Skip to main content
Top
Published in: BMC Public Health 1/2024

Open Access 01-12-2024 | Research

Ideal cardiovascular health and risk of death in a large Swedish cohort

Authors: Lijie Ding, Marta Ponzano, Alessandra Grotta, Hans-Olov Adami, Fuzhong Xue, Ylva Trolle Lagerros, Rino Bellocco, Weimin Ye

Published in: BMC Public Health | Issue 1/2024

Login to get access

Abstract

Background

Ideal cardiovascular health (CVH) can be assessed by 7 metrics: smoking, body mass index, physical activity, diet, hypertension, dyslipidemia and diabetes, proposed by the American Heart Association. We examined the association of ideal CVH metrics with risk of all-cause, CVD and non-CVD death in a large cohort.

Methods

A total of 29,557 participants in the Swedish National March Cohort were included in this study. We ascertained 3,799 deaths during a median follow-up of 19 years. Cox regression models were used to estimate hazard ratios with 95% confidence intervals (95% CIs) of the association between CVH metrics with risk of death. Laplace regression was used to estimate 25th, 50th and 75th percentiles of age at death.

Results

Compared with those having 6–7 ideal CVH metrics, participants with 0–2 ideal metrics had 107% (95% CI = 46-192%) excess risk of all-cause, 224% (95% CI = 72-509%) excess risk of CVD and 108% (31-231%) excess risk of non-CVD death. The median age at death among those with 6–7 vs. 0–2 ideal metrics was extended by 4.2 years for all-causes, 5.8 years for CVD and 2.9 years for non-CVD, respectively. The observed associations were stronger among females than males.

