Relationship Between Cardiovascular Health Score, Coronary Artery Calcification And Cardiovascular Events In Community Populatio

Part Ⅰ The Association of Ideal Cardiovascular Health with Coronary Artery Calcium at Baseline in a Community-based PopulationObjective:To evaluate the association of ideal cardiovascular health(CVH)with the presence and severity of subclinical atherosclerosis measured as coronary artery calcium(CAC)in Chinese community-based population.Methods and materials:Residents aged 35-75 years old from Xishan community of Beijing were selected to participate in the cardiovascular disease risk factor survey and CT coronary artery calcium(CAC)scan by typical sampling method from 2009 to 2010 and 2012.The ideal CVH metrics(including smoke,body mass index,physical activity,health diet,total cholesterol,blood pressure and fasting blood glucose)were determined based on the definition of the American Heart Association(AHA).All participants were grouped into three categories according to the number of ideal CVH metrics:0-2,3-4,and 5-7.Multi-slice CT was used for CAC scanning and Agatston score was used to calculate CAC scores(CACS).Diffuse calcification was defined as calcification involving more than 3 coronary arteries.Results:Of 1068 participants,427(39.98%)showed CACS>0.The prevalence of CACS>0 in 0-2,3-4 and 5-7 ideal CVH metrics subgroups was 61.26%,41.84%and 22.92%,respectively.The more ideal CVH metrics,the lower CAC burden and diffusivity.Compared with 0-2 ideal CVH metrics,participants with 3-4,5-7 ideal CVH metrics had a lower risk of CACS>0[OR=0.44(0.30,0.64),0,28(0.18,0.44),all P<0.001],a lower risk of CACS>400[OR=0.56(0.32,0.97),P=0.037;0.22(0.09,0.54),P=0.001],and a lower risk of diffuse calcification[OR=0.51(0.32,0.79),P=0.003;0.22(0.11,0.44),P<0.001].Conclusion:The participants with more ideal CVH metrics had a lower prevalence of CAC,as well as a lower burden and diffusivity of CAC.Maintaining an ideal CVH may be valuable in the prevention of atherosclerosis in the general population.Part Ⅱ The Association of Cardiovascular Health Score with Progression of Coronary Artery Calcium in a Community-based PopulationObjective:We examined the association of cardiovascular health(CVH)with the development and progression of coronary artery calcium(CAC)among community population.Methods and Materials:Residents aged 35-75 in Beijing Xishan Community were invited to participate in the study through typical sampling.All participants completed a questionnaire about the baseline cardiovascular risk factor and two CT coronary artery calcium(CAC)scans.According to the American Heart Association(AHA)recommendation and Chinese dietary guidelines,we defined 7 CVH metrics,including smoking,body mass index,physical activity,dietary habits,blood pressure,total cholesterol,and fasting glucose.Levels of each metric were classified as ideal(2 points),intermediate(1 point),and poor(0 points).Points were summed to produce a CVH score(CHS).CAC score(CACS)was evaluated by Agatston score.The differences of incidence and severity of CAC progression were compared among different CVH status.Results:A total of 734 patients were included,with an average age of 52.41±8.51 years and 363(49.46%)males,and 498(67.85%)participants had CACS=0 at baseline.During a median follow-up of 875(861,889)days,258(35.15%)experienced CAC progression.The incidence and severity of CAC progression varied in different numbers of ideal CVH metrics or CHS.Logistic regression analysis showed that CAC progression was correlated with the number of ideal CVH metrics and CHS,and the odd ratios(ORs)were 0.65(0.56,0.75)and 0.77(0.71,0.84)(all P<0.001).Taking the number of 0-2 ideal CVH metrics as a reference,the ORs of 3-4 and 5-7 ideal CVH metrics for CAC progression were 0.32(0.20,0.50)and 0.22(0.13,0.38)(P<0.001).Compared with participants with CHS=3-8,the ORs of CAC progression in participants of CHS=9-10,11-14 subgroups were 0.42(0.28,0.61)and 0.37(0.24,0.58)(P<0.001).The annualized progression of CACS with 0-2,3-4 and 5-7 ideal metrics was 50.48±8.87,42.10±6.13 and 32.87±10.49,respectively,with no significance(P=0.436).The annualized progression of CACS with CHS=3-8,9-10,and 11-14 was 50.94±6.20,41.42±8.25 and 20.49±10.51,respectively(P=0.046).Conclusions:Cardiovascular health was correlated with the progression of CAC.The higher the ideal CVH metrics or CHS score,the lower incidence of CAC progression.The higher CHS was,the lower severity of CAC progression was.It is suggested that paying more attention to and actively improving cardiovascular health could slow down the development and progression of subclinical coronary atherosclerosis.Part Ⅲ Association of Ideal Cardiovascular Health and Coronary Artery Calcium with Cardiovascular Events—a 10-year Follow Up StudyObjectives:To examine the association of ideal cardiovascular health(CVH)with major adverse cardiovascular events(MACEs)at different degrees of coronary artery calcium(CAC),and whether cardiovascular health score(CHS)provides additional predictive value on MACEs over coronary calcium score(CACS).Methods:719 participants free of heart disease or stroke at baseline in a community-based cohort study during 2009-2010 were involved.The American Heart Association has proposed a definition of CVH,including 7 metrics,and each metric levels were classified as ideal(2 points),intermediate(1 point),and poor(0 points).Points were summed to produce a CHS(3-8,9-10,11-14).Cox regression models were used to estimate the hazard ratios(HRs)of CHS for the risk of MACEs.Analyses were stratified by CACS(0,1400,>400).Results:61(8.48%)MACEs were recorded during a median follow up of 9.91(9.83,10.91)years.Participants with higher CHS had lower incidence of MACEs.In CACS=0 group,participants with CHS=9-10,11-14 had lower risks of MACEs compared with CHS=3-8[HRs=0.237(0.070,0.799)and 0.129(0.026,0.649),P<0.05]after adjusting for age,gender;income,education level,drinking and family history of CVD.In CACS=1-400 group,HRs of CHS=9-10,11-14 were 0.273(0.100,0.745),0.091(0.012,0.705)(all P<0.05).In group of CACS>400,the HRs of CHS=9-10,11-14 were nonsignificant compared with that of CHS=3-8[HRs=0.386(0.117,1.274),0.295(0.054,1.604),all P>0.05].CHS and CACS predicted risk of MACEs with similar value,and the area under curve(AUC)was 0.756(0.723,0.787),0.723(0.688,0.755)(P=0.441).Using both scores together,the AUC increased to 0.818(0.788,0.846).Conclusions:Ideal CVH was associated with lower risk of mortality and CVD events overall,especially in participants with CACS=0 and 1-400,while the association was not significant in those with CACS>400.CACS and CHS had equal value in predicting 10year risk of MACEs.Using both scores together can increase the predictive value.