The Framingham 10-year (FRS-10) and lifetime (FRS-LIFE) risk scores use clinical CVD risk factors to predict coronary heart disease (CHD) and CVD outcomes, respectively. In contrast, the AHA’s Ideal Cardiovascular Health (IDEAL) paradigm encourages a 7-component, healthy phenotype that additionally includes healthy diet, body mass index (BMI), and physical activity behaviors that are also associated with the avoidance of developing cardiovascular disease (CVD).
Objective:
To compare changes in IDEAL, FRS-10, and FRS-LIFE over 6 months in young adults enrolled in a behavioral weight loss intervention
Methods:
FRS-10 and FRS-LIFE were calculated using published equations at baseline and 6 months in young adults who were overweight or obese at study entry but otherwise healthy. IDEAL was calculated on a 14-point scale where, for each component, 0, 1, or 2 points were given for ‘poor’, ‘moderate’, or ‘ideal’ classification, respectively. Descriptive statistics are reported as % or median [IQR]. McNemar’s test, test of symmetry, and Wilcoxon signed rank test were employed to evaluate pre- to post-intervention changes. Spearman’s correlations evaluate associations.
Results:
In 335 young adults, age 31 [27, 34] yrs, BMI 31 [28, 34] kg/m
2
, and 32% male, the intervention achieved significant 6-month decreases in BMI: -3.0 [-4.3, -1.5] kg/m
2
. Out of a possible 14 points (higher is better), IDEAL was 9 [8, 10] at baseline and 11 [10, 12] at 6 months, with 73% improving and 9% worsening (net improvement 64%) (p<.0001). Though<1% ever had IDEAL diet, a net improvement in diet was observed in 19%, with specific improvements in sugar-sweetened beverage and sodium components (p<0.001). Significant net improvements were also observed in IDEAL classification for BMI (49%), physical activity (39%), total cholesterol (14%), blood pressure (14%) and glucose (11%) components (all p<.0001). FRS-10 was negligible (<1%) for 88% of the cohort at baseline and 94% at 6 months. Across predicted FRS-10 scores, 7% improved and 2% worsened (net improvement 5%) over the 6 months (p<.0001). Improved FRS-10 and IDEAL were correlated (Spearman’s rho = -0.49, p<0.001). IDEAL had a stronger correlation with change in weight compared to FRS-10 (Spearman’s rho = -0.49 vs. 0.30; both p<0.001). FRS-LIFE indicated lifetime risk was high for 35% of the cohort at baseline and 22% at 6 months (p<.0001). FRS-LIFE as a 5-category scale improved in 38% and worsened in 13% (net improvement 26%) (p<.0001).
Conclusions:
In a cohort of overweight or obese, but otherwise healthy, young adults enrolled in a weight loss intervention, IDEAL was able to measure positive lifestyle changes in a majority of participants while the FRS-10 and FRS-LIFE did not. These results suggest that IDEAL may be particularly sensitive and appropriate to detect positive cardiovascular health changes in the growing population of overweight and obese young adults.
Efficacy of a Multi-Component m-Health Diet, Physical Activity, and Sleep Intervention on Dietary Intake in Adults with Overweight and Obesity: A Randomised Controlled Trial
