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.
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