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Meeting greater number of recommended CV health factors lowered risk for death
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In a nationally representative sample of 44,959 participants, adults who met a greater number of CV health metrics, such as not smoking, maintaining normal cholesterol levels and following a healthy diet, had a lower risk for total and CVD mortality compared with adults who met fewer factors.
Researchers analyzed data from the National Health and Nutrition Examination Surveys from 1988-1994, 1999-2004 and 2005-2010 and the NHANES III Linked Mortality file through 2006.
Overall, 2,673 all-cause deaths, 1,085 CVD-related deaths and 576 ischemic heart disease deaths were reported during an average 14.5 years of follow-up in NHANES III participants. For adults who met one or fewer CV health metrics, the absolute risk for all-cause mortality was 14.8 deaths per 1,000 person-years, risk for CVD mortality was 6.5 deaths per 1,000 person-years and risk for ischemic heart disease mortality was 3.7 deaths per 1,000 person-years. Adults who met six or more CV health metrics had a corresponding risk for all-cause mortality of 5.4 deaths per 1,000 person-years, risk for CVD mortality of 1.5 deaths per 1,000 person-years and risk for ischemic heart disease mortality of 1.1 deaths per 1,000 person-years. Comparing adults who met six or more CV health metrics with adults who met one or fewer CV health metrics, the adjusted HR was 0.49 (95% CI, 0.33-0.74) for all-cause mortality, 0.24 (95% CI, 0.13-0.47) for CVD mortality and 0.30 (95% CI, 0.13-0.68) for ischemic heart disease mortality. Adjusted population-attributable fractions were 59% for all-cause mortality, 64% for CVD mortality and 63% for ischemic heart disease mortality, according to the study results. Meeting a greater number of CV health metrics also appeared to be associated with lower risk for all-cancer mortality, the researchers noted.
Younger participants, women, non-Hispanic whites and adults with a higher education level tended to meet a greater number of CV health metrics.
Additionally, during the study period, the prevalence of current smoking declined from 27.8% in 1988-1994 to 22.6% in 2005-2010. Similar trends were observed for adults who maintained a healthy diet, have a BMI less than 25 and have fasting glucose levels less than 100 mg/dL. However, the prevalence of adults with cholesterol levels less than 200 mg/dL and BP less than 120 mm Hg/80 mm Hg remained largely unchanged from 1988 to 2010.
In an accompanying editorial, Donald M. Lloyd-Jones, MD, ScM, of the department of preventive medicine and division of cardiology at the Northwestern University Feinberg School of Medicine, said a proposed concept to shift the population distribution toward greater health is key to improving CV health.
“Despite the apparent difficulties in achieving the goal, there is much to be optimistic about, and opportunities abound for physicians, policy makers and consumers to support improvements in CV health,” Lloyd-Jones wrote. “Continued focus through the health care system on meeting primary and secondary prevention targets is critically important, so that individuals at risk can take one step forward from poor to intermediate CV health.”
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Disclosure: The researchers and Dr. Lloyd-Jones report no relevant financial disclosures.