Abstract 09: The Health Freedom Path to Wellness Program: A Novel Educational and Behavioral Intervention to Promote Cardiovascular Health Equity

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Tanjala S Purnell ◽  
Ina Glenn-Smith ◽  
Sunjae Bae ◽  
Grecia Vargas ◽  
Anika L Hines ◽  
...  
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Blood Pressure ◽  
Behavioral Intervention ◽  
Cardiovascular Health ◽  
Health Workers ◽  
Opportunity To Learn ◽  
Wellness Program ◽  
Cvd Risk ◽  
Associated Risk Factors

Background: African Americans (AAs) and adults living in urban communities continue to experience disproportionately high rates of cardiovascular disease (CVD) and associated risk factors (e.g., hypertension, diabetes, obesity) despite decades of recognition of these disparities. Methods: The Health Freedom Path to Wellness Program is an innovative community-based educational and behavioral intervention to reduce disparities in CVD risk factors. The goal of this study was to test the effectiveness of the Circle of Friends (COF) educational and social support component of the Health Freedom intervention. The Health Freedom-COF incorporated six weekly one-hour long sessions led by lay health workers trained in CVD health education based on the AHA’s Simple 7 guidelines, blood pressure (BP) measurement, physical activity, and behavior change strategies, and culminated in a 5K celebration walk that gives participants an opportunity to learn about Maryland’s important role in the Underground Railroad. Results: Study participants included 353 adults in Maryland (93% AAs, mean age: 53 years; 85% female; and 35% with annual incomes <$50,000). At baseline, mean BP(SD) was 127.4 (17.6)/77.1 (10.8) mmHg; mean weight in pounds (SD) was 191.6 (45.2); 43.1% had diagnosed hypertension, and 15.0% had diabetes. Compared with their pre-intervention assessments, adults who completed the intervention experienced an average reduction of -5.2 mm Hg systolic blood pressure (95% CI: 4.1-6.3, p<0.001) and -3.3 mm Hg diastolic BP (95% CI: 2.5-4.1, p<0.001). At baseline, only 3.3% of participants reported a weekly consumption of 5+ fruit servings; 5.9% reported 5+ vegetable servings, and 12.8% reported 5+ days of physical activity. However, after completing the program, 22.4% of participants reported a weekly consumption of 5+ fruit servings; 28.6% reported 5+ vegetable servings, and 46.7% reported 5+ days of physical activity. Conclusions: The Health Freedom educational and behavioral intervention was associated with improvements in blood pressure, diet, and physical activity among socially at-risk adults.

scholarly journals Geographical profiles of cardiovascular risk and the risk factors in China: data from a nationwide population-based screening project

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C.Q Wu ◽  
X Li ◽  
J.P Lu ◽  
B.W Chen ◽  
Y.C Li ◽  
...  
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Blood Pressure ◽  
Population Based ◽  
Staple Food ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Food Factor ◽  
Rural And Urban ◽  
Activity Factor