Conclusions

The strong inverse association between number of ideal CVH metrics and risk of death supports the application of the proposed seven metrics for individual risk assessment and general health promotion.
Appendix
Available only for authorised users
Literature
1.
go back to reference Lloyd-Jones DM, Hong Y, Labarthe D, Mozaffarian D, Appel LJ, Van Horn L, Greenlund K, Daniels S, Nichol G, Tomaselli GF, et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic impact goal through 2020 and beyond. Circulation. 2010;121(4):586–613.CrossRefPubMed Lloyd-Jones DM, Hong Y, Labarthe D, Mozaffarian D, Appel LJ, Van Horn L, Greenlund K, Daniels S, Nichol G, Tomaselli GF, et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic impact goal through 2020 and beyond. Circulation. 2010;121(4):586–613.CrossRefPubMed
2.
go back to reference Sanchez E. Life’s simple 7: vital but not easy. J Am Heart Association. 2018;7(11):e009324.CrossRef Sanchez E. Life’s simple 7: vital but not easy. J Am Heart Association. 2018;7(11):e009324.CrossRef
3.
go back to reference Maclagan LC, Tu JV. Using the concept of ideal cardiovascular health to measure population health: a review. Curr Opin Cardiol. 2015;30(5):518–24.CrossRefPubMed Maclagan LC, Tu JV. Using the concept of ideal cardiovascular health to measure population health: a review. Curr Opin Cardiol. 2015;30(5):518–24.CrossRefPubMed
4.
go back to reference Peng Y, Cao S, Yao Z, Wang Z. Prevalence of the cardiovascular health status in adults: a systematic review and meta-analysis. Nutr Metabolism Cardiovasc Diseases: NMCD. 2018;28(12):1197–207.CrossRefPubMed Peng Y, Cao S, Yao Z, Wang Z. Prevalence of the cardiovascular health status in adults: a systematic review and meta-analysis. Nutr Metabolism Cardiovasc Diseases: NMCD. 2018;28(12):1197–207.CrossRefPubMed
5.
go back to reference Crichton GE, Elias MF, Davey A, Sauvageot N, Delagardelle C, Beissel J, Alkerwi A. Cardiovascular health: a cross-national comparison between the Maine Syracuse Study (Central New York, USA) and ORISCAV-LUX (Luxembourg). BMC Public Health. 2014;14:253.CrossRefPubMedPubMedCentral Crichton GE, Elias MF, Davey A, Sauvageot N, Delagardelle C, Beissel J, Alkerwi A. Cardiovascular health: a cross-national comparison between the Maine Syracuse Study (Central New York, USA) and ORISCAV-LUX (Luxembourg). BMC Public Health. 2014;14:253.CrossRefPubMedPubMedCentral
6.
go back to reference Dong C, Rundek T, Wright CB, Anwar Z, Elkind MS, Sacco RL. Ideal cardiovascular health predicts lower risks of myocardial infarction, stroke, and vascular death across whites, blacks, and hispanics: the northern Manhattan study. Circulation. 2012;125(24):2975–84.CrossRefPubMedPubMedCentral Dong C, Rundek T, Wright CB, Anwar Z, Elkind MS, Sacco RL. Ideal cardiovascular health predicts lower risks of myocardial infarction, stroke, and vascular death across whites, blacks, and hispanics: the northern Manhattan study. Circulation. 2012;125(24):2975–84.CrossRefPubMedPubMedCentral
7.
go back to reference Ford ES, Greenlund KJ, Hong Y. Ideal cardiovascular health and mortality from all causes and diseases of the circulatory system among adults in the United States. Circulation. 2012;125(8):987–95.CrossRefPubMedPubMedCentral Ford ES, Greenlund KJ, Hong Y. Ideal cardiovascular health and mortality from all causes and diseases of the circulatory system among adults in the United States. Circulation. 2012;125(8):987–95.CrossRefPubMedPubMedCentral
8.
go back to reference Yang Q, Cogswell ME, Flanders WD, Hong Y, Zhang Z, Loustalot F, et al. Trends in cardiovascular health metrics and associations with all-cause and CVD mortality among US adults. JAMA. 2012;307(12):1273–83CrossRef Yang Q, Cogswell ME, Flanders WD, Hong Y, Zhang Z, Loustalot F, et al. Trends in cardiovascular health metrics and associations with all-cause and CVD mortality among US adults. JAMA. 2012;307(12):1273–83CrossRef
9.
