Abstract
Background:
The American Heart Association’s metric of ideal cardiovascular health (CVH) has been previously associated with vascular events, mortality, and subclinical atherosclerotic disease, but its association with functional impairment independent of cardiovascular disease and stroke has not been explored. We hypothesized that ideal CVH predicts improved long-term functional status after adjusting for incident stroke and myocardial infarction.
Methods:
In the prospective, multiethnic Northern Manhattan Study, stroke-free individuals in northern Manhattan aged >=40 years had annual assessments of disability with the Barthel index (BI), for a median of 13 years. Baseline demographics, medical risk factors, and laboratory studies were collected. Ideal CVH was calculated as a composite of 7 measures, each scored on a scale of 0-2: smoking, body mass index, physical activity, diet, total cholesterol, blood pressure, and fasting plasma glucose. This analysis was based on: 1) number of ideal CVH metrics, and 2) total score of all CVH metrics.
Results:
Of 3219 participants, mean age was 69 years (SD 10), 63% were female, 21% non-Hispanic White, 25% non-Hispanic black, and 54% Hispanic. Twenty percent had 0-1 ideal CVH metrics, 32% had 2, 30% had 3, 14% had 4, and 4% had 5-7. Both the number of ideal CVH categories and higher total CVH metric scores were associated with higher mean BI scores at 5 and 10 years. These gradients persisted when results were adjusted for incident stroke and MI, when mobility and non-mobility domains of the BI were analyzed separately, and when the BI was analyzed dichotomously. At 10 years, in a fully adjusted model, differences in mean BI score were lower for poor versus ideal physical activity (3.48 points, p<0.0001) and fasting glucose (4.58 points, p<0.0001).
Conclusions:
Ideal CVH predicts functional impairment, even after accounting for incident vascular events. Vascular functional impairment is an important outcome, and further research is needed to determine whether it may be improved by optimizing vascular health. Achieving the AHA 2020 goal will not only have favorable effects on stroke and MI, but also likely reduce functional impairment.