heart Association Cardiovascular Health Score and Impact on Subclinical and Clinical Cardiovascular Disease: The Framingham Offspring Study.

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