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Application of a Lifestyle-Based Tool to Estimate Premature Cardiovascular Disease Events in Young Adults: The Coronary Artery Risk Development in Young Adults (CARDIA) Study.
JAMA Intern Med. 2017 09 01; 177(9):1354-1360.JIM

Abstract

Importance

Few tools exist for assessing the risk for early atherosclerotic cardiovascular disease (ASCVD) events in young adults.

Objective

To assess the performance of the Healthy Heart Score (HHS), a lifestyle-based tool that estimates ASCVD events in older adults, for ASCVD events occurring before 55 years of age.

Design, Setting, and Participants

This prospective cohort study included 4893 US adults aged 18 to 30 years from the Coronary Artery Risk Development in Young Adults (CARDIA) study. Participants underwent measurement of lifestyle factors from March 25, 1985, through June 7, 1986, and were followed up for a median of 27.1 years (interquartile range, 26.9-27.2 years). Data for this study were analyzed from February 24 through December 12, 2016.

Exposures

The HHS includes age, smoking status, body mass index, alcohol intake, exercise, and a diet score composed of self-reported daily intake of cereal fiber, fruits and/or vegetables, nuts, sugar-sweetened beverages, and red and/or processed meats. The HHS in the CARDIA study was calculated using sex-specific equations produced by its derivation cohorts.

Main Outcomes and Measures

The ability of the HHS to assess the 25-year risk for ASCVD (death from coronary heart disease, nonfatal myocardial infarction, and fatal or nonfatal ischemic stroke) in the total sample, in race- and sex-specific subgroups, and in those with and without clinical ASCVD risk factors at baseline. Model discrimination was assessed with the Harrell C statistic; model calibration, with Greenwood-Nam-D'Agostino statistics.

Results

The study population of 4893 participants included 2205 men (45.1%) and 2688 women (54.9%) with a mean (SD) age at baseline of 24.8 (3.6) years; 2483 (50.7%) were black; and 427 (8.7%) had at least 1 clinical ASCVD risk factor (hypertension, hyperlipidemia, or diabetes types 1 and 2). Among these participants, 64 premature ASCVD events occurred in women and 99 in men. The HHS showed moderate discrimination for ASCVD risk assessment in this diverse population of mostly healthy young adults (C statistic, 0.71; 95% CI, 0.66-0.76); it performed better in men (C statistic, 0.74; 95% CI, 0.68-0.79) than in women (C statistic, 0.69; 95% CI, 0.62-0.75); in white (C statistic, 0.77; 95% CI, 0.71-0.84) than in black (C statistic, 0.66; 95% CI, 0.60-0.72) participants; and in those without (C statistic, 0.71; 95% CI, 0.66-0.76) vs with (C statistic, 0.64; 95% CI, 0.55-0.73) clinical risk factors at baseline. The HHS was adequately calibrated overall and within each subgroup.

Conclusions and Relevance

The HHS, when measured in younger persons without ASCVD risk factors, performs moderately well in assessing risk for ASCVD events by early middle age. Its reliance on self-reported, modifiable lifestyle factors makes it an attractive tool for risk assessment and counseling for early ASCVD prevention.

Authors+Show Affiliations

Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts.Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.Division of Chronic Disease Research Across the Life Course, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts. now affiliated with Office of the Director, Environmental Influences on Child Health Outcomes Program, National Institutes of Health, Bethesda, Maryland.Center for Health Metrics and Evaluation, American Heart Association, Dallas, Texas.Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.Office of the Dean, Colorado School of Public Health, Denver. now affiliated with National Heart, Lung, and Blood Institute, Bethesda, Maryland.Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts. AbbVie, Inc, Pharmaceuticals, West Roxbury, Massachusetts.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

