MedicalResearch.com Interview with:
Mercedes Sotos Prieto, PhD
Research Associate, Department of Nutrition
Harvard T.H. Chan School of Public Health
Boston, MA, 02115
Medical Research: What is the background for this study? What are the main findings?
Dr. Sotos-Prieto: Given that CVD remains the leading cause of death in the US, the prevention of risk factor development through healthy lifestyle factors, or primordial prevention, is of paramount importance to minimize the long-term risk of CVD. However, the prevalence of these healthy behaviors among US adults remains low.
The Healthy Heart Score is a 20-year CVD risk prediction model based on modifiable lifestyle factors and we have shown previously that this score effectively predicted the 20-year risk of CVD in mid-adulthood. Whether this risk score is associated with clinically-relevant CVD risk factors is unknown. Therefore, in this study we analyzed the association between the Healthy Heart Score and incidence of clinical CVD risk factors, including diabetes, hypertension, and hypercholesterolemia among 69,505 U.S women in the Nurses’ Health Study II during 20 years of follow-up. The Healthy Heart Score is based on the 9 most critical lifestyle factors that best estimate CVD risk including: current smoking, higher BMI, low physical activity, lack of moderate alcohol consumption, low intakes of fruits, vegetables, cereal fiber, and nuts, and high intakes of sugar-sweetened beverages and red and processed meats. The Healthy Heart Score estimates the 20 –year CVD risk, thus a higher score reflected a higher predictive CVD risk. Over 20 years, we documented 3,275 incident cases of diabetes, 17,420 of hypertension, and 24,385 of hypercholesterolemia.
Our main findings showed that women with higher predicted CVD risk based on the Healthy Heart Score (highest quintile vs. lowest) had significantly greater risk of developing each clinical risk factor individually. Specifically, women with a higher predictive CVD risk had an 18-fold higher risk of type 2 diabetes, 5-fold higher risk of hypertension, and 3-fold higher risk of hypercholesterolemia over 20-years. Further, a higher predictive CVD risk was associated with a 53-fold greater risk of developing a high CVD risk profile (defined as the diagnosis of all 3 clinical risk factors) and this association was most pronounced among women who were younger, did not smoke, and had optimal weight
Medical Research: What should clinicians and patients take away from your report?
Dr. Sotos-Prieto: Our results highlight the need to develop educational strategies for CVD prevention that address many lifestyle factors simultaneously. These results further support previous studies that have shown benefits of healthy lifestyle behaviors initiated early in life, such as adolescence and young adulthood.
The Healthy Heart Score is a patient-oriented, scientifically-derived lifestyle-based prediction model. Given that physicians often have limited time to address disease prevention in their patients, this tool may eventually serve as the first step for risk assessment and a catalyst for communication between patients and clinicians in the primordial prevention setting
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Sotos-Prieto: Additional research that evaluates the use of this scientifically-derived tool as a primordial prevention strategy in the clinical or community-based setting is warranted. Further, a predictive model that includes lifestyle measures without the need for clinical measurements may be useful beyond the clinical setting, such as workplace wellness programs or community-based health fairs
Association Between a Healthy Heart Score and the Development of Clinical Cardiovascular Risk Factors Among Women: Potential Role for Primordial Prevention
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Circ Cardiovasc Qual Outcomes. 2016;9:S77–S85,doi:10.1161/CIRCOUTCOMES.115.002372
Mercedes Sotos Prieto, PhD (2016). CVD Risk in Women Also Raises Risk of Diabetes, Hypertension and High Cholesterol