Author + information
- Adnan Younus, MD,
- Ehimen C. Aneni, MD, MPH,
- Erica S. Spatz, MD, MPH,
- Chukwuemeka U. Osondu, MD, MPH,
- Sameer Shaharyar, MD, MHS,
- Lara Roberson, MPH,
- Shozab S. Ali, MD,
- Oluseye Ogunmoroti, MD, MPH,
- Rameez Ahmad, MD,
- Janisse Post, RN, MSH,
- Theodore Feldman, MD,
- Wasim Maziak, MD, PhD,
- Arthur S. Agatston, MD,
- Emir Veledar, PhD and
- Khurram Nasir, MD, MPH∗ ()
- ↵∗Center for Healthcare Advancement & Outcomes, Baptist Health South Florida, 1500 San Remo Avenue, Suite 340, Coral Gables, Florida 33139
In 2010, the American Heart Association set 2020 national goals for promoting cardiovascular health (CVH), emphasizing measurement of reproducible health behaviors and health factors and attaining ideal CVH status (1). In this letter, we describe the frequency of ideal status for individual CVH metrics with a focus on presence of ideal CVH.
The MEDLINE database was searched for studies conducted in U.S. adults (age ≥18 years) between January 2000 and June 2015. Studies without information on individual metrics or numeric CVH index were excluded. Ideal CVH was defined as 6 to 7 ideal factors or ≥11 points on a 14-point scale (each factor scored 0, 1, or 2 for poor, intermediate, and ideal, respectively).
Overall, 18 studies were included in this review with 16 reported frequencies of individual CVH metrics, whereas 15 had information on ideal CVH categorization (Table 1). Across varying population cohorts studied from 1987 to 2014 in the United States, the diet metric consistently appeared suboptimal with 10 of 16 (63%) studies reporting ideal proportions of ≤5%. None of the studies reported ideal body mass index or blood pressure metrics >50%. Presence of ideal status >50% was noted in 13 of 18 (81%) for smoking and blood glucose metrics, respectively. Overall, ideal CVH was very low ranging from 1% to 12% with 11 of 15 (73%) studies reporting ≤5% prevalence.
There is convincing evidence that ideal CVH, as described in the American Heart Association 2020 goal, protects from cardiovascular and all-cause mortality. Lack of substantial change in ideal CVH status over the last 2 decades and a projected 6% improvement by 2020 underscores emergent need for coordinated efforts to maximize gains in near-term for sustainable impact (1). The results of our findings show that metrics most likely to achieve the highest yield are healthy diet and physical activity because they are noted to be least prevalent uniformly across all cohorts studied in the United States. Systematic efforts focusing on these targets will likely accelerate achieving ideal CVH goals by also indirectly influencing attainment of favorable status for body mass index, blood pressure, and fasting glucose metrics.
Please note: Dr. Nasir is on the advisory board for Quest Diagnostic; and is a consultant for Regeneron. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Younus and Aneni contributed equally to this work.
- American College of Cardiology Foundation