Achieving Optimal Cardiovascular Health: a Social Epidemiological Approach
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Purpose of Review
The American Heart Association (AHA) created the cardiovascular health (CVH) index to measure and monitor population-level reduction of cardiovascular disease (CVD) risk, with a goal of 20% reduction in CVD morbidity and mortality by 2020. Few U.S. adults meet all seven ideal CVH metrics (non-smoking behavior, healthy diet and body weight, active lifestyle, good cholesterol, glucose, and blood pressure scores), with 17% of men and women only achieving five or more ideal CVH metrics. This review describes the importance of considering sociodemographic, psychosocial, and behavioral factors as key strategies to achieve the AHA 2020 goals.
Men, racial/ethnic minorities, and individuals of lower socioeconomic status are less likely to achieve ideal CVH—which may start in early childhood. An emerging body of literature indicates that individuals with high-quality social relationships, positive childhood experiences and psychological functioning, along with lifestyle factors, may impact attainment of optimal CVH. For example, exploring the role of food insecurity in CVH attainment demonstrates the complex interplay between contextual factors and lifestyle behaviors that may promote or deter ideal CVH. Evidence also suggests that the CVH index has convergent validity with intermediate and hard endpoints of CVD. Interventions that seek to promote multi-system resiliency may help close the gap in attainment of the AHA 2020 goals.
Research on psychosocial and behavioral factors suggests that social connections, psychological resources, and health-maintaining behaviors are important areas to target to improve CVH in minorities and other vulnerable groups.
KeywordsIdeal cardiovascular health Cardiovascular disease risk Psychosocial factors Socioeconomic status Social epidemiology Social determinants of health
Dr. Durazo was supported by a National Institute on Aging grant T32AG049663. Dr. Rodriguez was funded in part by the Center of Excellence Faculty Fellowship, Stanford University, the US Department of Health and Human Services, the Hispanic Center of Excellence.
Compliance with Ethical Standards
Conflict of Interest
Tomás Cabeza de Baca, Eva M. Durazo, and Fatima Rodriguez declare no conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major Importance
- 1.•• Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, et al. Heart Disease and Stroke Statistics—2018 Update: A Report From the American Heart Association. Circulation. 2018;137:e67–492. This is comprehensive summary from the American Heart Association reports the reports prevalence rates of CVD and includes information regarding the Life’s Simple 7. CrossRefPubMedGoogle Scholar
- 2.•• Lloyd-Jones DM, Hong Y, Labarthe D, Mozaffarian D, Appel LJ, Van Horn L, et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic impact goal through 2020 and beyond. Circulation. 2010;121:586–613. Lloyd-Jones et al. articulate the creation of the CVH index and review the conceptual factors and goals considered in its design. CrossRefPubMedGoogle Scholar
- 4.Berkman LF, Kawachi I, Glymour MM, editors. Social epidemiology. Second edition. Oxford: Oxford University Press; 2014.Google Scholar
- 5.von dem Knesebeck O. Concepts of social epidemiology in health services research. BMC Health Serv Res [Internet]. 2015;15. Available from: http://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-015-1020-z.
- 10.Folsom AR, Yatsuya H, Nettleton JA, Lutsey PL, Cushman M, Rosamond WD. Community prevalence of ideal cardiovascular health, by the American Heart Association definition, and relationship with cardiovascular disease incidence. J Am Coll Cardiol. 2011;57:1690–6.CrossRefPubMedPubMedCentralGoogle Scholar
- 15.Mathews L, Ogunmoroti O, Nasir K, Blumenthal RS, Utuama OA, Rouseff M, et al. Psychological factors and their association with ideal cardiovascular health among women and men. In: J Womens Health; 2018.Google Scholar
- 16.Pilkerton CS, Singh SS, Bias TK, Frisbee SJ. Changes in cardiovascular health in the United States, 2003–2011. J Am Heart Assoc [Internet]. 2015;4. Available from: http://jaha.ahajournals.org/content/4/9/e001650.abstract.
