Age, Sex, Race/Ethnicity, and Income Patterns in Ideal Cardiovascular Health Among Adolescents and Adults in the U.S.

Introduction: We assessed the hypothesis that a novel healthy blood pressure phenotype is familial and sought to identify factors associated with this phenotype in the Long Life Family Study (LLFS). Methods: The LLFS is a unique multi-center, international study that recruited families demonstrating clustering for longevity. Families were recruited from four centers; three in the U.S.: Boston, New York, and Pittsburgh and one in Denmark. The pedigrees included two generations: 1) probands and their siblings and 2) offspring of participants in the proband generation. Offspring (n=2211, ages 32-88, mean age=60.5; 43% male) were classified as having healthy blood pressure if their age- and sex-adjusted systolic blood pressure z-score was between -1.5 and -0.5 (i.e., a systolic blood pressure lower than expected for their age and sex, but not “too low”). Offspring on anti-hypertensive medications were classified as not having healthy blood pressure. Families (n=419) were defined as having healthy blood pressure if ≥2 and ≥50% of their offspring met the healthy blood pressure phenotype. Results: There were 476 (22%) offspring who met the healthy blood pressure phenotype. These offspring tended to have a better health profile than remaining offspring. When examining families, only 44 (11%) families met the criteria for healthy blood pressure. Both offspring and probands from families with healthy blood pressure performed better on neuropsychological tests that place demands on complex attention and executive function than offspring and probands from remaining families. Among families with healthy blood pressure, a higher proportion of offspring met the American Heart Association ideal cardiovascular health definition compared to remaining families (11% versus 4%, respectively, p<0.0001; not including the diet component). There was also a larger proportion of probands (n=1164, ages 71-110, mean age=90.5; 45% male) who met the American Heart Association ideal cardiovascular health definition when compared to the U.S. prevalence for ≥6 components among those ages ≥60 (1% versus 0.1%, respectively). Conclusion: In this cohort of familial longevity, few families had a novel healthy blood pressure phenotype in multiple members. Families and individuals with healthy blood pressure performed better on neuropsychological tests that represent aspects of executive function and had a higher proportion with ideal cardiovascular health than the U.S. population. In summary, a novel healthy blood pressure phenotype was rarely familial in this cohort; however, when it was, it was associated with cognitive and cardiovascular health benefits. Blood pressure may be a key pathway for family longevity.

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Abstract P113: The Probability of Maintaining Ideal Levels of Glucose in US Populations: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) and the National Health and Nutrition Examination Survey (NHANES)

Circulation ◽

10.1161/circ.129.suppl_1.p113 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Christy L Avery ◽

Donglin Zeng ◽

Sujatro Chakladar ◽

Katelyn M Holliday ◽

Dan Yu Lin ◽

...

Keyword(s):

Ethnic Groups ◽

Cardiovascular Health ◽

Markov Models ◽

Fasting Glucose ◽

Heart Association ◽

Health Study ◽

Cross Sectional ◽

Ideal Cardiovascular Health ◽

Glucose Levels ◽

Race Ethnicity

Ideal cardiovascular health is a novel concept adopted by the American Heart Association (AHA) that is operationalized through measurement and classification (ideal; intermediate; poor) of seven health metrics, including fasting glucose. Declines in the prevalence of ideal fasting glucose levels have been consistently associated with higher rates of cardiovascular disease, yet few studies have examined the ages at which such declines begin. We used cross-sectional data from NHANES (2007-2010, n=5,961) and the HCHS/SOL (n=14,357) to estimate the age-specific prevalence of ideal (<100 mg/dl without medication), intermediate (100-125 mg/dl or treated to <100 mg/dl) and poor (≥126 mg/dl) fasting glucose levels defined per AHA criteria among European American (EA), African American (AA), and Hispanic/Latino (H/L) participants ≥16 years of age. Race/ethnicity-stratified age-specific net probabilities of transitioning between ideal, intermediate and poor glucose levels were then calculated from cross-sectional estimates using state-of-the-art Markov models that accommodated complex sampling under the assumption that transitions remained stable across time. In all race/ethnic groups, approximately 80% of participants ≤20 years of age had ideal glucose levels. However, the estimated probability of maintaining ideal glucose levels after age 20 varied by race/ethnicity. For example, by the age of 40, the estimated probability of maintaining ideal levels of glucose over the next five years was approximately 90% for EAs and AAs and slightly higher for H/Ls (five-year probability: 92.1%, 95% CI: 91.1%, 93.1%). Among individuals with intermediate glucose levels at age 40, the estimated five-year probability of transitioning to poor levels of glucose was twice as high for AAs (five-year probability: 8.1%, 95% CI: 4.3%, 11.9%) and H/Ls (five-year probability: 9.8%, 95% CI: 8.0%, 11.6%) compared to EAs (five-year probability = 3.9%, 95% CI: 2.7%, 5.3%). Unfortunately, among participants with poor glucose levels, the estimated probability of transitioning to ideal glucose levels remained 0% for all race/ethnic groups and across all ages. Our results suggest that efforts to maintain ideal glucose levels should target young adults and extend through 40 years of age, given the sizeable prevalence of intermediate and poor levels of glucose observed by age 20, the estimated acceleration in the transition to intermediate and poor glucose levels that occurs between the second and fourth decade of life, and the negligible estimated probability of successfully re-attaining ideal glucose levels among those with intermediate or poor glucose levels. Enhanced efforts to identify and treat populations with poor glucose levels also are needed, since these populations would include persons with undiagnosed and therefore untreated type 2 diabetes.

