Table 4. Hazard ratios of the high CVD risk profile* stratified by age, smoker status and BMI based on quintiles of the Healthy Heart Score.
| Predictive 20-year risk of CVD (%) based on the Healthy Heart Score | |||||||
|---|---|---|---|---|---|---|---|
|
| |||||||
| Q1 | Q2 | Q3 | Q4 | Q5 | p trend | P- interaction | |
| Age | |||||||
| < 45 years | |||||||
| Median Healthy Heart Score (20-y risk)** | 0.41 | 0.73 | 1.10 | 1.70 | 2.85 | ||
| Cases | 17 | 54 | 93 | 86 | 37 | ||
| Person-years | 230091 | 185730 | 105033 | 49018 | 16545 | ||
| Model 2 | 1 [Ref] | 4.25 (2.39-7.54) | 15.6 (8.94-27.2) | 32.9 (18.5-58.3) | 47.3 (25.0-89.5) | <.0001 | <.0001 |
| ≥45 years | |||||||
| Median Healthy Heart Score (20-y risk)** | 0.47 | 0.79 | 1.17 | 1.80 | 3.45 | ||
| Cases | 11 | 34 | 89 | 253 | 967 | ||
| Person-years | 15419 | 58273 | 137639 | 191660 | 220301 | ||
| Model 2 | 1 [Ref] | 0.93 (0.47-1.85) | 1.22 (0.65-2.31) | 2.80 (1.51-5.21) | 10.4 (5.6-19.2) | <.0001 | |
| Smoking status | |||||||
| Non smokers | |||||||
| Median Healthy Heart Score (20-y risk)** | 0.42 | 0.74 | 1.14 | 1.77 | 3.32 | ||
| Cases | 25 | 85 | 177 | 326 | 871 | ||
| Person-years | 240548 | 233547 | 225110 | 212651 | 184538 | ||
| Model 2 | 1 [Ref] | 4.35 (2.67-7.08) | 12.6 (7.71-20.5) | 30.4 (18.6-49.8) | 122.4 (74.5- 201.2) | <.0001 | 0.002 |
| Current smokers | |||||||
| Median Healthy Heart Score (20-y risk)** | 0.46 | 0.77 | 1.16 | 1.84 | 3.87 | ||
| Cases | 3 | 3 | 5 | 13 | 133 | ||
| Person-years | 4962 | 10456 | 17562 | 28027 | 52309 | ||
| Model 2 | 1 [Ref] | 0.61 (0.11- 3.42) | 0.51 (0.10-2.57) | 0.57 (0.13-2.54) | 2.32 (0.53-10.0) | <.0001 | |
| BMI | |||||||
| Median Healthy Heart Score (20-y risk)** | 0.41 | 0.74 | 1.13 | 1.75 | 3.14 | ||
| < 25 kg/m2 | |||||||
| Cases | 6 | 22 | 50 | 56 | 111 | ||
| Person-years | 201120 | 171435 | 147154 | 119590 | 80021 | ||
| Model 2 | 1 [Ref] | 4.55 (1.76-11.8) | 13.8 (5.36-35.5) | 19.0 (7.22-49.9) | 62.1 (23.4-164.5) | <.0001 | 0.003 |
| BMI≥25 kg/m2 | |||||||
| Median Healthy Heart Score (20-y risk)** | 0.76 | 0.76 | 1.15 | 1.81 | 3.59 | ||
| Cases | 22 | 66 | 132 | 283 | 893 | ||
| Person-years | 44391 | 72568 | 95519 | 121088 | 156824 | ||
| Model 2 | 1 [Ref] | 1.61 (0.96-2.69) | 2.53 (1.53-4.19) | 4.36 (2.63-7.22) | 10.1 (6.06-16.7) | <.0001 | |
*
High risk profile=having all 3 clinical risk factors (type 2 diabetes, hypertension, and hypercholesterolemia). Model 2: Adjusted for age, parental history of MI before 60 years of age, aspirin use, menopausal status, postmenopausal hormone use, parity, oral contraceptive use
**
The formula to estimate the 20-year risk of CVD based on lifestyle predictors derived including smoking, BMI, physical activity, alcohol, and a composite diet score (fruit and vegetables, sugar-sweetened beverages, red/processed meats, cereal fiber, nuts)(Figure 1)