Abstract Background In China, an abundance of cardiovascular risk factors has contributed to the increasing prevalence of cardiovascular diseases (CVD), which caused almost 4 million deaths per year. However, comprehensive evidence on the geographical profiles of cardiovascular disease risk in China is lacking, as findings in prior studies have been limited to relatively small sample sizes, had incomplete regional coverage, or focused on a narrow risk factor spectrum. Purpose To compare the population CVD risk among different regions across China, and to describe the geographical distributions of CVD risk factors and their clusters throughout the nation. Methods In a nationwide population-based screening project covering 252 counties of China, standardized measurements were conducted to collect information on 12 major CVD risk factors. Individuals of high CVD risk were identified as those with previous CVD, or with a predicted 10-year risk of CVD greater than 10% according to the WHO risk prediction charts. We applied factor analysis to generate “clusters” that characterized the clustering of these risk factors, then explored their relationship with the local ambient temperature and per capital GDP. Results Among 983476 participants included, 9.2% were of high CVD risk, with a range of 1.6% to 23.6% across counties. Among the seven regions in China, the rate was relatively high in the Northeast (11.8%) and North China (10.4%), while low in the South China (7.2%) and Northwest (7.8%). We identified 6 clusters underlying CVD risk factors, including Obesity factor, Blood pressure factor, Staple food factor, Non-staple food factor, Smoking and alcohol factor, and Metabolic and physical activity factor (Figure). We found high risk regions were facing different leading challenges, like obesity and blood pressure for the North China, while unhealthy non-staple food for the Northeast. The South China, as the region with the lowest CVD risk, still had the highest prevalence of unhealthy staple food. Lower annual average ambient temperature was associated with higher risk in Blood pressure factor, Obesity factor and Non-staple food factor, but lower risk in Staple food factor and Metabolic and physical activity factor (p&lt;0.001 for all), consistently between rural and urban. Higher per capital GDP was associated with lower risk in Non-staple food factor in urban and higher risk in Metabolic and physical activity factor in rural (p&lt;0.05 for both). The correlation between per capital GDP and Smoking and alcohol factor differed significantly between in rural and urban regions (p=0.042). Conclusions The geographical profile of CVD risk in China is complex - population risk levels varied substantially across regions, which were contributed by different risk factors. China needs geographically targeted intervention strategies considering environmental and socio-economic factors to control CVD risk and reduce the burden related to CVD. Geographical disparity of risk clusters Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): The National Key Research and Development Program from the Ministry of Science and Technology of China; the CAMS Innovation Fund for Medical Science

Modalities of physical activity and exercise in the management of cardiovascular health in individuals with cardiovascular risk factors

2020 ◽  
pp. 49-58
Author(s):  
Dominique Hansen ◽  
Martin Halle
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Cardiovascular Health ◽  
Exercise Intervention ◽  
Body Fat Mass ◽  
Control Body ◽  
Prevention Of Cardiovascular Disease

Physical activity (PA) and exercise training (ET) are highly effective in the prevention of cardiovascular disease (CVD) via improvement of cardiovascular risk factors (CV RFs), such as blood pressure (BP), lipid profile, glycaemic control, body fat mass, and inflammation. In the first part of this chapter, we describe the currently observed effects of PA and exercise intervention on these RFs. In the second part, we explain which exercise modalities should be selected to optimize these CVD RFs, especially for those patients with multiple CVD RFs.

Physical activity, physical fitness, and cardiovascular health

2013 ◽  
Author(s):  
Jos Twisk ◽  
Isabel Ferreira
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Physical Fitness ◽  
Children And Adolescents ◽  
Cardiovascular Health ◽  
Density Lipoprotein ◽  
Hdl Cholesterol ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Apo B

The incidence of morbidity and mortality related to CVD is rather low in a paediatric population. Studies investigating the relationship between physical activity, physical fitness, and cardiovascular health in children and adolescents are therefore mostly limited to CVD risk factors as outcome measures. For this reason, this chapter will focus on the association of physical activity and physical fitness with CVD risk factors in children and adolescents. These risk factors can be divided into the so-called traditional CVD risk factors; that is, lipoproteins [total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides (TG)], blood pressure, body fatness, and diabetes, and ‘new’ CVD risk factors; that is, other lipoproteins [lipoprotein(a) (Lp(a)), apolipoprotein (apo)B, and apoA-1], coagulation and inflammation markers [fibrinogen, C-reactive protein (CRP)], homocysteine, and heart rate variability.

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

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.

scholarly journals Evaluation of a 10-week lifestyle and weight management programme on cardiovascular disease risk factors in a group of people living with obesity referred from a specialist bariatric clinic

2021 ◽  
Vol 20 (Supplement_1) ◽  
Author(s):  
A Harris ◽  
D Keegan ◽  
S Seery ◽  
D Dunne ◽  
Z Mc Crudden ◽  
...  
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Lifestyle Modification ◽  
Interdisciplinary Team ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Risk Factor Reduction

