Feasibility of Ideal Cardiovascular Health Evaluation in a Pediatric Clinic Setting

The feasibility of “point-of-care” screening for ideal cardiovascular health was explored in a pediatric specialty clinic setting. Children and adolescents aged 9–18 years (n=91) with treated and stabilized diseases were recruited at a pediatric endocrinology clinic. A table-top device was used to assay fingerstick samples for non-HDL cholesterol (non-HDL-C), which was used to divide participants into two groups based on the non-HDL-C threshold for comparison of the remaining metrics between groups. A significant number of children had low scores, and score frequency distribution was similar to larger retrospective studies, with few participants achieving none or all of the health metrics. Healthy diet was the metric least often achieved. Those with a non-HDL-C above the ideal threshold of 3.1 mmol/L (120 mg/dl) had a higher BMI percentile (p<0.01) and diastolic blood pressure percentile (p<0.05). We conclude that pediatric risk factor screening and scoring can be performed in a specialty clinic with meaningful cardiovascular health scores for patients and providers. Association of abnormal “point-of care” non-HDL-C levels with elevated BMI and blood pressure supports evidence for risk factor clustering and use of the ideal health construct in pediatric clinic settings.

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Abstract 12944: Geographical Variations in Cardiovascular Health in China: A Nationwide Population-based Survey of 74,771 Adults

Circulation ◽

10.1161/circ.142.suppl_3.12944 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Mei Zhang ◽

Yu Shi ◽

Oumin Shi ◽

Zhenping Zhao ◽

Xiao Zhang ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Health Behavior ◽

Health Behaviors ◽

Cardiovascular Health ◽

Significant Heterogeneity ◽

Chinese Adults ◽

Ideal Cardiovascular Health ◽

Geographical Variations ◽

Health Factors

Background: Cardiovascular disease is the leading cause of death in China. Objectives: We aimed to evaluate the levels of cardiovascular health among Chinese adults and to understand the geographic patterns based on a nationally and provincially representative survey. Methods: In 2015, a total of 74,771 respondents aged ≥ 20 years with no history of cardiovascular disease were randomly sampled from 298 counties/districts of 31 provinces in mainland China and were interviewed. Seven metrics, including smoking, body mass index, physical activity, diet, total cholesterol, blood pressure, and fasting glucose, were determined. Ideal cardiovascular health was defined as the simultaneous presence of all metrics at the ideal level. A score ranging from 0 to 14 was calculated as the sum of all seven metrics for each province. Scores for four health behaviors and four health factors were also calculated. Results: The age-adjusted prevalence of ideal cardiovascular health was only 1.13% among Chinese adults above 20 years old in 2015 (0.50% among men and 1.77% among women; 1.63% among urban residents and 0.68% among rural residents). The age-adjusted prevalence varied greatly across provinces, ranging from 0.05% in Qinghai to 2.97% in Heilongjiang. Ideal diet (7.4%) was the least common among seven cardiovascular health metrics and ideal blood pressure (32.2%) was the second least one. We also saw significant heterogeneity among provinces in age-adjusted cardiovascular health score, health behavior score, and health factors score. In all provinces, women had higher scores than men for cardiovascular health, health behaviors and health factors. Differences in cardiovascular health and health behavior scores between urban and rural areas were associated with levels of socio-economic development. Conclusions: Strategies for addressing poor cardiovascular health require geographic targeting and localized consideration.

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Stroke Disparities: From Observations to Actions

Stroke ◽

10.1161/strokeaha.120.030428 ◽

2020 ◽

Vol 51 (11) ◽

pp. 3392-3405 ◽

Cited By ~ 1

Author(s):

Ralph L. Sacco

Keyword(s):

Risk Factor ◽

Ethnic Groups ◽

Cardiovascular Health ◽

Disease Incidence ◽

Human Populations ◽

Stroke Incidence ◽

Ideal Cardiovascular Health ◽

Awareness Campaigns ◽

Study Results ◽

Improvement Programs

Numerous epidemiological studies have demonstrated stroke disparities across race and ethnic groups. The goal of the NOMAS (Northern Manhattan Study) was to evaluate race and ethnic differences in stroke within a community with 3 different race-ethnic groups. Starting as a population-based incidence and case-control study, the study evolved into a cohort study. Results from NOMAS have demonstrated differences in stroke incidence, subtypes, risk factors, and outcomes. Disparities in ideal cardiovascular health can help explain many differences in stroke incidence and call for tailored risk factor modification through innovative portals to shift more diverse subjects to ideal cardiovascular health. The results of NOMAS and multiple other studies have provided foundational data to support interventions. Conceptual models to address health disparities have called for moving from detecting disparities in disease incidence, to determining the underlying causes of disparities and developing interventions, and then to testing interventions in human populations. Further actions to address race and ethnic stroke disparities are needed including innovative risk factor interventions, stroke awareness campaigns, quality improvement programs, workforce diversification, and accelerating policy changes.

