Further understanding of ideal cardiovascular health score metrics and cardiovascular disease

ABSTRACT

Introduction

The American Heart Association (AHA) introduced the construct of ‘cardiovascular health (CVH)’, to focus on primordial prevention to reduce the burden of cardiovascular disease (CVD). The CVH score includes seven health and behavioral metrics (smoking, physical activity, body mass index, diet, total cholesterol, blood pressure, blood glucose), which are characterized as being ideal, intermediate, or poor.

Areas covered

In this review, we describe the utility of the CVH score for monitoring and promoting wellness, overall and by key sociodemographic groups, and for tracking of temporal trends.

Expert opinion

Notably, the seven factors are all modifiable, which differs from 10-year CVD risk scores that include non-modifiable components such as age, sex, and race. Numerous epidemiological studies have shown that achievement of a greater number of ideal CVH metrics is associated with lower incidences of CVD, cardiovascular mortality, and all-cause mortality. Longer duration of favorable CVH is associated with greater longevity and compressed morbidity. Nevertheless, the prevalence of favorable CVH is low, with <20% of U.S. adults meeting ≥5 metrics at ideal levels and significant racial/ethnic disparities persist. Many challenges must be overcome to improve CVH at individual and societal levels if the AHA Impact Goals are to be fully realized.

KEYWORDS:

• Cardiovascular health
• prevention
• atherosclerotic cardiovascular disease
• heart failure

Article highlights

• The cardiovascular health (CVH) is characterized by seven health behaviors and health factors that are all modifiable.

• A greater number of ideal CVH metrics and higher composite scores are associated with lower incidences of cardiovascular disease (CVD), cardiovascular mortality, non-cardiovascular diseases, and all-cause mortality

• Even modest gains in CVH across the population can have large impact in reducing CVD events.

• Maternal CVH influences offspring CVH; it is important to support CVH of women before, during, and after pregnancy

• Longer duration spent in optimal CVH is association with longevity and compressed morbidity

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

E Michos is supported by the Amato Fund in Women’s Cardiovascular Health at Johns Hopkins School of Medicine. S Khan is supported by grants from the American Heart Association (#19TPA34890060) and National Institutes of Health (P30DK092939; P30AG059988).