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Health Service Executive Health and Wellbeing, Saolta University Healthcare Group OnBehalf Croí the West of Ireland Cardiac Foundation, Galway, Ireland and the National Institute for Prevention and Cardiovascular Health Introduction People living with obesity are at an increased risk of cardiovascular disease (CVD). While development of obesity is multifactorial, lifestyle modification is fundamental to obesity treatment and risk factor reduction. We sought to measure the effects of a structured lifestyle modification programme on the physical and mental health of people living with obesity. Purpose This study investigated the impact of a 10-week, community based, lifestyle modification programme on CVD risk factors in people living with obesity (BMI ≥35kg/m2 with a co-morbidity or BMI ≥40kg/m2) who were referred from a specialist bariatric service. Methods Delivered by an interdisciplinary team (Nurse, Dietitian & Physiotherapist) the programme included weekly group-based exercise sessions and health promotion workshops. A wide range of topics were addressed in workshops, including nutrition, food labels, emotional eating, physical activity, sedentary behaviour, stress management and CVD risk factor reduction. Outcomes were measured at initial and end of programme assessments. Results 1122 people participated in the intervention between 2013 and 2019 with 78% (n = 877) completing the programme. At initial assessment 26.7% of participants had a diagnosis of type 2 diabetes; 37.3% were at high or very high risk of CVD; 44.7% were hypertensive and 31.4% had a history of depression. Mean BMI was 47.0kg/m2 with 56.4% of participants having a BMI &gt;45kg/m2. The intervention had significant positive impacts on key outcomes such as psychosocial health, lipid profiles, blood pressure, adiposity and cardiovascular fitness. One of the most significant outcomes observed was the improvement in psycho-social health. Scores of anxiety and depression, assessed using the HADS, decreased by 1.5 and 2.2 points respectively (p &lt;0.001). Mean EQ-VAS score increased by 11 points (p &lt;0.001). There were significant changes in total cholesterol levels with a mean reduction in total cholesterol from 4.69mmol/l to 4.54mmol/l (p &lt;0.001) and LDL cholesterol from 2.79mmol/l to 2.64mmol/l (p &lt;0.001). There were also significant improvements in blood pressure with mean systolic blood pressure reducing by 15.7mmHg (p &lt;0.001) and diastolic blood pressure reducing by 1.4mmHg (p &lt;0.001). For people with type 2 diabetes, there was an increase in those achieving the recommended HbA1c target (&lt;53mmol/l) from 47.6% to 57.4% (p &lt;0.001). Mean reduction in bodyweight was 2.0kg (p &lt;0.001), with 27.2% achieving a weight loss of &gt;3% of initial bodyweight. The percentage of participants achieving the recommended physical activity guidelines increased by 31% (p &lt;0.001). Conclusions A lifestyle modification programme delivered by an interdisciplinary team, aimed at individuals living with obesity, is not only acceptable to participants but also significantly reduces CVD risk factors. These findings should influence the design of future programmes and healthcare policies in Ireland and abroad.

Abstract MP16: Reallocating Sedentary Behavior With Sleep or Physical Activity is Associated With Favorable Cardiovascular Health in the Multi-Ethnic Study of Atherosclerosis: MESA

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Charles German ◽  
Nour Makarem ◽  
Jason Fanning ◽  
Susan Redline ◽  
Tali Elfassy ◽  
...  
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Blood Pressure ◽  
Sedentary Behavior ◽  
Diastolic Blood Pressure ◽  
Cardiovascular Health ◽  
Sedentary Time ◽  
Vigorous Physical Activity ◽  
Ethnic Study ◽  
The Mean