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Abstract T P345: Cardiovascular Health Metrics and All-cause and Cardiovascular Disease Mortality among Middle Aged Men in Korea: The Seoul Male Cohort Study

Stroke ◽

10.1161/str.45.suppl_1.tp345 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Ji Young Kim ◽

Chul Woo Rhee ◽

Young-Jin Ko ◽

Byung-Joo Park ◽

Dong-Hyun Kim ◽

...

Keyword(s):

Blood Pressure ◽

Blood Glucose ◽

Health Behaviors ◽

Cardiovascular Health ◽

Fasting Blood Glucose ◽

Asian Population ◽

Heart Association ◽

Middle Aged ◽

Ideal Cardiovascular Health ◽

Cvd Mortality

Background: In Korea, Cerebrovascular and cardiovascular diseases (CVD) were the second leading cause of deaths in 2011. In 2010, the American Heart Association (AHA) published cardiovascular health metrics (CVHM) aimed at reducing deaths from all CVDs and stroke, and improving the cardiovascular health of the population as a whole. Despite their implications, the AHA’s metrics have not been broadly studied or previously applied to an Asian population. Objectives: This study estimated the combined association of cardiovascular health behaviors on the risk of all-cause and CVD mortality in middle-aged men in Korea. Methods: In total, 14,533 men aged 40-59 years were enrolled in 1993 and followed-up through 2011. CVHM defined the following lifestyles proposed by the AHA: smoking, physical activity, BMI, healthy diet score, total cholesterol, blood pressure, and fasting blood glucose. The CVHMs score was calculated as a single categorical variable, by assigning 1 point to each ideal healthy behavior vs. 0 points otherwise. All subjects were classified as meeting 0-7 CVHM. The principal outcome variables were all-cause and CVD mortality. The Cox proportional hazard regression model was used to estimate the hazard ratio (HR) of cardiovascular health behavior, and CVHMs score. PARs were calculated from significant CVHMs. Results: During 266,482.8 person-years of follow-up, there were 1,314 deaths in total. Current smoking, blood pressure, and fasting blood glucose were significantly associated with all-cause and CVD mortality. The adjusted PARs for the 3 significant metrics combined were 81% (95% CI, 50-94%) and 96% (66-99%) for all-cause and CVD mortality, respectively. More ideal CVHM was significantly associated with lower risks of all-cause and CVD mortality ( p-trend<.0001 ). The adjusted HRs of the groups with 6-7 vs. 0-2 ideal CVHM were 0.49 (0.35-0.70) and 0.23 (0.10-0.57) for all-cause and CVD mortality, respectively. Conclusions: Among ideal cardiovascular health behaviors, non-smoking, normal blood pressure, and recommended fasting blood glucose levels associated with reduced risks of all-cause and total CVD mortality. There was a strong trend towards decreased all-cause and CVD mortality risk with increasing the number of ideal CVHMs.

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Abstract P015: A Novel Healthy Blood Pressure Phenotype is Associated With Better Cardiovascular Health Benefits and Neuropsychological Performance in the Long Life Family Study

Circulation ◽

10.1161/circ.135.suppl_1.p015 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

Megan M Marron ◽

Robert M Boudreau ◽

Kaare Christensen ◽

Stephanie Cosentino ◽

Mary Feitosa ◽

...

Keyword(s):

Blood Pressure ◽

Neuropsychological Tests ◽

American Heart Association ◽

Cardiovascular Health ◽

American Heart ◽

Family Study ◽

Heart Association ◽

Ideal Cardiovascular Health ◽

Blood Pressure Phenotype ◽

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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Arterial disease in the young

ESC CardioMed ◽

10.1093/med/9780198784906.003.0179 ◽

2018 ◽

pp. 775-778

Author(s):

Marietta Charakida ◽

John Deanfield

Keyword(s):

Risk Factors ◽

Congenital Heart Disease ◽

Risk Factor ◽

Congenital Heart ◽

Cardiovascular Health ◽

Adult Population ◽

Arterial Disease ◽

Ideal Cardiovascular Health ◽

Reduce Risk ◽

Reduce Risk Factor

The growing adult population with congenital heart disease (CHD) are getting older and their clinical presentation and outcomes are likely to be determined not only by their underlying CHD, but also by the development of acquired cardiovascular diseases such as atherosclerosis. This begins in childhood. The adult CHD population have multiple cardiovascular risk factors, as found in the general population, including obesity, smoking, and sedentary behaviour. Adults with complex congenital heart circulation are likely to be particularly vulnerable to the development of acquired arterial disease. Maintenance of ‘ideal cardiovascular health’ from childhood, is a key target, as leveraged gains can be achieved by early intervention to reduce risk factor exposure.

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Association of the ideal cardiovascular health with vascular function and central hemodynamic parameters

Journal of the American Society of Hypertension ◽

10.1016/j.jash.2016.03.020 ◽

2016 ◽

Vol 10 (4) ◽

pp. e8

Author(s):

Jose I. Recio-Rodriguez ◽

Manuel A. Gomez-Marcos ◽

Natalia Sanchez-Aguadero ◽

Cristina Agudo-Conde ◽

Rosario Alonso-Dominguez ◽

...

