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

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...

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Bibliographic Details
Published in:The American heart journal Vol. 198; pp. 180 - 188
Main Authors: Al Rifai, Mahmoud, Greenland, Philip, Blaha, Michael J., Michos, Erin D., Nasir, Khurram, Miedema, Michael D., Yeboah, Joseph, Sandfort, Veit, Frazier-Wood, Alexis C., Shea, Steven, Lima, Joao AC, Szklo, Moyses, Post, Wendy S., Blumenthal, Roger S., McEvoy, John W.
Format: Journal Article
Language:English
Published: United States Elsevier Inc 01.04.2018
Elsevier Limited
Subjects:
Adjustment
Adults
Aged
Aged, 80 and over
Angina pectoris
Arteriosclerosis
Asymptomatic Diseases
Atherosclerosis
Atherosclerosis - mortality
Atherosclerosis - physiopathology
Atherosclerosis - prevention & control
Blood pressure
Calcification (ectopic)
Calcium
Calcium - blood
Cardiovascular disease
Cardiovascular diseases
Cardiovascular Diseases - mortality
Cardiovascular Diseases - prevention & control
Cause of Death
Cholesterol
Cohort Studies
Coronary artery
Coronary Artery Disease - mortality
Coronary Artery Disease - physiopathology
Coronary Artery Disease - prevention & control
Coronary vessels
Disease control
Disease prevention
Ethnicity - statistics & numerical data
Female
Glucose
Health risks
Humans
Kaplan-Meier Estimate
Life Style
Lipids
Male
Mental depression
Middle Aged
Mortality
Physical activity
Primary Prevention - methods
Proportional Hazards Models
Risk Factors
Risk management
Sleep
Smoking
Social support
Stress
Stresses
Survival Rate
Timing
United States
Wellness
United States
Los Angeles California
New York
Chicago Illinois
United States > US
Baltimore Maryland
ISSN:0002-8703, 1097-6744, 1097-6744
Online Access:Get full text
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Summary: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). 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. 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. 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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ISSN:0002-8703
1097-6744
1097-6744
DOI:10.1016/j.ahj.2017.10.026