go back to reference Lachman S, Peters RJ, Lentjes MA, Mulligan AA, Luben RN, Wareham NJ, Khaw KT, Boekholdt SM. Ideal cardiovascular health and risk of cardiovascular events in the EPIC-Norfolk prospective population study. Eur J Prev Cardiol. 2016;23(9):986–94.CrossRefPubMed Lachman S, Peters RJ, Lentjes MA, Mulligan AA, Luben RN, Wareham NJ, Khaw KT, Boekholdt SM. Ideal cardiovascular health and risk of cardiovascular events in the EPIC-Norfolk prospective population study. Eur J Prev Cardiol. 2016;23(9):986–94.CrossRefPubMed
10.
go back to reference Liu Y, Chi HJ, Cui LF, Yang XC, Wu YT, Huang Z, Zhao HY, Gao JS, Wu SL, Cai J. The ideal cardiovascular health metrics associated inversely with mortality from all causes and from cardiovascular diseases among adults in a Northern Chinese industrial city. PLoS ONE. 2014;9(2):e89161.ADSCrossRefPubMedPubMedCentral Liu Y, Chi HJ, Cui LF, Yang XC, Wu YT, Huang Z, Zhao HY, Gao JS, Wu SL, Cai J. The ideal cardiovascular health metrics associated inversely with mortality from all causes and from cardiovascular diseases among adults in a Northern Chinese industrial city. PLoS ONE. 2014;9(2):e89161.ADSCrossRefPubMedPubMedCentral
11.
go back to reference Zhou L, Zhao L, Wu Y, Wu Y, Gao X, Li Y, Mai J, Nie Z, Ou Y, Guo M, et al. Ideal cardiovascular health metrics and its association with 20-year cardiovascular morbidity and mortality in a Chinese population. J Epidemiol Community Health. 2018;72(8):752–8.CrossRefPubMed Zhou L, Zhao L, Wu Y, Wu Y, Gao X, Li Y, Mai J, Nie Z, Ou Y, Guo M, et al. Ideal cardiovascular health metrics and its association with 20-year cardiovascular morbidity and mortality in a Chinese population. J Epidemiol Community Health. 2018;72(8):752–8.CrossRefPubMed
12.
go back to reference Kim JY, Ko YJ, Rhee CW, Park BJ, Kim DH, Bae JM, et al. Cardiovascular health metrics and all-cause and cardiovascular disease mortality among middle-aged men in Korea: the Seoul male cohort study. J Prev Med Public Health. 2013;46(6):319–28. Kim JY, Ko YJ, Rhee CW, Park BJ, Kim DH, Bae JM, et al. Cardiovascular health metrics and all-cause and cardiovascular disease mortality among middle-aged men in Korea: the Seoul male cohort study. J Prev Med Public Health. 2013;46(6):319–28.
13.
go back to reference Aneni EC, Crippa A, Osondu CU, Valero-Elizondo J, Younus A, Nasir K, et al. Estimates of mortality benefit from ideal cardiovascular health metrics: a dose response meta-analysis. J Am Heart Assoc. 2017;6(12):e006904. Aneni EC, Crippa A, Osondu CU, Valero-Elizondo J, Younus A, Nasir K, et al. Estimates of mortality benefit from ideal cardiovascular health metrics: a dose response meta-analysis. J Am Heart Assoc. 2017;6(12):e006904.
14.
go back to reference Li Z, Meng L, Huang Z, Cui L, Li W, Gao J, Wang Z, Zhang R, Zhou J, Zhang G, et al. Ideal Cardiovascular Health Metrics and Incident Hyperuricemia. Arthritis Care Res (Hoboken). 2016;68(5):660–6.CrossRefPubMed Li Z, Meng L, Huang Z, Cui L, Li W, Gao J, Wang Z, Zhang R, Zhou J, Zhang G, et al. Ideal Cardiovascular Health Metrics and Incident Hyperuricemia. Arthritis Care Res (Hoboken). 2016;68(5):660–6.CrossRefPubMed
15.
go back to reference Jang E-H, Chang Y, Ryu S, Kim S, Byrne CD. Cardiovascular Health Metrics in the development and regression of nonalcoholic fatty liver disease: a Cohort Study. J Clin Med. 2019;8(5):610.CrossRefPubMedPubMedCentral Jang E-H, Chang Y, Ryu S, Kim S, Byrne CD. Cardiovascular Health Metrics in the development and regression of nonalcoholic fatty liver disease: a Cohort Study. J Clin Med. 2019;8(5):610.CrossRefPubMedPubMedCentral
16.
go back to reference Han C, Liu F, Yang X, Chen J, Li J, Cao J, et al. Ideal cardiovascular health and incidence of atherosclerotic cardiovascular disease among Chinese adults: the China-PAR project. Sci China Life Sci. 2018;61(5):504–14.CrossRef Han C, Liu F, Yang X, Chen J, Li J, Cao J, et al. Ideal cardiovascular health and incidence of atherosclerotic cardiovascular disease among Chinese adults: the China-PAR project. Sci China Life Sci. 2018;61(5):504–14.CrossRef
