Association of Change in Cardiovascular Risk Factors With Incident Cardiovascular Events

Abstract

<div class="section"> <a class="named-anchor" id="ab-joi180131-1"> <!-- named anchor --> </a> <h5 class="section-title" id="d3783173e418">Question</h5> <p id="d3783173e420">Are changes in cardiovascular health associated with incident cardiovascular events?</p> </div><div class="section"> <a class="named-anchor" id="ab-joi180131-2"> <!-- named anchor --> </a> <h5 class="section-title" id="d3783173e423">Findings</h5> <p id="d3783173e425">In this prospective cohort study that included 9256 participants without cardiovascular disease (CVD), changes over 10 years in category of cardiovascular health, based on a composite metric, did not show a consistent association with incident CVD. For example, while increase from a moderate to a high category of cardiovascular health was associated with a significant hazard ratio of 0.39, decrease from a high to a low category of cardiovascular health was also associated with a significant hazard ratio of 0.49. </p> </div><div class="section"> <a class="named-anchor" id="ab-joi180131-3"> <!-- named anchor --> </a> <h5 class="section-title" id="d3783173e428">Meaning</h5> <p id="d3783173e430">This study did not find a consistent relationship between direction of change in category of a composite metric of cardiovascular health and risk of CVD. </p> </div><div class="section"> <a class="named-anchor" id="ab-joi180131-4"> <!-- named anchor --> </a> <h5 class="section-title" id="d3783173e434">Importance</h5> <p id="d3783173e436">There is consistent evidence of the association between ideal cardiovascular health and lower incident cardiovascular disease (CVD); however, most studies used a single measure of cardiovascular health. </p> </div><div class="section"> <a class="named-anchor" id="ab-joi180131-5"> <!-- named anchor --> </a> <h5 class="section-title" id="d3783173e439">Objective</h5> <p id="d3783173e441">To examine how cardiovascular health changes over time and whether these changes are associated with incident CVD. </p> </div><div class="section"> <a class="named-anchor" id="ab-joi180131-6"> <!-- named anchor --> </a> <h5 class="section-title" id="d3783173e444">Design, Setting, and Participants</h5> <p id="d3783173e446">Prospective cohort study in a UK general community (Whitehall II), with examinations of cardiovascular health from 1985/1988 (baseline) and every 5 years thereafter until 2015/2016 and follow-up for incident CVD until March 2017. </p> </div><div class="section"> <a class="named-anchor" id="ab-joi180131-7"> <!-- named anchor --> </a> <h5 class="section-title" id="d3783173e449">Exposures</h5> <p id="d3783173e451">Using the 7 metrics of the American Heart Association (nonsmoking; and ideal levels of body mass index, physical activity, diet, blood pressure, fasting blood glucose, and total cholesterol), participants with 0 to 2, 3 to 4, and 5 to 7 ideal metrics were categorized as having low, moderate, and high cardiovascular health. Change in cardiovascular health over 10 years between 1985/1988 and 1997/1999 was considered. </p> </div><div class="section"> <a class="named-anchor" id="ab-joi180131-8"> <!-- named anchor --> </a> <h5 class="section-title" id="d3783173e454">Main Outcome and Measure</h5> <p id="d3783173e456">Incident CVD (coronary heart disease and stroke).</p> </div><div class="section"> <a class="named-anchor" id="ab-joi180131-9"> <!-- named anchor --> </a> <h5 class="section-title" id="d3783173e459">Results</h5> <p id="d3783173e461">The study population included 9256 participants without prior CVD (mean [SD] age at baseline, 44.8 [6.0] years; 2941 [32%] women), of whom 6326 had data about cardiovascular health change. Over a median follow-up of 18.9 years after 1997/1999, 1114 incident CVD events occurred. In multivariable analysis and compared with individuals with persistently low cardiovascular health (consistently low group, 13.5% of participants; CVD incident rate per 1000 person-years, 9.6 [95% CI, 8.4-10.9]), there was no significant association with CVD risk in the low to moderate group (6.8% of participants; absolute rate difference per 1000 person-years, −1.9 [95% CI, −3.9 to 0.1]; HR, 0.84 [95% CI, 0.66-1.08]), the low to high group, (0.3% of participants; absolute rate difference per 1000 person-years, −7.7 [95% CI, −11.5 to −3.9]; HR, 0.19 [95% CI, 0.03-1.35]), and the moderate to low group (18.0% of participants; absolute rate difference per 1000 person-years, −1.3 [95% CI, −3.0 to 0.3]; HR, 0.96 [95% CI, 0.80-1.15]). A lower CVD risk was observed in the consistently moderate group (38.9% of participants; absolute rate difference per 1000 person-years, −4.2 [95% CI, −5.5 to −2.8]; HR, 0.62 [95% CI, 0.53-0.74]), the moderate to high group (5.8% of participants; absolute rate difference per 1000 person-years, −6.4 [95% CI, −8.0 to −4.7]; HR, 0.39 [95% CI, 0.27-0.56]), the high to low group (1.9% of participants; absolute rate difference per 1000 person-years, −5.3 [95% CI, −7.8 to −2.8]; HR, 0.49 [95% CI, 0.29-0.83]), the high to moderate group (9.3% of participants; absolute rate difference per 1000 person-years, −4.5 [95% CI, −6.2 to −2.9]; HR, 0.66 [95% CI, 0.51-0.85]), and the consistently high group (5.5% of participants; absolute rate difference per 1000 person-years, −5.6 [95% CI, −7.4 to −3.9]; HR, 0.57 [95% CI, 0.40-0.80]). </p> </div><div class="section"> <a class="named-anchor" id="ab-joi180131-10"> <!-- named anchor --> </a> <h5 class="section-title" id="d3783173e464">Conclusions and Relevance</h5> <p id="d3783173e466">Among a group of participants without CVD who received follow-up over a median 18.9 years, there was no consistent relationship between direction of change in category of a composite metric of cardiovascular health and risk of CVD. </p> </div><p class="first" id="d3783173e469">This cohort study uses UK Whitehall II study data to characterize changes in cardiovascular risk factors over 10 years and associations between change in risk and incident cardiovascular events among people without baseline cardiovascular disease. </p>