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Healthy Heart Score performs ‘moderately well’ estimating risk for early CVD events

In mostly healthy younger adults, the Healthy Heart Score predicted premature atherosclerotic CVD events moderately well, making it a viable tool for risk assessment and counseling for primary prevention of the disease, according to findings published in JAMA Internal Medicine.

“Mortality rates associated with atherosclerotic cardiovascular disease (ASCVD) have steadily declined in past decades owing to advances in prevention, detection, and treatment,” Holly C. Gooding, MD, MS, from Boston Children’s Hospital, and colleagues wrote. “Unfortunately, scientists caution this trend may soon reverse owing to increasing obesity rates and unhealthy diet and exercise patterns in younger individuals. Adolescents and young adults are a prime target for ASCVD prevention efforts, especially because most do not yet have major clinical risk factors for ASCVD, such as hypertension, hyperlipidemia and diabetes.”

“Although numerous risk calculators exist to estimate the future risk for ASCVD among individuals and populations, few are validated for use in adults younger than 30 years of age,” they added.

Gooding and colleagues evaluated the effectiveness of the Healthy Heart Score at estimating the 25-year risk for ASCVD events, such as death from coronary heart disease, nonfatal myocardial infarction, and fatal or nonfatal ischemic stroke, that occur before 55 years of age. They enrolled 4,893 mostly healthy adults aged between 18 and 30 years (45.1% men; mean age at baseline, 24.8 years; 50.7% black). Among the cohort, 8.7% had at least one clinical ASCVD risk factor — hypertension, hyperlipidemia or type 1 or type 2 diabetes — from the Coronary Artery Risk Development in Young Adults study. The researchers measured and/or documented lifestyle factors, including age, smoking status, BMI, alcohol intake and exercise; and daily intake of cereal fiber, fruits and/or vegetables, nuts, sugar-sweetened beverages and red and/or processed meats. Baseline measurements were conducted between March 25, 1985, and June 7, 1986. Participants were followed for a median of 27.1 years. The Healthy Heart Score, a lifestyle-based risk tool, was calculated by using sex-specific equations.

Data showed that there were 64 premature ASCVD events in women and 99 in men. Moderate discrimination for ASCVD risk assessment was observed when using the Healthy Heart Score (C statistic = 0.71; 95% CI, 0.66-0.76). The score performed better in men (C statistic = 0.74; 95% CI, 0.68-0.79), whites (C statistic = 0.77; 95% CI, 0.71-0.84) and those without clinical risk factors at baseline (C statistic = 0.71; 95% CI, 0.66-0.76) vs. women (C statistic = 0.69; 95% CI, 0.62-0.75), blacks (C statistic = 0.66; 95% CI, 0.6-0.72) and those with clinical risk factors at baseline (C statistic = 0.64; 95% CI, 0.55-0.73). There was adequate calibration of the Healthy Heart Score overall and within each subgroup.

“The [Healthy Heart Score], when measured in younger persons without ASCVD risk factors, performs moderately well in assessing risk for ASCVD events by early middle age,” Gooding and colleagues wrote. “Its reliance on self-reported, modifiable lifestyle factors makes it an attractive tool for risk assessment and counseling for early ASCVD prevention.” – by Alaina Tedesco

Disclosure: The researchers report no relevant financial disclosures.