17.
go back to reference Fuster V, Ibanez B. Address Cardiovascular Health in Middle Age: time to remove the Blindfold. J Am Coll Cardiol. 2023;81(7):705–7.CrossRefPubMed Fuster V, Ibanez B. Address Cardiovascular Health in Middle Age: time to remove the Blindfold. J Am Coll Cardiol. 2023;81(7):705–7.CrossRefPubMed
18.
go back to reference Jerome GJ, Boyer WR, Bustamante EE, Kariuki J, Lopez-Jimenez F, Paluch AE, Swift DL, Webber-Ritchey KJ. Barone Gibbs B: Increasing Equity of Physical Activity Promotion for Optimal Cardiovascular Health in adults: A Scientific Statement from the American Heart Association. Circulation. 2023;147(25):1951–62.CrossRefPubMed Jerome GJ, Boyer WR, Bustamante EE, Kariuki J, Lopez-Jimenez F, Paluch AE, Swift DL, Webber-Ritchey KJ. Barone Gibbs B: Increasing Equity of Physical Activity Promotion for Optimal Cardiovascular Health in adults: A Scientific Statement from the American Heart Association. Circulation. 2023;147(25):1951–62.CrossRefPubMed
19.
go back to reference Lagerros YT, Bellocco R, Adami HO, Nyren O. Measures of physical activity and their correlates: the Swedish National March cohort. Eur J Epidemiol. 2009;24(4):161–9.CrossRefPubMed Lagerros YT, Bellocco R, Adami HO, Nyren O. Measures of physical activity and their correlates: the Swedish National March cohort. Eur J Epidemiol. 2009;24(4):161–9.CrossRefPubMed
20.
go back to reference Trolle Lagerros Y, Hantikainen E, Mariosa D, Ye W, Adami HO, Grotta A, et al. Cohort profile: the swedish national march cohort. Int J Epidemiol. 2017;46(3):795–795e. Trolle Lagerros Y, Hantikainen E, Mariosa D, Ye W, Adami HO, Grotta A, et al. Cohort profile: the swedish national march cohort. Int J Epidemiol. 2017;46(3):795–795e.
21.
go back to reference Ludvigsson JF, Almqvist C, Bonamy AK, Ljung R, Michaelsson K, Neovius M, Stephansson O, Ye W. Registers of the Swedish total population and their use in medical research. Eur J Epidemiol. 2016;31(2):125–36.CrossRefPubMed Ludvigsson JF, Almqvist C, Bonamy AK, Ljung R, Michaelsson K, Neovius M, Stephansson O, Ye W. Registers of the Swedish total population and their use in medical research. Eur J Epidemiol. 2016;31(2):125–36.CrossRefPubMed
22.
go back to reference Rautiainen S, Serafini M, Morgenstern R, Prior RL, Wolk A. The validity and reproducibility of food-frequency questionnaire-based total antioxidant capacity estimates in Swedish women. Am J Clin Nutr. 2008;87(5):1247–53.CrossRefPubMed Rautiainen S, Serafini M, Morgenstern R, Prior RL, Wolk A. The validity and reproducibility of food-frequency questionnaire-based total antioxidant capacity estimates in Swedish women. Am J Clin Nutr. 2008;87(5):1247–53.CrossRefPubMed
23.
go back to reference Mukamal KJ. A safe level of alcohol consumption: the right answer demands the right question. J Intern Med. 2020;288(5):550–9.CrossRefPubMed Mukamal KJ. A safe level of alcohol consumption: the right answer demands the right question. J Intern Med. 2020;288(5):550–9.CrossRefPubMed
25.
go back to reference Korn EL, Graubard BI, Midthune D. Time-to-event analysis of longitudinal follow-up of a survey: choice of the time-scale. Am J Epidemiol. 1997;145(1):72–80.CrossRefPubMed Korn EL, Graubard BI, Midthune D. Time-to-event analysis of longitudinal follow-up of a survey: choice of the time-scale. Am J Epidemiol. 1997;145(1):72–80.CrossRefPubMed
26.
go back to reference Collaboration PSCAPCS. Sex-specific relevance of diabetes to occlusive vascular and other mortality: a collaborative meta-analysis of individual data from 980 793 adults from 68 prospective studies. Lancet Diabetes Endocrinol. 2018;6(7):538–46.CrossRef Collaboration PSCAPCS. Sex-specific relevance of diabetes to occlusive vascular and other mortality: a collaborative meta-analysis of individual data from 980 793 adults from 68 prospective studies. Lancet Diabetes Endocrinol. 2018;6(7):538–46.CrossRef
