Association of Cardiovascular Health With Subclinical Disease and Incident Events: The Multi-Ethnic Study of Atherosclerosis

Tamar S. Polonsky, Hongyan Ning, Martha L. Daviglus, Kiang Liu, Gregory L. Burke, Mary Cushman, John Eng, Aaron R. Folsom, Pamela L. Lutsey, Jennifer A. Nettleton, Wendy S. Post, Ralph L. Sacco, Moyses Szklo, Donald M. Lloyd-Jones

Research output: Contribution to journalArticlepeer-review


Background--Few adults have ideal cardiovascular health (CVH). We studied associations of an overall CVH score with subclinical cardiovascular disease and events. We assessed whether associations varied by race/ethnicity. Methods and Results--Among 5961 participants in the Multi-Ethnic Study of Atherosclerosis, components of CVH were measured at baseline, 2000-2002: systolic blood pressure, total cholesterol, fasting glucose, smoking, physical activity, diet, and body mass index. Levels were classified as ideal (2 points), intermediate (1 point), and poor (0 points) according to American Heart Association definitions. Points were summed to produce a CVH score (0-7 low, 8-11 moderate, 12-14 high). Coronary artery calcium, carotid intima-media thickness, and left ventricular mass were measured at baseline. Cardiovascular disease was defined as myocardial infarction, coronary heart disease death, resuscitated cardiac arrest, stroke, heart failure, or peripheral artery disease. Follow-up was 10.3 years. Regression models were used to examine associations of the CVH score with subclinical disease and events, adjusting for age, sex, and education. Analyses were stratified by race/ethnicity. Adults with high or moderate CVH scores had significantly lower odds of coronary artery calcium and lower carotid intima-media thickness and left ventricular mass than adults with low CVH scores. Adults with high or moderate CVH scores were 67% (95%CI 41% to 82%) and 37% (95%CI 22% to 49%) less likely, respectively, to experience a cardiovascular disease event than adults with low scores. There was no interaction with race/ ethnicity. Conclusions--There is a graded inverse association between CVH scores and measures of subclinical and overt cardiovascular disease that is similar across race/ethnic groups.

Original languageEnglish (US)
Article numbere004894
JournalJournal of the American Heart Association
Issue number3
StatePublished - Mar 2017


  • Cardiovascular disease prevention
  • Disparities
  • Subclinical atherosclerosis risk factor

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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