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Research Project: Childhood Obesity Prevention

Location: Children's Nutrition Research Center

Title: Factors of health in the protection against death and cardiovascular disease among adults with subclinical atherosclerosis

Author
item Rifai, Mahmoud - University Of Kansas Medical School
item Greenland, Philip - Northwestern University
item Blaha, Michael - Northwestern University
item Michos, Erin - Johns Hopkins University School Of Medicine
item Nasir, Khurram - Johns Hopkins University School Of Medicine
item Miedema, Michael - Minneapolis Heart Institute
item Yeboah, Joseph - Wake Forest Baptist Medical Center
item Sandfort, Veit - National Institutes Of Health (NIH)
item Frazier-wood, Alexis - Children'S Nutrition Research Center (CNRC)
item Shea, Steven - Columbia University - New York
item Lima, Joao - Johns Hopkins University School Of Medicine
item Szklo, Moyses - Johns Hopkins School Of Public Health
item Post, Wendy - Northwestern University
item Blumenthal, Roger - Johns Hopkins University School Of Medicine
item Mcevoy, John - Johns Hopkins University School Of Medicine

Submitted to: American Heart Journal
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 10/3/2017
Publication Date: 11/11/2017
Citation: Rifai, M.A., Greenland, P., Blaha, M.J., Michos, E.D., Nasir, K., Miedema, M.D., Yeboah, J., Sandfort, V., Frazier-Wood, A.C., Shea, S., Lima, J.A., Szklo, M., Post, W.S., Blumenthal, R.S., McEvoy, J.W. 2017. Factors of health in the protection against death and cardiovascular disease among adults with subclinical atherosclerosis. American Heart Journal. https://doi.org/10.1016/j.ahj.2017.10.026.

Interpretive Summary: Obesity is a risk factor for cardiovascular disease (CVD), and many CVD prevention efforts have focused on controlling and reducing such risk factors once they manifest. Fewer efforts have focused on promoting "health-factors" associated with cardiovascular wellness, and the problem is that it is not known if this preventative approach will benefit all individuals, such as those with subclinical atherosclerosis who are at a high risk of CVD. We aimed to study the association between health-factors and CVD events among persons with elevated coronary artery calcium in US adults from a multi-ethnic study population. We found that health behaviors such as refraining from smoking, maintaining healthy cholesterol levels, conducting regular physical activity and reducing stress were all associated with a reduction in CVD events, among those with subclinical atherosclerosis. This information will be useful for clinicians seeking to help reduce adverse cardiovascular events in some of those patients who are already at a high risk of these.

Technical Abstract: While cardiovascular disease (CVD) prevention traditionally emphasizes risk-factor control, recent evidence also supports the promotion of "health-factors" associated with cardiovascular wellness. However, whether such health-factors exist among adults with advanced subclinical atherosclerosis is unknown. We aimed to study the association between health-factors and events among persons with elevated coronary artery calcium (CAC). Self-reported health-factors studied included non-smoking, physical activity, Mediterranean-style diet, sleep quality, emotional support, low stress burden, and absence of depression. Measured health-factors included optimal weight, blood pressure, lipids, and glucose. Multivariable-adjusted Cox models examined the association between health-factors and incident CVD or mortality, independent of risk-factor treatment. Accelerated failure-time models assessed whether health-factors were associated with relative time-delays in disease onset. Among 1601 Multi-Ethnic Study of Atherosclerosis participants with CAC> 100, without baseline clinical ASCVD, mean age was 69 (+/-9) years, 64% were male, and median CAC score was 332 Agatston-units. Over 12 years follow-up, non-smoking, HDL-C levels >40 mg/dL for men and >50 mg/dL for women, and low stress burden were inversely associated with ASCVD (Hazard Ratios [HRs] ranging from 0.58 to 0.71, all P<.05). Non-smoking, glucose levels <100 mg/dL, regular physical activity, and low stress burden were inversely associated with mortality (HRs ranging from 0.40 to 0.77, all P<.05). Each of these factors was also associated with delays in onset of clinical disease, as was absence of depression. Adults with elevated CAC appear to have healthy lifestyle options to lower risk and delay onset of CVD, over and above standard preventive therapies.