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Ideal cardiovascular health predicts functional status independently of vascular events: the Northern Manhattan Study
Mandip S Dhamoon1, Chuanhui Dong2, Mitchell S V Elkind3
1Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY (M.S.D.).
Insights
Maintaining ideal cardiovascular health (CVH) is linked to better long-term functional status. Optimizing CVH can reduce vascular functional impairment, even after considering stroke and heart attack.
Area of Science:
- Cardiology
- Gerontology
- Public Health
Background:
- The American Heart Association's ideal cardiovascular health (CVH) metrics are widely used.
- Previous studies have not fully elucidated the long-term impact of ideal CVH on functional status.
- Cardiovascular health is a critical determinant of overall well-being and independence.
Purpose of the Study:
- To investigate whether ideal cardiovascular health (CVH) predicts long-term functional status.
- To determine if this prediction holds true after accounting for major vascular events like stroke and myocardial infarction.
- To assess the relationship between CVH metrics and functional status using the Barthel index (BI).
Main Methods:
- Prospective, multiethnic cohort study (Northern Manhattan Study) of individuals aged 40 years and older.
- Annual assessments of functional status using the Barthel index (BI) over a median of 13 years.
- Ideal CVH calculated from 7 measures; analyzed by number of ideal metrics and total score.
Main Results:
- Higher number of ideal CVH metrics and higher total CVH scores were associated with better functional status (higher BI scores) at 5 and 10 years.
- These associations persisted after adjusting for incident stroke and myocardial infarction.
- Significant differences in BI scores were observed between ideal and poor physical activity and fasting glucose levels at 10 years.
Conclusions:
- Ideal cardiovascular health is a significant predictor of long-term functional status.
- Optimizing vascular health through ideal CVH can mitigate functional decline, even in the presence of vascular events.
- Functional impairment is a key outcome that can be positively influenced by improving cardiovascular health.
Background:
We hypothesized that the American Heart Association's metric of ideal cardiovascular health (CVH) predicts improved long-term functional status after adjusting for incident stroke and myocardial infarction.
Methods And Results:
In the prospective, multiethnic Northern Manhattan Study, stroke-free individuals in northern Manhattan aged ≥40 years had annual assessments of the primary outcome of functional status with the Barthel index (BI), for a median of 13 years. Ideal CVH was calculated as a composite of 7 measures, each scored on a scale of 0 to 2. Primary predictors were (1) number of ideal CVH metrics, and (2) total score of all CVH metrics. Of 3219 participants, mean age was 69 years (SD 10), 63% were female, 21% were white, 25% were non-Hispanic black, and 54% were Hispanic. Twenty percent had 0 to 1 ideal CVH metrics, 32% had 2, 30% had 3, 14% had 4, and 4% had 5 to 7. Both number of ideal CVH categories and higher CVH metric scores were associated with higher mean BI scores at 5 and 10 years. 0047 Gradients persisted when results were adjusted for incident stroke and myocardial infarction, when mobility and nonmobility domains of the BI were analyzed separately, and when 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 status, even after accounting for incident vascular events. Vascular functional impairment is an important outcome that can be reduced by optimizing vascular health.
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