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

Mahmoud Al Rifai, Philip Greenland, Michael Blaha, Erin Donnelly Michos, Khurram Nasir, Michael D. Miedema, Joseph Yeboah, Veit Sandfort, Alexis C. Frazier-Wood, Steven Shea, Joao Lima, Moyses Szklo, Wendy S Post, Roger S Blumenthal, John W. McEvoy

Research output: Contribution to journalArticle

Abstract

Background: Although 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). Methods: Self-reported health-factors studied included nonsmoking, 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. Results: Among 1,601 Multi-Ethnic Study of Atherosclerosis participants with CAC >. 100 without baseline clinical atherosclerotic CVD, mean age was 69 (±9) years, 64% were male, and median CAC score was 332 Agatston units. Over 12 years of follow-up, nonsmoking, high-density lipoprotein cholesterol levels >40 mg/dL for men and >50 mg/dL for women, and low stress burden were inversely associated with ASCVD (hazard ratios ranging from 0.58 to 0.71, all P <. .05). Nonsmoking, glucose levels <100 mg/dL, regular physical activity, and low stress burden were inversely associated with mortality (hazard ratios 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. Conclusions: Adults with elevated CAC appear to have healthy lifestyle options to lower risk and delay onset of CVD, over and above standard preventive therapies.

Original languageEnglish (US)
JournalAmerican Heart Journal
DOIs
StateAccepted/In press - Jan 1 2018

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Atherosclerosis
Cardiovascular Diseases
Coronary Vessels
Health
Calcium
Exercise
Depression
Mediterranean Diet
Mortality
Health Promotion
Proportional Hazards Models
HDL Cholesterol
Blood Glucose
Sleep
Blood Pressure
Lipids
Weights and Measures
Glucose
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Factors of health in the protection against death and cardiovascular disease among adults with subclinical atherosclerosis. / Al Rifai, Mahmoud; Greenland, Philip; Blaha, Michael; Michos, Erin Donnelly; Nasir, Khurram; Miedema, Michael D.; Yeboah, Joseph; Sandfort, Veit; Frazier-Wood, Alexis C.; Shea, Steven; Lima, Joao; Szklo, Moyses; Post, Wendy S; Blumenthal, Roger S; McEvoy, John W.

In: American Heart Journal, 01.01.2018.

Research output: Contribution to journalArticle

Al Rifai, Mahmoud ; Greenland, Philip ; Blaha, Michael ; Michos, Erin Donnelly ; Nasir, Khurram ; Miedema, Michael D. ; Yeboah, Joseph ; Sandfort, Veit ; Frazier-Wood, Alexis C. ; Shea, Steven ; Lima, Joao ; Szklo, Moyses ; Post, Wendy S ; Blumenthal, Roger S ; McEvoy, John W. / Factors of health in the protection against death and cardiovascular disease among adults with subclinical atherosclerosis. In: American Heart Journal. 2018.
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T1 - Factors of health in the protection against death and cardiovascular disease among adults with subclinical atherosclerosis

AU - Al Rifai, Mahmoud

AU - Greenland, Philip

AU - Blaha, Michael

AU - Michos, Erin Donnelly

AU - Nasir, Khurram

AU - Miedema, Michael D.

AU - Yeboah, Joseph

AU - Sandfort, Veit

AU - Frazier-Wood, Alexis C.

AU - Shea, Steven

AU - Lima, Joao

AU - Szklo, Moyses

AU - Post, Wendy S

AU - Blumenthal, Roger S

AU - McEvoy, John W.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Although 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). Methods: Self-reported health-factors studied included nonsmoking, 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. Results: Among 1,601 Multi-Ethnic Study of Atherosclerosis participants with CAC >. 100 without baseline clinical atherosclerotic CVD, mean age was 69 (±9) years, 64% were male, and median CAC score was 332 Agatston units. Over 12 years of follow-up, nonsmoking, high-density lipoprotein cholesterol levels >40 mg/dL for men and >50 mg/dL for women, and low stress burden were inversely associated with ASCVD (hazard ratios ranging from 0.58 to 0.71, all P <. .05). Nonsmoking, glucose levels <100 mg/dL, regular physical activity, and low stress burden were inversely associated with mortality (hazard ratios 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. Conclusions: Adults with elevated CAC appear to have healthy lifestyle options to lower risk and delay onset of CVD, over and above standard preventive therapies.

AB - Background: Although 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). Methods: Self-reported health-factors studied included nonsmoking, 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. Results: Among 1,601 Multi-Ethnic Study of Atherosclerosis participants with CAC >. 100 without baseline clinical atherosclerotic CVD, mean age was 69 (±9) years, 64% were male, and median CAC score was 332 Agatston units. Over 12 years of follow-up, nonsmoking, high-density lipoprotein cholesterol levels >40 mg/dL for men and >50 mg/dL for women, and low stress burden were inversely associated with ASCVD (hazard ratios ranging from 0.58 to 0.71, all P <. .05). Nonsmoking, glucose levels <100 mg/dL, regular physical activity, and low stress burden were inversely associated with mortality (hazard ratios 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. Conclusions: Adults with elevated CAC appear to have healthy lifestyle options to lower risk and delay onset of CVD, over and above standard preventive therapies.

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