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Abstract P315: Is Self-rated Health Associated With Ideal Cardiovascular Health? The Multi-Ethnic Study of Atherosclerosis

Circulation ◽

10.1161/circ.137.suppl_1.p315 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Olatokunbo I Osibogun ◽

Oluseye Ogunmoroti ◽

Erica S Spatz ◽

Gregory L Burke ◽

Erin D Michos

Keyword(s):

Cardiovascular Health ◽

Reference Group ◽

Multinomial Logistic Regression ◽

Heart Association ◽

Cross Sectional ◽

Ethnic Study ◽

Ideal Cardiovascular Health ◽

Health Insurance Status ◽

Self Rated Health ◽

Race Ethnicity

Introduction: Self-rated health (SRH) is a commonly used indicator of health status. It has been identified as a determinant of health-promoting behaviors and a predictor of morbidity and mortality. However, little is known about the association between SRH and ideal cardiovascular health (CVH) as measured by the American Heart Association Life’s Simple 7 (LS7) criteria. We examined whether SRH was associated with ideal CVH, for the overall cohort and by sex and race/ethnicity. Methods: We conducted a cross-sectional analysis of 6457 men and women of 4 race/ethnicities, aged 45 to 84 years, who participated in the Multi-Ethnic Study of Atherosclerosis. SRH was measured on a 5-point Likert scale (excellent, very good, good, fair and poor). CVH was determined using the LS7 score with each of the 7 metrics scored from 0-2, and a total score ranging from 0-14. Scores of 0-8 indicate an inadequate score, 9-10, average and 11-14, optimal. Odds ratios (OR) and 95% confidence intervals were calculated for the associations between SRH and LS7 score categories using multinomial logistic regression, adjusted for age, sex, race/ethnicity, education, income, marital status, health insurance status and chronic diseases Results: The mean age (SD) of participants was 62 (10) years; 53% were women. Approximately, 16% of participants rated their health as excellent, 33% very good, 41% good and 9% poor-fair. In this population, 47% had inadequate LS7 scores, 33%, average and 20% optimal. The odds of having a higher LS7 score increased as SRH improved. Using participants who rated their health as poor-fair as the reference group, the adjusted OR for having an optimal LS7 score in the overall cohort was: excellent 3.0 (2.1-4.3); very good 1.6 (1.1-2.1); good 1.2 (0.9-1.7). A similar trend was observed in the stratified analyses by sex and race/ethnicity ( Table ) Conclusion: A more favorable SRH was associated with better CVH irrespective of sex or race/ethnicity. Further research could explore whether optimization of SRH predicts cardiovascular outcomes.

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Abstract P236: Association Between Alcohol and Ideal Cardiovascular Health: The Multi-Ethnic Study of Atherosclerosis

Circulation ◽

10.1161/circ.137.suppl_1.p236 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Oluseye Ogunmoroti ◽

Olatokunbo Osibogun ◽

Robyn L McClelland ◽

Erin D Michos ◽

Gregory L Burke ◽

...