27.
go back to reference Kleinbaum D, Klein M. Survival analysis: a Self-Learning text. New York: Springer; 2012.CrossRef Kleinbaum D, Klein M. Survival analysis: a Self-Learning text. New York: Springer; 2012.CrossRef
28.
go back to reference Bellavia A, Discacciati A, Bottai M, Wolk A, Orsini N. Using Laplace regression to Model and Predict Percentiles of Age at Death when Age is the primary time scale. Am J Epidemiol. 2015;182(3):271–7.CrossRefPubMed Bellavia A, Discacciati A, Bottai M, Wolk A, Orsini N. Using Laplace regression to Model and Predict Percentiles of Age at Death when Age is the primary time scale. Am J Epidemiol. 2015;182(3):271–7.CrossRefPubMed
29.
go back to reference Olsen GS, Holm AS, Jorgensen T, Borglykke A. Distribution of ideal cardiovascular health by educational levels from 1978 to 2006: a time trend study from the capital region of Denmark. Eur J Prev Cardiol. 2014;21(9):1145–52.CrossRefPubMed Olsen GS, Holm AS, Jorgensen T, Borglykke A. Distribution of ideal cardiovascular health by educational levels from 1978 to 2006: a time trend study from the capital region of Denmark. Eur J Prev Cardiol. 2014;21(9):1145–52.CrossRefPubMed
30.
go back to reference Djousse L, Petrone AB, Blackshear C, Griswold M, Harman JL, Clark CR, Talegawkar S, Hickson DA, Gaziano JM, Dubbert PM, et al. Prevalence and changes over time of ideal cardiovascular health metrics among African-Americans: the Jackson Heart Study. Prev Med. 2015;74:111–6.CrossRefPubMedPubMedCentral Djousse L, Petrone AB, Blackshear C, Griswold M, Harman JL, Clark CR, Talegawkar S, Hickson DA, Gaziano JM, Dubbert PM, et al. Prevalence and changes over time of ideal cardiovascular health metrics among African-Americans: the Jackson Heart Study. Prev Med. 2015;74:111–6.CrossRefPubMedPubMedCentral
31.
go back to reference Graciani A, Leon-Munoz LM, Guallar-Castillon P, Rodriguez-Artalejo F, Banegas JR. Cardiovascular health in a southern Mediterranean European country: a nationwide population-based study. Circulation Cardiovasc Qual Outcomes. 2013;6(1):90–8.CrossRef Graciani A, Leon-Munoz LM, Guallar-Castillon P, Rodriguez-Artalejo F, Banegas JR. Cardiovascular health in a southern Mediterranean European country: a nationwide population-based study. Circulation Cardiovasc Qual Outcomes. 2013;6(1):90–8.CrossRef
32.
go back to reference Zeng Q, Dong SY, Song ZY, Zheng YS, Wu HY, Mao LN. Ideal cardiovascular health in Chinese urban population. Int J Cardiol. 2013;167(5):2311–7.CrossRefPubMed Zeng Q, Dong SY, Song ZY, Zheng YS, Wu HY, Mao LN. Ideal cardiovascular health in Chinese urban population. Int J Cardiol. 2013;167(5):2311–7.CrossRefPubMed
33.
go back to reference Enserro DM, Vasan RS, Xanthakis V. Twenty-year trends in the American Heart Association cardiovascular health score and impact on subclinical and clinical cardiovascular disease: the Framingham offspring study. J Am Heart Assoc. 2018;7(11):e008741. Enserro DM, Vasan RS, Xanthakis V. Twenty-year trends in the American Heart Association cardiovascular health score and impact on subclinical and clinical cardiovascular disease: the Framingham offspring study. J Am Heart Assoc. 2018;7(11):e008741.
34.
go back to reference Hasbani N, Ligthart S, Brown M, Heath A, Bebo A, Ashley K, et al. American Heart Association’s life’s simple 7: Lifestyle recommendations, polygenic risk, and lifetime risk of coronary heart disease. Circulation. 2022;145(11):808–18. Hasbani N, Ligthart S, Brown M, Heath A, Bebo A, Ashley K, et al. American Heart Association’s life’s simple 7: Lifestyle recommendations, polygenic risk, and lifetime risk of coronary heart disease. Circulation. 2022;145(11):808–18.
35.