Introduction: Sleep, sedentary behavior, and physical activity are each independently associated with cardiovascular health (CVH). However, many studies have investigated these relationships in isolation even though a change in any one given behavior will affect the time spent in the others. It is unknown how reallocating time in sedentary behavior with sleep or physical activity effects overall CVH in a diverse cohort of men and women at risk of cardiovascular disease (CVD). Hypothesis: Reallocating 30 minutes of sedentary time with sleep, light (LIPA), or moderate to vigorous physical activity (MVPA) is associated with more favorable overall CVH due to improvements in risk factors for CVD. Methods: Data for this analysis were taken from the Multi-Ethnic Study on Atherosclerosis (MESA) Sleep Ancillary Study. Eligible participants (n= 1718) wore Actiwatch accelerometers for 24 hours a day, and had at least 3 days of valid accelerometry. Time spent in sleep, sedentary behavior, LIPA, and MVPA was determined based on an established algorithm. The American Heart Association’s life simple 7 was used to represent the CVH score after excluding the physical activity component, with higher scores indicating more favorable CVH. All components were ascertained from MESA exam 5. Isotemporal substitution modeling was conducted to examine the effect of substituting 30 minutes of sedentary time for an equivalent amount of sleep, LIPA, or MVPA. Results: The mean age of participants was 68.3, 54.0% were female and 38.6% were white. The mean CVH score was 5.9 (95%CI: 5.8-6.0). On average, participants spent 499.3 minutes/day in sedentary time, 415.3 minutes/day in LIPA, 26.0 minutes/day in MVPA, and 388.2 minutes/day sleeping. Reallocating 30 minutes of sedentary time to sleep, LIPA, and MVPA was associated with a significantly higher CVH score [β(SE): 0.077(0.023), 0.039(0.017), and 0.485(0.065) respectively]. Reallocating 30 minutes of sedentary time to sleep was associated with lower BMI. Reallocating 30 minutes of sedentary time to LIPA was associated with higher diastolic blood pressure and total cholesterol, and lower BMI. Reallocating 30 minutes of sedentary time to MVPA was associated with lower systolic and diastolic blood pressure, and lower BMI. Conclusions: Our study demonstrates that sleep, LIPA, and MVPA are all positively associated with more favorable overall CVH and several key CVD risk factors. These findings underscore the importance of lifestyle modifications in improving CVH.

Blood pressure risk factors in healthy postmenopausal women: physical activity and hormone replacement

1997 ◽  
Vol 82 (2) ◽  
pp. 652-660 ◽  
Author(s):  
Edith T. Stevenson ◽  
Kevin P. Davy ◽  
Pamela P. Jones ◽  
Christopher A. Desouza ◽  
and Douglas R. Seals ◽  
...  
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Blood Pressure ◽  
Waist Circumference ◽  
Postmenopausal Women ◽  
Hormone Replacement ◽  
Stepwise Multiple Regression ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Physically Active

Stevenson, Edith T., Kevin P. Davy, Pamela P. Jones, Christopher A. Desouza, and Douglas R. Seals. Blood pressure risk factors in healthy postmenopausal women: physical activity and hormone replacement. J. Appl. Physiol. 82(2): 652–660, 1997.—The prevalence of cardiovascular disease (CVD) increases with advancing age in women, particularly after menopause. CVD risk is lower in physically active women relative to their sedentary peers, but the responsible mechanisms are not well understood. The aims of this study were to test the hypotheses that 1) physically active postmenopausal women demonstrate more favorable blood pressure (BP)-related risk factors for CVD than do sedentary healthy women and 2) women on hormone replacement therapy (HRT) also have more favorable levels of these CVD risk factors. BP-related CVD risk factors were measured in physically active women ( n = 18; age 55 ± 1 yr; n = 8 on HRT) and in healthy less-active controls ( n = 34; age 59 ± 1 yr; n = 17 on HRT). Maximal oxygen consumption was higher in the active group, whereas waist-to-hip ratio and waist circumference were lower (all P < 0.005). The active women demonstrated marginally lower (5–8 mmHg; P ≤ 0.10) levels of casual, 24-h, and daytime systolic BP (SBP). They also tended to have lower ( P = 0.11) daytime SBP loads (percentage of BP recordings >140/90 mmHg) and lower daytime and nighttime BP variabilities ( P = 0.04) and a reduced ( P < 0.007) SBP response to submaximal exercise. Women on HRT tended to have lower (3–4 mmHg; P = 0.07) levels of 24-h and nighttime diastolic BP (DBP) relative to the nonusers and smaller ( P < 0.04) daytime and 24-h DBP loads. Stepwise multiple regression indicated that waist circumference was the primary predictor of most of the SBP-related CVD risk factors while HRT use was the best predictor for DBP loads. These findings indicate that, in general, physically active postmenopausal women demonstrate more favorable SBP-related CVD risk factors relative to their less-active healthy peers, which may be mediated, in part, by their lower levels of abdominal adiposity. In addition, HRT use tends to be associated with lower levels of DBP-related CVD risk factors.