Keyword(s):

Alcohol Intake ◽

Cardiovascular Health ◽

Multinomial Logistic Regression ◽

Cvd Risk ◽

Cross Sectional ◽

Ideal Cardiovascular Health ◽

Logistic Regression Models ◽

Race Ethnicity ◽

Moderate Alcohol Intake ◽

Heavy Alcohol Intake

Introduction: Alcohol intake is associated with cardiovascular disease (CVD), with moderate drinkers having a decreased CVD risk compared to non- and heavy drinkers. However, this association is yet to be examined using the AHA Life’s Simple 7 (LS7) metrics as a proxy for cardiovascular health (CVH). We explored associations between alcohol intake and CVH in a multi-ethnic population. Methods: Our cross-sectional analyses included 6,506 MESA participants, free of CVD, aged 45 to 84 years. The LS7 metrics (smoking, physical activity, body mass index, diet, blood pressure, total cholesterol and blood glucose) were each scored 0-2, with 2 indicating “ideal”, 1 “intermediate” and 0 “poor”. Total LS7 score ranged from 0-14. Alcohol data was obtained from personal history and food frequency questionnaires. Participants were classified as never, former or current drinkers. Current drinkers were categorized as <1 (light), 1-2 (moderate) and >2 (heavy) drinks/day. Multinomial logistic regression models assessed associations between alcohol intake and CVH, adjusted for age, sex, race/ethnicity, education, income and health insurance. Results: Mean (SD) age was 62 (10) years, 53% were women; 20% were never, 24% former and 56% current drinkers. Among current drinkers, 44% had <1, 9% 1-2 and 3% >2 drinks/day. Additionally, 47% had inadequate LS7 scores, 33% average and 20% optimal. Compared to never drinkers, those who drank <1 drink/day were more likely to have average and optimal scores, although most of the associations were not significant. Women with 1-2 drinks/day were more likely than men to have optimal scores. Overall and in men, those who drank >2 drinks/day were less likely to have average or optimal scores. Whites and Hispanics with >2 drinks/day were less likely to have optimal and average scores, respectively (Table). Conclusion: Light alcohol intake tended to show favorable CVH, whereas heavy alcohol intake was unfavorable. For moderate alcohol intake, the associations with CVH varied by sex and race/ethnicity.

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Abstract P008: Ideal Cardiovascular Health And Hepatocyte Growth Factor In The Multi-ethnic Study Of Atherosclerosis

Circulation ◽

10.1161/circ.143.suppl_1.p008 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Olatokunbo Osibogun ◽

Oluseye Ogunmoroti ◽

Richard A Ferraro ◽

Olumuyiwa A Esuruoso ◽

Chiadi E Ndumele ◽

...

Keyword(s):

Growth Factor ◽

Hepatocyte Growth Factor ◽

Vascular Injury ◽

Cardiovascular Health ◽

Linear Regression Models ◽

Cvd Risk ◽

Ideal Cardiovascular Health ◽

Ideal Metrics ◽

Race Ethnicity ◽

Hepatocyte Growth

Background: Hepatocyte growth factor (HGF) is a cytokine released in response to vascular injury and a novel biomarker of cardiovascular disease (CVD) risk. However, the relationship between ideal cardiovascular health (CVH) and HGF is unknown. We examined whether ideal CVH is associated with lower HGF levels in a multi-ethnic cohort of adults free from clinical CVD at baseline. Methods: We analyzed data from the MESA study of 6,490 men and women aged 45-84 years. The independent variable was the CVH score derived from 7 metrics (smoking, body mass index, physical activity, diet, total cholesterol, blood pressure and blood glucose). Each metric was scored 0 points (poor), 1 point (intermediate) and 2 points (ideal). The total CVH score ranged from 0-14. An inadequate score was 0-8, average, 9-10 and optimal, 11-14. The number of ideal metrics was also counted. The dependent variable was logarithmically transformed HGF. We examined the association between the CVH score and HGF using linear regression models adjusted for age, sex, race/ethnicity, education, income, health insurance and study site. Results: The mean (SD) age of participants was 62 (10) years. Fifty-three percent were women. Participants with optimal CVH scores had the lowest HGF concentration [Median (IQR): 807 (678-962) pg/mL] compared to those with average [870 (740-1,036)] and inadequate scores [969 (821-1,159)]. A one-unit increment in the CVH score was significantly associated with a 3% lower HGF concentration (Table). Average and optimal CVH scores were also significantly associated with 8% and 12% lower HGF concentrations, respectively, compared to inadequate scores. Additionally, a greater number of ideal metrics was associated with lower HGF concentrations. Interactions by age, sex and race/ethnicity were not significant. Conclusion: In this ethnically diverse cohort, optimal CVH was significantly associated with lower HGF levels. Interventions aimed at promoting ideal CVH may reduce vascular injury as indicated by lower serum HGF levels.

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Educational Attainment and Prevalence of Cardiovascular Health (Life’s Simple 7) in Asian Americans

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18041480 ◽

2021 ◽

Vol 18 (4) ◽

pp. 1480

Author(s):

Md Towfiqul Alam ◽

Sandra E. Echeverria ◽

Melissa J. DuPont-Reyes ◽

Elizabeth Vasquez ◽

Rosenda Murillo ◽

...

