What is the clinical evidence from this study?

Study design: Observational. Population: Cardiovascular disease (n=42143). Intervention: High cardiovascular health (CVH) vs. Low and moderate CVH. Primary outcome: Population attributable fractions of CVD and number of CVD events prevented annually (PAF 70.0%, 95% CI 56.5%-79.9%).

March 25, 2021Open Access

Estimated Impact of Achieving Optimal Cardiovascular Health Among US Adults on Cardiovascular Disease Events

Key Result

Achieving high cardiovascular health among all US adults could prevent an estimated 2.0 million (95% CI, 1.6-2.3 million) cardiovascular disease events annually.

Study Design

Type

Observational (n=42,143)

Multicenter

Yes

Structured PICO

Does achieving optimal cardiovascular health reduce the number of major CVD events in US adults?

Population

US adults from the National Health and Nutrition Examination Survey 2011 to 2016 (n=11,696) and 7 US community-based cohort studies (n=30,447)

Intervention

Achieving high cardiovascular health (CVH) (12-14 points on 7 American Heart Association CVH metrics)

Comparator

Low (0-8 points) or moderate (9-11 points) cardiovascular health

Outcome

Annual incidence rates of major CVD events, population attributable fractions of CVD, and number of CVD events prevented annuallyhard clinical

Achieving high cardiovascular health across the US adult population could prevent up to 2 million major CVD events annually, highlighting the massive public health potential of cardiovascular prevention.

Main Result

Effect estimate: PAF 70.0% (95% CI 56.5%-79.9%)

Abstract

Background Better cardiovascular health (CVH) scores are associated with lower risk of cardiovascular disease (CVD). However, estimates of the potential population-level impact of improving CVH on US CVD event rates are not currently available. Methods and Results Using data from the National Health and Nutrition Examination Survey 2011 to 2016 (n=11 696), we estimated the proportions of US adults in CVH groups. Levels of 7 American Heart Association CVH metrics were scored as ideal (2 points), intermediate (1 point), or poor (0 points), and summed to define overall CVH (low, 0-8 points; moderate, 9-11 points; or high, 12-14 points). Using individual-level data from 7 US community-based cohort studies (n=30 447), we estimated annual incidence rates of major CVD events by levels of CVH. Using the combined data sources, we estimated population attributable fractions of CVD and the number of CVD events that could be prevented annually if all US adults achieved high CVH. High CVH was identified in 7.3% (95% CI, 6.3%-8.3%) of US adults. We estimated that 70.0% (95% CI, 56.5%-79.9%) of CVD events were attributable to low and moderate CVH. If all US adults attained high CVH, we estimated that 2.0 (95% CI, 1.6-2.3) million CVD events could be prevented annually. If all US adults with low CVH attained moderate CVH, we estimated that 1.2 (95% CI, 1.0-1.4) million CVD events could be prevented annually. Conclusions The potential benefits of achieving high CVH in all US adults are considerable, and even a partial improvement in CVH scores would be highly beneficial.