- 19.Siliki Mbassa RA, Zaslavsky AM, Williams DR, Natalie SB, Buring J, Albert MA. Abstract 18364: cumulative psychosocial stress and ideal cardiovascular health in women: data according to race/ethnicity. Circulation. 2016;134:A18364.Google Scholar
- 20.Pool LR, Ning H, Lloyd-Jones DM, Allen NB. Trends in racial/ethnic disparities in cardiovascular health among US adults From 1999–2012. J Am Heart Assoc [Internet]. 2017;6. Available from: http://jaha.ahajournals.org/content/6/9/e006027.abstract.
- 27.Olsen GS, Holm A-SS, Jørgensen T, Borglykke A. Distribution of ideal cardiovascular health by educational levels from 1978 to 2006: a time trend study from the capital region of Denmark. Eur J Prev Cardiol 2014;21:1145–1152.Google Scholar
- 32.• Boehm JK, Soo J, Chen Y, Zevon ES, Hernandez R, Lloyd-Jones D, et al. Psychological well-being’s link with cardiovascular health in older adults. Am J Prev Med. 2017;53:791–8. Analyses from the English Longitudinal Study of Ageing highlight the importance of psychological well-being on the progression of ideal cardiovascular health (including smoking status, diabetes, blood pressure, cholesterol, and BMI) in older adults. CrossRefPubMedGoogle Scholar
- 35.Cabeza de Baca T, Wahl RA, Barnett MA, Figueredo AJ, Ellis BJ. Adversity, adaptive calibration, and health: The case of disadvantaged families. Adapt Hum Behav Physiol 2016;2:93–115.Google Scholar
- 38.Rosengren A, Hawken S, Ôunpuu S, Sliwa K, Zubaid M, Almahmeed WA, et al. Association of psychosocial risk factors with risk of acute myocardial infarction in 11 119 cases and 13 648 controls from 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364:953–62.CrossRefPubMedGoogle Scholar
- 39.Gaye B, Prugger C, Perier MC, Thomas F, Plichart M, Guibout C, et al. High level of depressive symptoms as a barrier to reach an ideal cardiovascular health. The Paris Prospective Study III Sci Rep 2016;6.Google Scholar
- 40.Li Z, Yang X, Wang A, Qiu J, Wang W, Song Q, et al. Association between ideal cardiovascular health metrics and depression in Chinese population: a cross-sectional study. Sci Rep [Internet]. 2015;5. Available from: http://www.nature.com/articles/srep11564.
- 47.Olson NC, Cushman M, Judd SE, McClure LA, Lakoski SG, Folsom AR, et al. American Heart Association’s Life’s Simple 7 and risk of venous thromboembolism: the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. J Am Heart Assoc. 2015;4:e001494.CrossRefPubMedPubMedCentralGoogle Scholar
- 52.•• Aneni EC, Crippa A, Osondu CU, Valero-Elizondo J, Younus A, Nasir K, et al. Estimates of mortality benefit from ideal cardiovascular health metrics: a dose response meta-analysis. J Am Heart Assoc. 2017;6:e006904. This meta-analysis documents the dose-response linear risk reduction in cardiovascular and all-cause mortality with the increase in ideal cardiovascular health components. CrossRefPubMedPubMedCentralGoogle Scholar
- 56.Dong C, Rundek T, Wright CB, Anwar Z, Elkind MSV, Sacco RL. Ideal cardiovascular health predicts lower risks of myocardial infarction, stroke, and vascular death across whites, blacks, and Hispanics: the northern Manhattan study. Circulation. 2012;125:2975–84.CrossRefPubMedPubMedCentralGoogle Scholar
- 60.Cabeza de Baca T, Albert MA. Psychosocial stress, the unpredictability schema, and cardiovascular disease in women. under reviewGoogle Scholar
- 61.Slopen N, Kontos EZ, Ryff CD, Ayanian JZ, Albert MA, Williams DR. Psychosocial stress and cigarette smoking persistence, cessation, and relapse over 9–10 years: a prospective study of middle-aged adults in the United States. Cancer Causes Control. 2013;24:1849–63.CrossRefPubMedPubMedCentralGoogle Scholar