go back to reference Nauman J, Nes BM, Zisko N, Revdal A, Myers J, Kaminsky LA, Wisløff U. Personal activity intelligence (PAI): a new standard in activity tracking for obtaining a healthy cardiorespiratory fitness level and low cardiovascular risk. Prog Cardiovasc Dis. 2019;62(2):179–85.CrossRefPubMed Nauman J, Nes BM, Zisko N, Revdal A, Myers J, Kaminsky LA, Wisløff U. Personal activity intelligence (PAI): a new standard in activity tracking for obtaining a healthy cardiorespiratory fitness level and low cardiovascular risk. Prog Cardiovasc Dis. 2019;62(2):179–85.CrossRefPubMed
36.
go back to reference Rasmussen-Torvik LJ, Shay CM, Abramson JG, Friedrich CA, Nettleton JA, Prizment AE, Folsom AR. Ideal cardiovascular health is inversely associated with incident cancer: the atherosclerosis risk in communities study. Circulation. 2013;127(12):1270–5.CrossRefPubMedPubMedCentral Rasmussen-Torvik LJ, Shay CM, Abramson JG, Friedrich CA, Nettleton JA, Prizment AE, Folsom AR. Ideal cardiovascular health is inversely associated with incident cancer: the atherosclerosis risk in communities study. Circulation. 2013;127(12):1270–5.CrossRefPubMedPubMedCentral
37.
go back to reference Suzuki Y, Kaneko H, Okada A, Itoh H, Morita K, Fujiu K, Michihata N, Jo T, Takeda N, Morita H, et al. Change in Cardiovascular Health Metrics and Risk for Proteinuria Development: analysis of a Nationwide Population-based database. Am J Nephrol. 2022;53:240–8.CrossRefPubMed Suzuki Y, Kaneko H, Okada A, Itoh H, Morita K, Fujiu K, Michihata N, Jo T, Takeda N, Morita H, et al. Change in Cardiovascular Health Metrics and Risk for Proteinuria Development: analysis of a Nationwide Population-based database. Am J Nephrol. 2022;53:240–8.CrossRefPubMed
38.
go back to reference Chevli PA, Mehta A, Allison M, Ding J, Nasir K, Blaha MJ, et al. Relationship of American Heart Association’s life simple 7, ectopic fat, and insulin resistance in 5 racial/ethnic groups. J Clin Endocrinol Metab. 2022;107(6):e2394–e2404. Chevli PA, Mehta A, Allison M, Ding J, Nasir K, Blaha MJ, et al. Relationship of American Heart Association’s life simple 7, ectopic fat, and insulin resistance in 5 racial/ethnic groups. J Clin Endocrinol Metab. 2022;107(6):e2394–e2404.
39.
go back to reference Weintraub WS, Daniels SR, Burke LE, Franklin BA, Goff DC Jr., Hayman LL, Lloyd-Jones D, Pandey DK, Sanchez EJ, Schram AP, et al. Value of primordial and primary prevention for cardiovascular disease: a policy statement from the American Heart Association. Circulation. 2011;124(8):967–90.CrossRefPubMed Weintraub WS, Daniels SR, Burke LE, Franklin BA, Goff DC Jr., Hayman LL, Lloyd-Jones D, Pandey DK, Sanchez EJ, Schram AP, et al. Value of primordial and primary prevention for cardiovascular disease: a policy statement from the American Heart Association. Circulation. 2011;124(8):967–90.CrossRefPubMed
40.
go back to reference Bambs C, Reis SE. Embracing primordial prevention for ideal cardiovascular health. Future Cardiol. 2011;7(4):447–50.CrossRefPubMed Bambs C, Reis SE. Embracing primordial prevention for ideal cardiovascular health. Future Cardiol. 2011;7(4):447–50.CrossRefPubMed
41.
go back to reference Andersson T, Ahlbom A, Carlsson S. Diabetes prevalence in Sweden at present and projections for year 2050. PLoS One. 2015;10(11):e0143084. Andersson T, Ahlbom A, Carlsson S. Diabetes prevalence in Sweden at present and projections for year 2050. PLoS One. 2015;10(11):e0143084.
42.
go back to reference Jansson SP, Andersson DK, Svärdsudd K. Prevalence and incidence rate of diabetes mellitus in a Swedish community during 30 years of follow-up. Diabetologia. 2007;50(4):703–10. Jansson SP, Andersson DK, Svärdsudd K. Prevalence and incidence rate of diabetes mellitus in a Swedish community during 30 years of follow-up. Diabetologia. 2007;50(4):703–10.
Metadata
Title
Ideal cardiovascular health and risk of death in a large Swedish cohort
Authors
Lijie Ding
Marta Ponzano
Alessandra Grotta
Hans-Olov Adami
Fuzhong Xue
Ylva Trolle Lagerros
Rino Bellocco
Weimin Ye
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2024
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-024-17885-4

Other articles of this Issue 1/2024

BMC Public Health 1/2024 Go to the issue