Relationship between cardiovascular health score trajectory and incident stroke in patients with hypertension

The relationship between changes in the cardiovascular health (CVH) score over time and the risk of stroke in hypertensive patients remains unclear.

A total of 17,631 hypertensive participants in the Kailuan study who attended three consecutive health checks in 2006, 2008, and 2010 and had no history of stroke or cancer were included. Their mean age was 56.45 ± 11.07 years, including 14,585 males (82.72 %) and 3046 females (17.28 %). The CVH score is calculated by averaging eight key cardiovascular health indicators-blood pressure, plasma glucose, blood lipids, body mass index, smoking, sleep duration, physical activity, and diet-each scored from 0 (lowest) to 100 (highest). Latent mixed models were used to determine the trajectory of CVH score during the exposure period (2006-2010) to predict stroke risk from 2010 to 2021. The Bayesian information criterion (BIC) was used to fit the model, and the five patterns were determined as the best fit. In addition, Cox proportional hazards models were used to calculate the hazard ratio (HR) and 95 % confidence interval (CI) for stroke in different trajectory groups, as they are well-suited for analyzing time-to-event data and can effectively handle censored observations, which is essential for our longitudinal study design. Five trajectories of CVH score were identified: low-stable (n = 1190; range, 43.7-41.0), moderate-increasing (n = 1035; mean increase from 46.9 to 56.1), moderate-decreasing (n = 4520; mean decrease from 56.6 to 52.1), high-stable I (n = 8551; range, 62.3-63.0), and high-stable II (n = 2335; range, 68.7-71.5). During a median follow-up of 10.94 years, 1499 cases of incident stroke were identified. After adjustment for potential confounders, and compared to the low-stable group, the HRs (95 % CIs) for stroke in the moderate-increasing, moderate-decreasing, high-stable I, and high-stable II groups were as follows: 0.76 (0.59,0.97), 0.72 (0.60,0.87), 0.51 (0.42,0.61), and 0.32 (0.25,0.41), respectively.

In hypertensive patients, the long-term maintenance of a high CVH score or an improvement in CVH score is associated with a lower risk of stroke than a low-stable CVH score trajectory.