scholarly journals Physical Activity for Campus Employees: A University Worksite Wellness Program

2015 ◽  
Vol 12 (4) ◽  
pp. 470-476 ◽  
Author(s):  
Carling E. Butler ◽  
B. Ruth Clark ◽  
Tamara L. Burlis ◽  
Jacqueline C. Castillo ◽  
Susan B. Racette
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Cardiorespiratory Fitness ◽  
Self Efficacy ◽  
Worksite Wellness ◽  
Wellness Program ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
University Employees ◽  
Daily Step Count

Background:Workplaces provide ideal environments for wellness programming. The purpose of this study was to explore exercise self-efficacy among university employees and the effects of a worksite wellness program on physical activity, cardiorespiratory fitness, and cardiovascular disease (CVD) risk factors.Methods:Participants included 121 university employees (85% female). The worksite wellness program included cardiovascular health assessments, personal health reports, 8 weeks of pedometer-based walking and tracking activities, and weekly wellness sessions. Daily step count was assessed at baseline, Week 4, and Week 8. Exercise self-efficacy and CVD risk factors were evaluated at baseline and follow-up.Results:Daily step count increased from 6566 ± 258 (LSM ± SE) at baseline to 8605 ± 356 at Week 4 and 9107 ± 388 at Week 8 (P < .0001). Steps increased among normal weight, overweight, and obese subgroups. Exercise self-efficacy correlated with baseline steps (P < .05). Small improvements were observed in cardiorespiratory fitness, body mass index, blood pressure, blood glucose, total cholesterol, and triglycerides (all P < .01).Conclusions:A worksite wellness program was effective for improving physical activity, cardiorespiratory fitness, and CVD risk factors among university employees. Exercise barriers and outcome expectations were identified and have implications for future worksite wellness programming.

scholarly journals Physical activity and cardiovascular disease risk in women with polycystic ovary syndrome

2021 ◽  
Author(s):  
◽  
Amie Woodward
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Cardiovascular Health ◽  
Exercise Intervention ◽  
Polycystic Ovary ◽  
Exercise Group ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Exercise Interventions ◽  
Supervised Exercise

Background Polycystic ovary syndrome (PCOS) is a complex, heterogeneous endocrinopathy affecting metabolic, reproductive, and cardiovascular health in women. Evidence indicates that women with PCOS present with a cluster of cardiovascular disease (CVD) risk factors. Physical activity (PA) interventions have been shown to reduce various CVD risk factors in women with PCOS. Research also suggests that sedentary behaviours have a distinct deleterious effect on cardiometabolic health. Thus, increasing PA and reducing sedentary behaviour may be a worthwhile therapeutic target to improve cardiovascular health in women with PCOS. The programme of research presented in this thesis investigates the feasibility and acceptability of two PA interventions to improve markers of CVD risk in women with PCOS using both quantitative and qualitive methods. Methods A systematic review and meta-analysis of the effects of exercise interventions on CVD risk factors in women with PCOS provided an evidence base on which to design a supervised exercise intervention. A feasibility randomised controlled trial (RCT) of two physical activity interventions for women with PCOS was conducted. Participants were randomised to either a supervised exercise intervention, a lifestyle physical activity intervention (LPAG) aimed at reducing sedentary behaviours, or a control group, for 12 weeks. Semi-structured interviews were conducted with a purposive sample of participants from each group on completion of the RCT to explore the acceptability of the interventions, and barriers and facilitators to PA. Results The systematic review and meta-analysis demonstrated that moderate intensity aerobic exercise interventions of ≥three months in duration, with a frequency of three sessions/week, had favourable effects on CVD risk factors. These results informed the design of the RCT. Thirty-six women with PCOS were enrolled onto the feasibility RCT (12 per group). The recruitment rate was 56% and adherence rate to the exercise intervention was considered moderate at 53%. The retention rate was high at 89%, with only five participants lost to follow-up. Adherence to the LPAG was 100%. Two non-serious adverse events were reported in the exercise group, unrelated to trial procedures. For the secondary outcomes, trend data indicates a 14% reduction in oxidised LDL concentrations in the exercise group. In addition, the data indicates weight loss (kg) of 3.4% and 3.6% in the exercise group and the LPAG, respectively. Qualitative data from the interviews (n=11) indicated that the interventions were well received, but acceptability could be improved by providing social connectivity and implementing measures that encourage the adoption of long-term health-promoting behaviours. Conclusions iii The findings suggest that the procedures for recruitment, allocation, and outcome measurements were acceptable. However, adherence to the supervised exercise intervention was below an acceptable rate. The qualitative component provides valuable contextual data that will be crucial to addressing adherence for both the progression to a full-scale RCT, and community interventions for women with PCOS.