28715555

Citation

Gooding, Holly C., et al. "Application of a Lifestyle-Based Tool to Estimate Premature Cardiovascular Disease Events in Young Adults: the Coronary Artery Risk Development in Young Adults (CARDIA) Study." JAMA Internal Medicine, vol. 177, no. 9, 2017, pp. 1354-1360.
Gooding HC, Ning H, Gillman MW, et al. Application of a Lifestyle-Based Tool to Estimate Premature Cardiovascular Disease Events in Young Adults: The Coronary Artery Risk Development in Young Adults (CARDIA) Study. JAMA Intern Med. 2017;177(9):1354-1360.
Gooding, H. C., Ning, H., Gillman, M. W., Shay, C., Allen, N., Goff, D. C., Lloyd-Jones, D., & Chiuve, S. (2017). Application of a Lifestyle-Based Tool to Estimate Premature Cardiovascular Disease Events in Young Adults: The Coronary Artery Risk Development in Young Adults (CARDIA) Study. JAMA Internal Medicine, 177(9), 1354-1360. https://doi.org/10.1001/jamainternmed.2017.2922
Gooding HC, et al. Application of a Lifestyle-Based Tool to Estimate Premature Cardiovascular Disease Events in Young Adults: the Coronary Artery Risk Development in Young Adults (CARDIA) Study. JAMA Intern Med. 2017 09 1;177(9):1354-1360. PubMed PMID: 28715555.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Application of a Lifestyle-Based Tool to Estimate Premature Cardiovascular Disease Events in Young Adults: The Coronary Artery Risk Development in Young Adults (CARDIA) Study. AU - Gooding,Holly C, AU - Ning,Hongyan, AU - Gillman,Matthew W, AU - Shay,Christina, AU - Allen,Norrina, AU - Goff,David C,Jr AU - Lloyd-Jones,Donald, AU - Chiuve,Stephanie, PY - 2017/7/18/pubmed PY - 2017/9/26/medline PY - 2017/7/18/entrez SP - 1354 EP - 1360 JF - JAMA internal medicine JO - JAMA Intern Med VL - 177 IS - 9 N2 - Importance: Few tools exist for assessing the risk for early atherosclerotic cardiovascular disease (ASCVD) events in young adults. Objective: To assess the performance of the Healthy Heart Score (HHS), a lifestyle-based tool that estimates ASCVD events in older adults, for ASCVD events occurring before 55 years of age. Design, Setting, and Participants: This prospective cohort study included 4893 US adults aged 18 to 30 years from the Coronary Artery Risk Development in Young Adults (CARDIA) study. Participants underwent measurement of lifestyle factors from March 25, 1985, through June 7, 1986, and were followed up for a median of 27.1 years (interquartile range, 26.9-27.2 years). Data for this study were analyzed from February 24 through December 12, 2016. Exposures: The HHS includes age, smoking status, body mass index, alcohol intake, exercise, and a diet score composed of self-reported daily intake of cereal fiber, fruits and/or vegetables, nuts, sugar-sweetened beverages, and red and/or processed meats. The HHS in the CARDIA study was calculated using sex-specific equations produced by its derivation cohorts. Main Outcomes and Measures: The ability of the HHS to assess the 25-year risk for ASCVD (death from coronary heart disease, nonfatal myocardial infarction, and fatal or nonfatal ischemic stroke) in the total sample, in race- and sex-specific subgroups, and in those with and without clinical ASCVD risk factors at baseline. Model discrimination was assessed with the Harrell C statistic; model calibration, with Greenwood-Nam-D'Agostino statistics. Results: The study population of 4893 participants included 2205 men (45.1%) and 2688 women (54.9%) with a mean (SD) age at baseline of 24.8 (3.6) years; 2483 (50.7%) were black; and 427 (8.7%) had at least 1 clinical ASCVD risk factor (hypertension, hyperlipidemia, or diabetes types 1 and 2). Among these participants, 64 premature ASCVD events occurred in women and 99 in men. The HHS showed moderate discrimination for ASCVD risk assessment in this diverse population of mostly healthy young adults (C statistic, 0.71; 95% CI, 0.66-0.76); it performed better in men (C statistic, 0.74; 95% CI, 0.68-0.79) than in women (C statistic, 0.69; 95% CI, 0.62-0.75); in white (C statistic, 0.77; 95% CI, 0.71-0.84) than in black (C statistic, 0.66; 95% CI, 0.60-0.72) participants; and in those without (C statistic, 0.71; 95% CI, 0.66-0.76) vs with (C statistic, 0.64; 95% CI, 0.55-0.73) clinical risk factors at baseline. The HHS was adequately calibrated overall and within each subgroup. Conclusions and Relevance: The HHS, when measured in younger persons without ASCVD risk factors, performs moderately well in assessing risk for ASCVD events by early middle age. Its reliance on self-reported, modifiable lifestyle factors makes it an attractive tool for risk assessment and counseling for early ASCVD prevention. SN - 2168-6114 UR - https://www.unboundmedicine.com/medline/citation/28715555/Application_of_a_Lifestyle_Based_Tool_to_Estimate_Premature_Cardiovascular_Disease_Events_in_Young_Adults:_The_Coronary_Artery_Risk_Development_in_Young_Adults__CARDIA__Study_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2017.2922 DB - PRIME DP - Unbound Medicine ER -