Elsevier

Mayo Clinic Proceedings

Volume 87, Issue 10, October 2012, Pages 944-952
Mayo Clinic Proceedings

Original article
Ideal Cardiovascular Health and Mortality: Aerobics Center Longitudinal Study

https://doi.org/10.1016/j.mayocp.2012.07.015Get rights and content

Abstract

Objective

To analyze the relationship of ideal cardiovascular health to disease-specific death.

Patients and Methods

We used data from the Aerobics Center Longitudinal Study from October 9, 1987, to March 3, 1999, to estimate the prevalence of ideal cardiovascular health in 11,993 individuals (24.3% women) and to examine its relationship with deaths from all causes, cardiovascular disease (CVD), and cancer.

Results

During a mean follow-up of 11.6 years, 305 deaths occurred: 70 (23.0%) from CVD and 127 (41.6%) from cancer. In the entire cohort, only 29 individuals (0.2%) had 7 ideal metrics. After adjusting for age, sex, examination year, alcohol intake, and parental history of CVD, risk of death due to CVD was 55% lower in those participants who met 3 or 4 ideal metrics (hazard ratio, 0.45; 95% confidence interval, 0.27-0.77) and 63% lower in those with 5 to 7 ideal metrics (hazard ratio, 0.37; 95% confidence interval, 0.15-0.95), compared with those who met 0 to 2 ideal metrics. Although not significant, there was also a trend toward lower risk of death due to all causes across incremental numbers of ideal metrics. No association was observed for deaths due to cancer.

Conclusion

The prevalence of ideal cardiovascular health was extremely low in a middle-aged cohort of men and women recruited between 1987 and 1999. The American Heart Association construct reflects well the subsequent risk of CVD, as reflected by graded CVD mortality in relation to the number of ideal metrics.

Section snippets

Study Population

The ACLS is a prospective observational study of individuals who underwent extensive preventive medical evaluation at the Cooper Clinic (Dallas, TX).12, 13 Participants were unpaid volunteers sent by their employers or physicians or were self-referred. All participants gave informed consent to participate in the study. The Cooper Institute Institutional Review Board reviewed and approved the study protocol annually.

The present study included all participants aged 20 years or older with

Results

Descriptive characteristics of the study population are given in Table 2. Mean (SD) age of the study population was 46.0 (9.9) years. Decedents had higher baseline values for age, BMI, total cholesterol and fasting plasma glucose concentrations, and blood pressure, as well as a higher prevalence of current smokers and individuals with hypercholesterolemia, diabetes mellitus, and hypertension. Values and prevalence of most characteristics also differed by sex.

The prevalence of poor,

Discussion

The AHA 2020 Impact Goal includes a new construct of cardiovascular health and presents metrics to monitor it over time.10 The 2 main findings in our study were that (1) among middle-aged men and women enrolled in the ACLS between 1987 and 1999, only 0.2% had ideal cardiovascular health (ie, ideal levels of all 7 metrics); and (2) the AHA construct indeed well reflects the subsequent risk of CVD, as reflected by graded CVD mortality in relation to the number of ideal metrics.

Comparable

Conclusion

The prevalence of ideal cardiovascular health is extremely low in a middle-aged cohort of men and women enrolled in the ACLS between 1987 and 1999. We found a decreasing number of deaths due to CVD in association with increasing numbers of ideal metrics. A tendency was observed only in the case of deaths due to all causes, and no association was found with deaths due to cancer. Our data support the notion that deaths due to CVD might be reduced by primordial prevention, in which individuals

Acknowledgments

We thank the Cooper Clinic physicians and technicians for collecting the data and staff at the Cooper Institute for data entry and data management.

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    See editorial comment, page 929

    Grant Support: This work was supported by National Institutes of Health grants AG06945, HL62508, and R21DK088195; by an unrestricted research grant from The Coca-Cola Co, Atlanta, GA; and by Spanish Ministry of Education grants EX-2009-0899 and EX-2010-1008.

    Potential Competing Interests: Dr Blair receives book royalties (<$5000/y) from Human Kinetics Publishers, Inc, Champaign, IL; and honoraria for service on the scientific/medical advisory boards of Alere, Inc, Waltham, MA; Technogym USA Corp, Seattle, WA; Santech, San Diego, CA; and Jenny Craig, Inc, Carlsbad, CA, and for lectures and consultations from scientific, corporate, educational, and lay groups.

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