American heart association’s cardiovascular health metrics and risk of cardiovascular disease mortality among a middle-aged male Scandinavian population

Figures & data

Table 1. Distribution of cardiovascular health metrics among participants and based on cardiovascular mortality.

Cardiovascular health metrics	All participants^a (n = 2607)	Cardiovascular disease death^a (n = 609)	Alive individuals at the end of follow-up period^a (n = 1998)
Physical activity
Ideal (150 min/week of moderate-intensity or 75mins/week of vigorous intensity or both)	2032 (77.9)	457 (75)	1575 (78.8)
Intermediate (1–149 min/week of moderate intensity physical activity or 1–74 min/week of vigorous intensity or both)	21 (0.8)	5 (0.8)	16 (0.8)
Poor (no physical activity)	554 (21.3)	147 (24.1)	407 (20.4)
Body mass index
Ideal (<25 kg/m^2)	817 (31.3)	149 (24.5)	668 (33.4)
Intermediate (25–29 kg/m^2)	1338 (51.4)	309 (50.7)	1029 (51.5)
Poor (≥30 kg/m^2)	452 (17.3)	151 (24.8)	301 (15.1)
Healthy diet score^b
Ideal (4–5)	50 (1.9)	10 (1.7)	40 (2.0)
Intermediate (2–3)	1242 (48.1)	300 (50.0)	942 (47.5)
Poor (0–1)	1290 (50.0)	290 (48.3)	1000 (50.5)
Blood pressure (mmHg)
Ideal (SBP < 120 and DBP < 80)	314 (12.0)	44 (7.2)	270 (13.5)
Intermediate (SBP, 120 – 139 or DBP, 80 – 89)	990 (38.0)	194 (31.9)	796 (39.8)
Poor (SBP ≥ 140 or DBP ≥ 90)	1303 (50.0)	371 (60.9)	932 (46.6)
Fasting blood glucose (mmol/l)^c
Ideal (<5.55)	1018 (39.0)	207 (34.0)	811 (40.6)
Intermediate (5.55–6.99)	1205 (46.2)	273 (44.8)	932 (46.6)
Poor (≥7.00)	384 (14.7)	129 (21.2)	255 (12.8)
Total cholesterol (mmol/l)^d
Ideal (<5.18)	669 (25.7)	123 (20.2)	546 (27.3)
Intermediate (5.18–6.21)	1034 (39.7)	226 (37.1)	808 (40.4)
Poor (≥6.22)	904 (34.7)	260 (42.7)	644 (32.2)
Smoking status
Ideal (never smoked)	839 (32.2)	145 (23.8)	694 (34.7)
Intermediate (previous smokers)	937 (35.9)	218 (35.8)	719 (36.0)
Poor (current smokers)	831 (31.9)	246 (40.4)	585 (29.3)
Number of Ideal Cardiovascular Health Metrics
7	1 (0.1)	0	1 (0.1)
6	22 (0.8)	1 (0.2)	21 (1.1)
5	94 (3.6)	5 (0.8)	89 (4.5)
4	336 (12.9)	59 (9.7)	277 (13.9)
3	532 (20.4)	98 (16.1)	434 (21.7)
2	725 (27.8)	183 (30.0)	542 (27.1)
1	740 (28.4)	208 (34.2)	532 (26.6)
0	157 (6.0)	55 (9.0)	102 (5.1)

DBP: diastolic blood pressure; mmHg: millimetres of mercury; mmol/l: millimole per litre; SBP: systolic blood pressure.

a Values presented as number (%).

b 1% missing.

c mmol/l × 18 = mg/dl.

d mmol/l × 38.6 = mg/dl.

Table 2. Baseline characteristics and outcomes of the participants.

Characteristics (mean [SD] or median [IQR])	All participants (n = 2607)	Cardiovascular disease death (n = 609)	Alive individuals at the end of follow-up period (n = 1998)
Age (years)	53.1 (5.1)	54.7 (4.2)	52.6 (5.3)
High density cholesterol (mmol/l)^a	1.3 (0.3)	1.3 (0.3)	1.3 (0.3)
Socioeconomic status (SES)	12.3 (5.1)	13.4 (5.0)	11.9 (5.1)
Alcohol/week (g)	31.5 (6.2–92.1)	34.1 (5.4–111.6)	30.5 (6.3–88.2)
History of coronary heart disease^b	658 (25.2)	246 (40.4)	412 (20.6)
History of type 2 diabetes mellitus^b	157 (6.0)	72 (11.8)	85 (4.3)
Antihypertensive medications^b	583 (22.4)	204 (33.5)	379 (19.0)
Cholesterol lowering medications^b	17 (0.7)	4 (0.7)	13 (0.7)
Cardiovascular health score^b
Inadequate	362 (13.9)	130 (21.3)	232 (11.6)
Average	1879 (72.1)	435 (71.4)	1444 (72.3)
Optimum	366 (14.0)	44 (7.2)	322 (16.1)

a mmol/l × 38.6 = mg/dl.

b Values are in numbers (%); g: gram; mmol/l: millimole per litre.

Socioeconomic status (SES) was defined, on a scale of 0–25, as a combined measure of income, education, occupation, occupational prestige, material standard of living and housing conditions with 0 being the highest SES, and 25 the lowest SES.

Figure 1. Dose–response curve of hazard ratio for cardiovascular disease mortality against cardiovascular health score. Restricted cubic spline functions were analysed with knots located at 5th, 35th 65th and 95th percentiles of cardiovascular health score distribution, with the referecne category set at 3; adjusted for age; alcohol consumption; socioeconomic status; high-density lipoprotein chlesterol; use of cholesterol lowering medications, use of antihypertensives, history of coronary heart disease and history of type 2 diabetes mellitus. The dashed lines represent the 95% confidence intervals. CVD, cardiovascular diseased; CVH, cardiovascular health.

Table 3. Associations between cardiovascular health score and risk of cardiovascular mortality.

Cardiovascular health metrics score		Model 1		Model 2
	Number of events/total	HR (95% CI)	p-value	HR (95% CI)	p-value
	609/2607
Inadequate	130/2607	1	<.001	1	<.001
Average	435/2607	0.57 (0.47–0.70)	<.001	0.64 (0.52–0.78)	<.001
Optimum	44/2607	0.30 (0.21–0.42)	<.001	0.35 (0.24–0.49)	<.001

HR: hazard ratio.

The hazard ratios compared “optimum” and “average” cardiovascular health with “inadequate” cardiovascular health.

Model 1, Adjusted for age; alcohol consumption; socioeconomic status.

Model 2, Model 1 plus high-density lipoprotein cholesterol; use of cholesterol lowering medications, use of antihypertensives, history of coronary heart disease, and history of type 2 diabetes mellitus.