Deep Diving Into the Cardiovascular Health Paradox: A Journey Towards Personalized Prevention.

Area of Science:

• Cardiovascular Health
• Preventive Cardiology
• Personalized Medicine

Background:

• The Life's Simple 7 (LS7) score promotes cardiovascular health (CVH), but some individuals with optimal LS7 develop cardiovascular disease (CVD), while others with poor CVH do not—this is the "CVH paradox."
• Current risk factor assessments are often suboptimal for predicting individual outcomes.

Purpose of the Study:

• To explore the pathways explaining the CVH paradox.
• To propose refined CVH assessment strategies for personalized prevention.

Main Methods:

• Examined methodological aspects including misclassification bias in self-reported lifestyle factors (smoking, physical activity, diet).
• Considered the impact of cumulative exposure to risk factors over a lifetime.
• Proposed incorporating novel elements for refined CVH assessment: subclinical vascular disease markers, metabolic biomarkers, emerging risk factors, polygenic risk scores (PRS), epigenetics, and the exposome.

Main Results:

• Addressing the CVH paradox requires a multifaceted approach.
• Reducing misclassification bias and considering cumulative risk exposure are crucial.
• Incorporating novel personalized prevention elements can refine CVH assessment.

Conclusions:

• A holistic, individualized approach to CVH assessment and CVD prevention is essential for reducing cardiovascular outcomes and improving population health.
• Effective implementation requires collaboration among researchers, healthcare providers, policymakers, and communities.