January 21, 2016Open Access

Positive changes in ideal CVH metrics reduce the incidence of stroke

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Stroke (n=64373). Intervention: Increase in ideal cardiovascular health (CVH) metrics vs. Baseline CVH metrics (per 1-metric increase). Primary outcome: First occurrence of stroke (HR 0.87, 95% CI 0.83-0.92, p=<0.001).

Key Result

Each increase in the number of ideal cardiovascular health metrics from 2006 to 2008 was associated with a 13% reduction in the risk of incident stroke (HR 0.87).

Study Design

Type

Cohort (n=64,373)

Multicenter

Yes

Structured PICO

Do positive changes in ideal cardiovascular health metrics reduce the incidence of stroke in participants of the Kailuan study?

Population

64,373 participants aged 18-98 years from the Kailuan study, free of prior stroke or myocardial infarction, followed for 4.89 person-years to assess the impact of changes in cardiovascular health metrics on stroke incidence.

Exposure

Positive changes (increase) in the numbers and total scores for the 7 ideal cardiovascular health (CVH) metrics from 2006 to 2008

Comparator

Participants whose CVH metrics deteriorated or stayed the same

Outcome

Incidence of total strokehard clinical

Positive changes in ideal cardiovascular health metrics over a 2-year period are associated with a significantly reduced subsequent risk of incident stroke.

Main Result

Hazard Ratio: 0.87 (95% CI 0.83–0.92)

p-value: p=<0.001

Limitations

The Kailuan study was not a nationwide study, and a large proportion of the participants were manual workers, limiting generalizability.
Modified definitions of physical activity and diet were used to compute scores for the relevant CVH metrics.
Assessments of diet, smoking habits, and physical activity levels were based on self-reports.
The mean follow-up period may not have been long enough to observe a sufficiently large number of stroke events for subtype analysis.
Cannot completely exclude the effects of residual confounding factors related to unmeasured lifestyle factors, such as stress and depression.

Abstract

The American Heart Association defined 7 ideal cardiovascular health (CVH) metrics and the benefits of them in reducing the incidence of stroke are well established, but it is unclear whether changes in them alter stroke risk. We calculated the changes of 7 ideal CVH metrics from 2006 to 2008 among 64,373 participants in the Kailuan study. We tested whether changes in the numbers and total scores for the CVH metrics were associated with the incidence of stroke in the 4.89 person-years follow-up. Cox regression modeling was used to estimate the risk of stroke. By year 2008, CVH metrics number of 32.54% participants improved (change ≥+1); 31.90% deteriorated (≤-1); 35.56% stayed the same; In the follow-up,we identified1,182 incident stroke events. Each increase in CVH metrics and every 1-point increase in total CVH score from 2006 to 2008 were associated with reduced odds of total stroke (hazard ratio = 0.87; 95% confidence interval; 0.83-0.92 and 0.890.86-0.92 respectively), after adjusting for age, gender, educational level, income and scores for the metrics of ideal CVH at baseline. Positive changes in ideal CVH metrics reduce the incidence of stroke. Our results support the concept that achieving ideal CVH helps to prevent stroke.

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Cite This Study

Yang et al. (Thu,) conducted a cohort in Stroke (n=64,373). Increase in ideal cardiovascular health (CVH) metrics vs. Baseline CVH metrics (per 1-metric increase) was evaluated on First occurrence of stroke (HR 0.87, 95% CI 0.83-0.92, p=<0.001). Each increase in the number of ideal cardiovascular health metrics from 2006 to 2008 was associated with a 13% reduction in the risk of incident stroke (HR 0.87).

synapsesocial.com/papers/6a20e6e976382611e518178a https://doi.org/https://doi.org/10.1038/srep19673

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