Keyword(s):

High School ◽

Asian Americans ◽

Cardiovascular Health ◽

The United States ◽

High School Diploma ◽

Ideal Cardiovascular Health ◽

Logistic Regression Models ◽

Health And Nutrition ◽

Low Education ◽

The U.S

Asian Americans have a high burden of cardiovascular disease, yet little is known about the social patterning of cardiovascular health (CVH) in this population. We examined if education (<high school diploma, high school diploma, some college, and college degree+) was associated with CVH and if this varied by time in the United States (U.S.). Our study population included Asian Americans 20+ years of age sampled in the 2011-16 National Health and Nutrition Examination Survey (n = 1634). Ideal cardiovascular health was based on a composite score of adiposity, total cholesterol, blood pressure, blood glucose, smoking, physical activity, and diet. We fit sequential weighted multivariate logistic regression models for all analyses. The prevalence of ideal cardiovascular (CV) health was 17.1% among those living in the U.S. <10 years, 7.1% for those living in the U.S. >10+ years, and 15.9% for the U.S.-born. All models showed that low education compared to high education was associated with lower odds of having ideal CVH. This pattern remained in adjusted models but became non-significant when controlling for nativity (odds ratio = 0.34, 95% confidence interval: 0.10, 1.13). Models stratified by time in the U.S. were less consistent but showed similar education gradients in CVH. Low education is a risk factor for attaining ideal cardiovascular health among Asian Americans, regardless of time in the U.S.

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Abstract P210: The Social Distribution Of Ideal Cardiovascular Health: A Global Systematic Review

Circulation ◽

10.1161/circ.143.suppl_1.p210 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Farah Qureshi ◽

Kelb Bousquet-Santos ◽

Sakurako Shiba ◽

Scott Delaney ◽

Anne-Josee Guimond ◽

...

Keyword(s):

Social Status ◽

Social Determinants ◽

Cardiovascular Health ◽

Risk Of Bias ◽

Cross Sectional ◽

Ideal Cardiovascular Health ◽

The Social ◽

The Us ◽

Race Ethnicity ◽

Social Distribution

Introduction: Numerous studies have examined the social determinants of ideal cardiovascular health (ICVH) around the world, but no work has summarized evidence to date. This study aimed to systematically review findings on the social distribution of ICVH globally, and to compare trends in high-income countries (HICs) vs. low/middle-income countries (LMICs). Methods: In November 2019, we systematically searched PubMed, Embase, and LILACS for observational studies published after the American Heart Association (AHA) defined ICVH as a combination of health factors and behaviors in 2010. Search terms included ICVH/Life’s Simple 7 and a pre-defined set of social determinants of health (i.e., education, income/wealth, socioeconomic status (SES), employment, occupation, and race/ethnicity). Each abstract was reviewed by two independent researchers. Studies were included if associations between a composite measure of ICVH and a social determinant of health was quantified using statistical methods. We evaluated risk of bias using an adapted version of the Newcastle-Ottawa Quality Assessment Scale. Overall findings and comparisons between HICs and LMICs (defined by World Bank guidelines) were summarized narratively. Results: A total of 33 studies met inclusion criteria. Only 8 studies were from LMICs (n=4 from China), while 25 were from HICs (n=19 from the US). The most commonly assessed social determinants were education (n=18) and income/wealth (n=17). In both HICs and LMICs, few studies examined occupation or area-level measures, like rurality/urbanicity. Most studies were cross-sectional (n=27). Two thirds of studies and had a moderate (n=14, 43%) or high (n=8, 24%) risk of bias, but no systematic differences were noted by country setting. Nearly half of studies used composite ICVH measures that were of moderate or poor quality (i.e., based on only self-reported data and/or unvalidated instruments), and only 15% of studies (n=5) assessed each ICVH component using the exact criteria defined by the AHA. Despite substantial heterogeneity in how ICVH measures were derived and analyzed (e.g., as a binary, categorical, or count variable), fairly consistent associations were observed between higher levels of ICVH and higher social status (higher education, income/wealth, racial/ethnic majority status) across both HICs and LMICs. Studies of occupation (n=6, all from HICs) and area-level measures (n=4, 3 from LMICs) were less conclusive. Conclusion: Associations between higher social status and ICVH were noted in both HICs and LMICs, but most evidence was based on correlational data from cross-sectional studies in the US, primarily in relation to education and income. Important gaps in the literature include studies from LMICs, longitudinal designs to improve causal inference, and investigations of occupation, rurality/urbanicity, and race/ethnicity in non-US settings.

