US: Measuring heart healthy activities

While it is well known that the US population is becoming increasingly heavier and more sedentary, it is unclear what proportion of the adult US population is engaged in heart healthy activities and whether this proportion has changed over time...

Title: Trends in cardiovascular health metrics and associations with all-cause and CVD mortality among US adults

Authors: Q Yang, M Cogswell, W Flanders, Y Hong, et al.

Reference: JAMA 2012; 307(12):1273-1283 (open access)

http://bit.ly/Hbfj2Q

Reviewer: Robert Goldberg, PhD, Contributing editor, ProCor; Professor of Medicine and Epidemiology, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA

Reviewer comments: There are a number of positive lifestyle practices that have been consistently associated with a reduced risk for CVD and coronary heart disease (CHD). These include not smoking cigarettes, eating healthy, and maintaining normal levels of blood pressure, serum glucose, serum lipids, and weight. While it is well known that the US population is becoming increasingly heavier and more sedentary, it is unclear what proportion of the adult US population is engaged in heart healthy activities, whether this proportion has changed over time, and the relation between these different CVD health metrics and all cause and CVD/CHD specific mortality.

The results of the present study, using data from the nationally representative NHANES cross-sectional and longitudinal studies, provide insights into overall and changing heart healthy practices in the US population and the impact of few, versus many, positive lifestyle practices/CVD health metrics on all-cause and cause-specific death rates. The results of this study showed that extremely few (less than 5%) of NHANES participants met all seven CVD health metrics, such as not smoking, being physically active, and eating a healthy diet, and the risk of dying from all-causes, CVD, and specifically from CHD was markedly higher in individuals with few positive lifestyle practices as compared to those with many positive health behaviors.

The present findings reinforce earlier results from observational epidemiologic studies that positive CVD lifestyle health behaviors are associated with an overall lower risk of dying, especially from CVD and CHD. On the other hand, much work needs to be done by the American public in this preventive health area as an extremely small percentage of the general adult population met all seven CVD health metrics. These data argue for more concerted national efforts to encourage the American public to engage in heart healthy behaviors and take the beginning steps to achieving better CVD health and fitness. Realistic targets can be set by individuals, their families, and their health care providers to become increasingly engaged in aerobic physical activity, stop smoking (or not take up this habit in the first place), and consume more vegetables, fruits, and legumes, and less red meat and fatty foods, which will also translate to beneficial effects on one's waistline, serum lipids, and blood pressure levels.

Purpose of study: To examine time trends in seven CVD health metrics and the impact of these lifestyle practices on all-cause, CVD, and CHD mortality in US adults

Location of study: US

Study design: Cross-sectional and longitudinal

Results: The authors used data from the nationally representative NHANES surveys to examine the proposed associations in. This included data from NHANES III for the period 1986-1994 (n=16,215), 1999-2004 (n=13,097), and 2005-2010 (n=15,647). The seven CVD health metrics that were examined included not smoking, being physically active, having normal levels of blood pressure, serum glucose, total cholesterol, and weight, and eating a healthy diet.

The mean age of the population included in these investigations was approximately 46 years, slightly more than half were women, and nearly three quarters were white.

In terms of specific risk factors, the prevalence of current smoking declined from the first NHANES survey (28%) to the most recent surveys between 2005 and 2010 (23%). On the other hand, the prevalence of consuming a healthy diet, having a BMI less than 25, and having a desirable serum glucose level declined over time.

Relatively few (less than 2%) of all surveyed individuals satisfied all seven CVD health metrics. The prevalence of six or more CVD health metrics was 10.3% in 1988-94 and 8.8% in 2005-2010 whereas the prevalence of 1 or fewer positive CVD health practices increased from 7.2% to 8.8% over this period.

In this study sample, a total of 2673 persons died, 1085 from CVD and 576 from CHD, over a median follow-up of 14.5 years. The all-cause, CVD, and CHD specific death rates were appreciably higher in persons who had one or fewer CVD health metrics (15, seven, and four deaths/1,000 person years, respectively) as compared to those who had six or more metrics with corresponding rates of five, two, and 0.5, respectively. This translated into multivariable adjusted hazard ratios of 0.49, 0.24, and 0.30 for all-cause, CVD, and CHD mortality, comparing persons who had 6 or more positive lifestyle behaviors to those with one or fewer.

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