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Ideal Cardiovascular Health and Incident Cardiovascular Disease: Heterogeneity Across Event Subtypes and Mediating
Bamba Gaye1, Muriel Tafflet2, Dominique Arveiler3
1INSERM, U970, Paris Cardiovascular Research Center, University Paris Descartes, Sorbonne Paris Cité, Paris, France bamba.gaye@inserm.fr.
Insights
Maintaining ideal cardiovascular health (CVH) significantly lowers the risk of coronary heart disease (CHD) and stroke. This benefit is consistent across cardiovascular disease subtypes and partly mediated by reduced inflammation and improved hemostasis.
Area of Science:
- Cardiology
- Preventive Medicine
- Biomarkers
Background:
- Cardiovascular disease (CVD) risk is influenced by baseline cardiovascular health (CVH).
- Investigating CVH association with CVD subtypes and mediating biomarkers is crucial for prevention strategies.
Purpose of the Study:
- To determine if the association between baseline CVH and incident CVD varies by coronary heart disease (CHD) and stroke subtypes.
- To assess the mediating role of inflammatory and hemostatic blood biomarkers in this association.
Main Methods:
- Analysis of 9312 middle-aged men from Northern Ireland and France using multivariable Cox proportional hazards regression.
- A nested case-control study evaluated mediating effects of biomarkers after 10 years of follow-up.
- Adjudication of 614 CHD events and 117 stroke events.
Main Results:
- Ideal CVH was associated with a 72% lower risk of CHD and a 76% lower risk of stroke compared to poor CVH.
- Risk reductions were similar for angina and myocardial infarction but lower for ischemic stroke.
- Inflammatory markers (hs-CRP, IL-6) and fibrinogen decreased with higher CVH and mediated the association with CHD.
Conclusions:
- No significant heterogeneity was observed in the association of baseline CVH with major CVD subtypes.
- Universal promotion of ideal CVH is recommended for all cardiovascular disease subtypes.
- Lower inflammatory and hemostatic biomarkers partially mediate the reduced CHD risk associated with ideal CVH.
Background:
The aim of this study was to investigate whether the association between baseline cardiovascular health (CVH) and incident cardiovascular disease differs according to coronary heart disease (CHD) and stroke subtypes, and to assess the mediating effect of inflammatory and hemostatic blood biomarkers.
Methods And Results:
The association of ideal CVH with outcomes was derived in 9312 middle-aged men from Northern Ireland and France (whole cohort) in multivariable Cox proportional hazards regression analysis. The mediating effect of baseline inflammatory and hemostatic blood biomarkers was evaluated in a case-control study nested within the cohort after 10 years of follow-up. After a median follow-up of 10 years, 614 first CHD events and 117 first stroke events were adjudicated. Compared with those with poor CVH, those with an ideal CVH profile at baseline had a 72% lower risk of CHD (hazard ratio=0.28; 95% confidence interval, 0.17; 0.46) and a 76% lower risk of stroke (hazard ratio =0.24; 95% confidence interval, 0.06; 0.98). The magnitude of the risk reductions was similar for incident angina and myocardial infarction, but was lower for ischemic stroke. In the controls, the mean concentrations of high-sensitivity C-reactive protein, IL-6, and fibrinogen decreased with higher CVH status. Furthermore, the association of behavioral CVH with incident CHD was partly mediated by high-sensitivity C-reactive protein (16.69%), IL-6 (8.52%), and fibrinogen (7.30%) CONCLUSIONS: Our study shows no clear heterogeneity in the association of baseline CVH with the main subtypes of cardiovascular disease. This supports a universal promotion of ideal CVH for all cardiovascular disease subtypes. Furthermore, our mediation analysis suggests that the lower risk of CHD associated with ideal CVH is partly mediated by lower inflammatory and hemostatic blood biomarkers.
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