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Original Investigation
March 11, 2020

Association of the Duration of Ideal Cardiovascular Health Through Adulthood With Cardiometabolic Outcomes and Mortality in the Framingham Offspring Study

Author Affiliations
  • 1Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
  • 2Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
  • 3Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
  • 4Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health Science Center at San Antonio, San Antonio
  • 5Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
  • 6Framingham Heart Study, Framingham, Massachusetts
JAMA Cardiol. 2020;5(5):549-556. doi:10.1001/jamacardio.2020.0109
Key Points

Question  Is the length of time lived in ideal cardiovascular health in midlife associated with cardiometabolic outcomes or with all-cause mortality later in life?

Findings  In this cohort study, using data from 1445 middle-aged participants from the Framingham Heart Study Offspring cohort, for each 5-year period that participants had intermediate or ideal cardiovascular health, they were 33% less likely to develop hypertension, 14% less likely to die, and approximately 25% less likely to develop diabetes, chronic kidney disease, or cardiovascular disease than individuals in poor cardiovascular health.

Meaning  Living longer in better cardiovascular health during midlife may be associated with lower risk of chronic disease or mortality later in life.

Abstract

Importance  The American Heart Association ideal cardiovascular health (CVH) score is associated with the risk of cardiovascular disease (CVD) and mortality. However, it is unclear whether the number of years spent in ideal CVH is associated with morbidity or with mortality.

Objective  To evaluate whether living longer with a higher CVH score in midlife is associated with lower risk of hypertension, diabetes, chronic kidney disease, CVD and its subtypes (coronary heart disease, stroke, congestive heart failure, and peripheral artery disease), or all-cause mortality in later life.

Design, Setting, and Participants  This prospective cohort study used data from 1445 participants from 1991 to 2015 who participated in the community-based Framingham Heart Study Offspring investigation conducted in Massachusetts. The CVH scores of participants were assessed at examination cycles 5, 6, and 7 (1991-1995; 1995-1998; and 1998-2001, respectively). Individuals were excluded from analyses of the association between duration of CVH score and outcomes if they had the outcome of interest at the seventh examination. The median follow-up was approximately 16 years. Data were analyzed from April 2018 to October 2019. The CVH score categories were poor for scores 0 to 7, intermediate for scores 8 to 11, and ideal for scores 12 to 14. A composite score was derived based on smoking status, diet, physical activity, resting blood pressure levels, body mass index, fasting blood glucose levels, and total serum cholesterol levels.

Main Outcomes and Measures  Number of events and number at risk for each main outcome, including incident hypertension, diabetes, chronic kidney disease, CVD, and all-cause mortality, after the seventh examination.

Results  Of 1445 eligible participants, the mean (SD) age was 60 (9) years, and 751 (52%) were women. Number of events/number at risk for each main outcome after the seventh examination were 348/795 for incident hypertension, 104/1304 for diabetes, 198/918 for chronic kidney disease, 210/1285 for CVD, and 300/1445 for all-cause mortality. At the seventh examination, participants mostly had poor (568 [39%]) or intermediate (782 [54%]) CVH scores. For each antecedent (before examination cycle 7) 5-year duration that participants had intermediate or ideal CVH, they were less likely to develop adverse outcomes (hazards ratios of 0.67 [95% CI, 0.56-0.80] for incident hypertension, 0.73 [95% CI, 0.57-0.93] for diabetes, 0.75 [95% CI, 0.63-0.89] for chronic kidney disease, 0.73 [95% CI, 0.63-0.85] for CVD, and 0.86 [95% CI, 0.76-0.97] for all-cause mortality) relative to living the same amount of time in poor CVH (referent group). No effect modification was observed by age or by sex.

Conclusions and Relevance  These results suggest that more time spent in better CVH in midlife may have salutary cardiometabolic benefits and may be associated with lower mortality later in life.

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