Abstract P013: Prevalence, Correlates and Prognosis of Healthy Vascular Aging in a Western Community-dwelling Population

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Teemu Niiranen ◽  
Asya Lyass ◽  
Martin Larson ◽  
Naomi Hamburg ◽  
Emelia Benjamin ◽  
...  
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Regression Models ◽  
Cardiovascular Health ◽  
Vascular Aging ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Health Score ◽  
Unit Increase ◽  
Life’S Simple 7

Introduction: Although hypertension in the elderly is no longer considered harmless, increasing arterial stiffness and blood pressure (BP) are still widely seen as inevitable parts of the aging process. However, these phenomena may not be unavoidable as they are nearly absent in populations leading traditional hunter-gatherer lifestyles. Our study had 3 aims: 1) to define a new concept - healthy vascular aging (HVA); 2) to assess prevalence and correlates of HVA in a sample acculturated to a western life-style; and 3) to estimate the magnitude of cardiovascular (CVD) risk associated with HVA vs. absence of HVA. Methods: We studied 3197 Framingham Heart Study participants aged ≥50 years (62±9 years, 56% women) who underwent physical examination, interviews, and measurement of carotid-femoral pulse wave velocity (PWV) in 1999-2008. We defined HVA as no hypertension (BP <140/90 mmHg without antihypertensive treatment) and PWV <7.6 m/s (equivalent to +2 SD above mean of non-hypertensive reference sample aged <30 years with no CVD risk factors). We used logistic regression models that included physical activity, caloric intake, and classical CVD factors as covariates to assess the correlates of HVA. For each participant, we constructed a cardiovascular health score based on presence vs. absence of 6 modifiable risk factors (cholesterol, plasma glucose, healthy diet score, physical activity, body mass index (BMI), and smoking) defined as dichotomous variables according to the American Heart Association’s Life’s Simple 7 score (modified to exclude hypertension). We estimated odds ratios (OR) per 1-unit increase in cardiovascular health score for HVA. We used Cox regression models adjusted for classical CVD risk factors, including systolic BP, to assess the relationship between HVA and incident CVD events (CVD death, myocardial infarction, heart failure, stroke, and unstable angina). Results: In our sample, only 566 (17.7%) had HVA. Lower age (OR per 1-SD increase 0.18, 95% confidence interval [CI] 0.14-0.23), female sex (OR 2.03; 95% CI 1.54-2.68), lower BMI (OR per 1-SD increase 0.54; 95% CI 0.47-0.63) and no diabetes (OR 0.09; 95% CI 0.02-0.36) were significantly associated with HVA. A 1-unit increase in the cardiovascular health score conferred 1.55-fold (95% CI 1.38-1.74) odds of HVA. During follow-up (median 9.6 years), 391 participants had CVD events. HVA was associated with an age- and sex-adjusted hazard ratio (HR) of 0.36 (95% CI, 0.22-0.60) and a multivariable-adjusted HR of 0.45 (95% CI, 0.26-0.77) for CVD relative to absence of HVA. Conclusions: One in 6 individuals experiences HVA in our sample. Individuals with HVA are at a considerably low risk of CVD. Prevention strategies targeting modifiable factors and behaviors included in Life’s Simple 7 are important for preventing or delaying vascular aging and the associated risk of CVD.

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