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Cardiovascular Health In Pediatric Heart Transplant Patients

10.21203/rs.3.rs-302556/v1 ◽

2021 ◽

Author(s):

Carmel Bogle ◽

Amanda M. Perak ◽

Sarah J. Wilkens ◽

Alaa Aljiffry ◽

Karen Rychlik ◽

...

Keyword(s):

Heart Transplant ◽

Cardiovascular Health ◽

Pediatric Population ◽

Small Sample ◽

Adverse Outcomes ◽

Ideal Cardiovascular Health ◽

Post Transplant ◽

Healthy Longevity ◽

Race Ethnicity ◽

Pediatric Heart Transplant

Abstract Background Ideal “cardiovascular health” (CVH)–optimal diet, exercise, nonsmoking, BMI, BP, lipids, and glucose—is associated with healthy longevity in adults. Pediatric heart transplant (HT) patients may be at risk for suboptimal CVH. Methods Single-center retrospective study of HT patients 2003–2014 who survived 1 year post-transplant. Five CVH metrics were collected at listing, 1, 3 and 5 years post-transplant (diet and exercise were unavailable). CVH was scored by summing individual metrics: ideal = 2, intermediate = 1, and poor = 0 points; total scores of 8–10 points were considered high (favorable). CVH was compared between HT patients and the US pediatric population (GP) utilizing NHANES 2007–2016. Logistic regression was performed to examine the association of CVH 1 year post-transplant with a composite adverse outcome (death, re-listing, coronary vasculopathy, or chronic kidney disease) 3 years post-transplant. Results We included 110 HT patients (median age at HT: 6 years [range 0.1–21]) and 19,081 NHANES participants. CVH scores among HT patients were generally high at listing (75%), 1 (74%), 3 (87%) and 5 (76%) years post-transplant and similar to GP, but some metrics (e.g., glucose) were worse among HT patients. Among HT patients, CVH was poorer with older age and non-Caucasian race/ethnicity. Per 1-point higher CVH score, the demographic-adjusted OR for adverse outcomes was 0.95 (95% CI, 0.7–1.4). Conclusions HT patients had generally favorable CVH, but some metrics were unfavorable and CVH varied by age and race/ethnicity. No significant association was detected between CVH and adverse outcomes in this small sample, but study in a larger sample is warranted.

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Abstract 194: Age, Gender, Race/ethnicity, and Income-related Patterns in Ideal Cardiovascular Health

Circulation ◽

10.1161/circ.142.suppl_3.194 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Emily M Bucholz ◽

Neel M Butala ◽

Norrina B Allen ◽

Andrew E Moran ◽

Sarah D De Ferranti

Keyword(s):

Physical Activity ◽

Early Adolescence ◽

Diet Quality ◽

Low Income ◽

Cardiovascular Health ◽

Smoking Status ◽

Ideal Cardiovascular Health ◽

Income Disparities ◽

Race Ethnicity ◽

The Relationship

Introduction: Ideal cardiovascular health (CVH) in adulthood is rare; however, the relationship between CVH and age has not been fully delineated. The aim of this study was to characterize the association of age with ideal CVH and individual CVH metrics across the lifespan and to compare these associations across gender, race, and income subgroups. Methods: We studied participants aged 12-80 years from NHANES 2005-2016 (n=42,367). Ideal CVH was defined using the AHA’s Simple 7 criteria (range 0-14) based on smoking status, body mass index, physical activity, diet quality, total cholesterol, plasma glucose, and blood pressure. Cubic models were used to model the association of mean CVH with age. The percentage of participants with ideal (≥5) and poor (≤2) CVH were plotted by age. Results: Mean CVH declined with increasing age starting in early adolescence and reaching a nadir by age 60 before stabilizing ( Figure 1 ). At age 20, only 45% of adults had ideal CVH; >50% of adults had poor CVH by age 53. Women had higher mean CVH than men at younger ages but lower mean CVH at age ≥60 ( Figure 2 ). Mean CVH scores were highest for non-Hispanic whites and higher income adults, and lowest for non-Hispanic blacks and low-income adults across all ages. Mean CVH decreased to poor levels ~30 years earlier for non-Hispanic blacks compared with non-Hispanic whites, and ~35 years earlier younger for low-income compared with higher-income adults. Conclusions: The proportion of the population with ideal CVH decreases within increasing age beginning in early adolescence and persists through adulthood. Race/ethnicity and income disparities in CVH are evident early in life and became more profound at older ages.

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