Keyword(s):

Vascular Function ◽

Cardiovascular Health ◽

Hemodynamic Parameters ◽

Ideal Cardiovascular Health ◽

Central Hemodynamic ◽

The Ideal

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Using Cluster Analysis to Explore Associations between Cardiovascular Risk and Lifestyle Factors in a Workplace Wellness Program

Building Healthy Academic Communities Journal ◽

10.18061/bhac.v5i1.7933 ◽

2021 ◽

Vol 5 (1) ◽

pp. 30-41

Author(s):

Heather Carter-Templeton ◽

Gary Templeton ◽

Barbara Ann Graves ◽

Leslie G. Cole

Keyword(s):

Risk Factors ◽

Cluster Analysis ◽

Risk Factor ◽

Cardiovascular Health ◽

The United States ◽

Workplace Wellness ◽

Wellness Program ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Ideal Cardiovascular Health

Background: Cardiovascular disease (CVD) is the number one cause of death in the United States with risk factors including hypertension, hyperlipidemia, diabetes, obesity, smoking, physical inactivity, age, genetics, and unhealthy diets. A university-based workplace wellness program (WWP) consisting of an annual biometric screening assessment with targeted, individualized health coaching was implemented in an effort to reduce these risk factors while encouraging and nurturing ideal cardiovascular health.Objective: The purpose of this study was to examine and describe the prevalence of single and combined, or multiple, CVD risk factors within a workplace wellness dataset.Methods: Cluster analysis was used to determine CVD risk factors within biometric screening data (BMI, waist circumference, LDL, total cholesterol, HDL, triglycerides, blood glucose age, ethnicity, and gender) collected during WWP interventions.Results: The cluster analysis provided visualizations of the distributions of participants having specific CVD risk factors. Of the 8,802 participants, 1,967 (22.4%) had no CVD risk factor, 1,497 (17%) had a single risk factor, and 5,529 (60.5%) had two or more risk factors. The majority of sample members are described as having more than one CVD risk factor with 78% having multiple.Conclusion: Cluster analysis demonstrated utility and efficacy in categorizing participant data based on their CVD risk factors. A baseline analysis of data was captured and provided understanding and awareness into employee health and CVD risk. This process and analysis facilitated WWP planning to target and focus on education to promote ideal cardiovascular health.

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Linking big data for cardiovascular health surveillance – opportunities and challenges using the CANHEART cohort

International Journal for Population Data Science ◽

10.23889/ijpds.v3i4.953 ◽

2018 ◽

Vol 3 (4) ◽

Author(s):

Anna Chu ◽

Deirdre Hennessy ◽

Sharon Johnston ◽

Jacob Udell ◽

Dennis Ko ◽

...

Keyword(s):

Blood Pressure ◽

Big Data ◽

Risk Factor ◽

Cardiovascular Risk ◽

Population Health ◽

Cardiovascular Risk Factor ◽

Cardiovascular Health ◽

Population Based ◽

Health Surveillance ◽

Risk Factor Prevalence

IntroductionOur increasing ability to link large population-based health administrative datasets to create ‘big data’ cohorts offers unique opportunities to conduct health and health services surveillance at lower costs than traditional methods using surveys or primary data collection. However, comparability of findings from big data with traditional methods is unknown. Objectives and ApproachIn the CArdiovascular HEalth in Ambulatory Care Research Team (CANHEART) ‘big data’ initiative, we linked 19 population-based health databases to obtain baseline and 5-year follow-up health information on a cohort of 9.8 million adult residents of Ontario, Canada as of January 2008. We compared cardiovascular risk factor prevalence with results from 3500 participants in the 2007-09 Canadian Health Measures Survey (CHMS), a traditional population health surveillance survey. Additionally, we determined cardiovascular preventative care use and clinical event rates by sex and age. Planned linkages to new data sources will enable continued cohort surveillance of population health-related and care indicators. ResultsCholesterol and glucose levels determined from the CANHEART cohort were comparable to the CHMS, whereas blood pressure values and obesity rates were substantially higher. Overall, receipt of cardiovascular preventive care in the CANHEART cohort was high, with 85.7% of males and 91.8% of females having blood pressure assessments, and 67.8% of males and 79.4% of females having weight assessments. Cholesterol and diabetes screening rates among those recommended for screening were over 75%. Incidence of myocardial infarction, stroke or cardiovascular death was 51% higher among males than females (3.8 and 2.5 events per 1000 person-years, respectively). Challenges encountered in analyzing data included treatment of repeated and time-varying measures, selection of valid diagnostic and physician billing codes, changing coding practices and handling of missing and outlying data. Conclusion/ImplicationsComparability of cardiovascular risk factor prevalence using linked administrative data with survey methods varies by indicator. Selection biases amongst survey participants and different measurement methods could explain discrepancies. The added ability to examine health care indicators longitudinally and by subgroup supports use of linked population-based data to enhance health surveillance.

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