Meeting Greater Number of Recommended Cardiovascular Health Factors Linked with Lower Risk of Death

In a study that included a nationally representative sample of nearly 45,000 adults, participants who met more of seven recommended cardiovascular health behaviors or factors (such as not smoking, having normal cholesterol levels, eating a healthy diet), had a lower risk of death compared to participants who met fewer factors, although only a low percentage of adults met all seven factors, according to a study appearing in JAMA. The study is being published early online to coincide with its presentation at a specialty meeting of the American Heart Association.

"Cardiovascular disease (CVD) is the leading cause of deaths in the United States [greater than 800,000, or about 1 in 3 overall deaths/year], with estimated annual direct and overall costs of $273 billion and $444 billion, respectively," according to background information in the article. The American Heart Association (AHA) recently published recommendations aimed at improving cardiovascular health and reducing deaths from CVD in the United States by encouraging the general population to meet seven defined ideal cardiovascular health behaviors or factors (for this study, called cardiovascular health metrics). The metrics are not smoking; being physically active; having normal blood pressure, blood glucose and total cholesterol levels, and weight; and eating a healthy diet.

Quanhe Yang, Ph.D., of the Centers for Disease Control and Prevention, Atlanta, and colleagues conducted a study to examine the trends of these health metrics and estimated their associations with risk of all-cause and CVD mortality. The study included 44,959 U.S. adults (age 20 years or older), using data from the National Health and Nutrition Examination Survey (NHANES) 1988-1994,1999-2004, and 2005-2010 and the NHANES III Linked Mortality File (through 2006).

The researchers found that regarding trends over the study period, the prevalence of current smoking continued to decline since 1988. However, the desirable level of untreated blood pressure and total cholesterol level remained unchanged, and the prevalence of desirable levels of body mass index (BMI) (less than 25) and fasting glucose continued to decline for the study period.

Few participants met all 7 cardiovascular health metrics (2.0 percent in 1988-1994, 1.2 percent in 2005-2010). Younger participants, women, non-Hispanic whites, and those with higher education levels tended to meet a greater number of cardiovascular health metrics.

The authors found that meeting a greater number of cardiovascular health metrics was associated with a significantly lower risk of all-cause, CVD, and ischemic heart disease (IHD) mortality. "During a median [midpoint] of 14.5 years of follow-up in the NHANES III Linked Mortality File cohort, participants who met 6 or more vs. 1 or fewer cardiovascular health metrics had a 51 percent lower risk of all-cause mortality, a 76 percent lower risk of CVD mortality, and a 70 percent lower risk of IHD mortality. In addition, meeting a greater number of cardiovascular health metrics also appeared to be associated with lower risk for all-cancer mortality."