Table 2.
Association of Change in Individual CVH Metrics Between 1987 to 1989 and 1993 to 1995 With Incident CVD and Mortality
| 1987–1989 to 1993–1995 | N (%) | CVD | Mortality | ||||
|---|---|---|---|---|---|---|---|
| N Events (%) | HR* (95% CI) | P Value† | N Events (%) | HR (95% CI) | P Value† | ||
| Smoking | <0.001 | <0.001 | |||||
| Poor to poor | 1604 (16.0) | 560 (34.9) | 1.00 (ref) | 810 (50.50) | 1.00 (ref) | ||
| Poor to intermediate or Ideal | 653 (6.5) | 211 (32.3) | 0.80 (0.68–0.94) | 275 (42.11) | 0.72 (0.63–0.84) | ||
| Intermediate to poor | 45 (0.4) | 11 (24.4) | 0.64 (0.35–1.15) | 16 (35.56) | 0.64 (0.39–1.04) | ||
| Intermediate to intermediate | 7 (0.1) | 3 (42.9) | 1.39 (0.45–4.32) | 2 (28.57) | 0.59 (0.15–2.36) | ||
| Intermediate to ideal | 220 (2.2) | 67 (30.4) | 0.66 (0.51–0.86) | 86 (39.09) | 0.56 (0.44–0.69) | ||
| Ideal to poor or intermediate | 137 (1.4) | 42 (30.7) | 0.77 (0.56–1.05) | 52 (37.96) | 0.61 (0.46–0.81) | ||
| Ideal to ideal | 7372 (73.4) | 1802 (24.4) | 0.53 (0.48–0.59) | 2190 (29.71) | 0.42 (0.39–0.46) | ||
| BMI | <0.001 | <0.001 | |||||
| Poor to poor | 2271 (22.6) | 804 (35.4) | 1.00 (ref) | 914 (40.25) | 1.00 (ref) | ||
| Poor to intermediate or ideal | 215 (2.1) | 82 (38.1) | 1.12 (0.88–1.41) | 109 (52.09) | 1.21 (0.99–1.48) | ||
| Intermediate to poor | 870 (8.7) | 233 (26.8) | 0.74 (0.64–0.86) | 284 (32.64) | 0.81 (0.71–0.93) | ||
| Intermediate to intermediate | 2849 (28.4) | 766 (26.9) | 0.65 (0.59–0.72) | 923 (32.40) | 0.69 (0.63–0.76) | ||
| Intermediate to ideal | 304 (3.0) | 89 (21.4) | 0.77 (0.62–0.96) | 142 (46.71) | 1.03 (0.86–1.23) | ||
| Ideal to poor or intermediate | 954 (9.5) | 175 (18.3) | 0.51 (0.43–0.60) | 261 (27.36) | 0.71 (0.61–0.81) | ||
| Ideal to ideal | 2575 (25.6) | 547 (21.2) | 0.58 (0.52–0.65) | 795 (30.87) | 0.78 (0.71–0.86) | ||
| Diet | 0.651 | 0.166 | |||||
| Poor to poor | 1641 (16.3) | 466 (28.4) | 1.00 (ref) | 613 (37.36) | 1.00 (ref) | ||
| Poor to intermediate or ideal | 1577 (15.7) | 437 (27.7) | 1.00 (0.88–1.14) | 561 (35.57) | 0.96 (0.86–1.08) | ||
| Intermediate to poor | 1345 (13.4) | 372 (27.7) | 1.01 (0.88–1.16) | 460 (34.20) | 0.93 (0.82–1.05) | ||
| Intermediate to intermediate | 4719 (47.0) | 1230 (26.1) | 0.98 (0.88–1.09) | 1556 (32.97) | 0.92 (0.84–1.01) | ||
| Intermediate to ideal | 331 (3.3) | 94 (28.4) | 1.03 (0.82–1.29) | 113 (34.14) | 0.92 (0.75–1.12) | ||
| Ideal to poor or intermediate | 332 (3.3) | 78 (23.5) | 0.85 (0.67–1.09) | 106 (31.93) | 0.82 (0.67–1.02) | ||
| Ideal to ideal | 93 (1.0) | 19 (20.4) | 0.73 (0.46–1.16) | 22 (23.66) | 0.63 (0.41–0.96) | ||
| Physical activity | <0.001 | <0.001 | |||||
| Poor to poor | 1967 (20.0) | 640 (32.5) | 1.00 (ref) | 786 (39.96) | 1.00 (ref) | ||
| Poor to intermediate or Ideal | 1461 (14.5) | 439 (30.0) | 0.86 (0.76–0.98) | 543 (37.17) | 0.81 (0.72–0.90) | ||
| Intermediate to poor | 823 (8.2) | 245 (29.8) | 0.94 (0.81–1.09) | 280 (34.02) | 0.86 (0.75–0.99) | ||
| Intermediate to intermediate | 813 (8.1) | 190 (23.8) | 0.76 (0.64–0.89) | 243 (29.89) | 0.78 (0.67–0.90) | ||
| Intermediate to ideal | 934 (9.3) | 238 (25.5) | 0.75 (0.64–0.87) | 300 (32.12) | 0.72 (0.63–0.83) | ||
| Ideal to poor or intermediate | 1424 (14.2) | 342 (24.0) | 0.72 (0.63–0.82) | 475 (33.36) | 0.80 (0.71–0.90) | ||
| Ideal to ideal | 2616 (26.1) | 602 (23.0) | 0.66 (0.59–0.75) | 804 (30.73) | 0.68 (0.61–0.75) | ||
| Blood glucose | <0.001 | <0.001 | |||||
| Poor to poor | 608 (6.1) | 318 (52.3) | 1.00 (ref) | 356 (58.55) | 1.00 (ref) | ||
| Poor to intermediate or ideal | 154 (1.5) | 66 (42.9) | 0.74 (0.57–0.97) | 88 (57.14) | 0.90 (0.71–1.14) | ||
| Intermediate to poor | 542 (5.4) | 227 (41.9) | 0.78 (0.65–0.93) | 265 (48.89) | 0.91 (0.77–1.06) | ||
| Intermediate to intermediate | 2181 (21.7) | 607 (27.8) | 0.43 (0.37–0.49) | 753 (34.53) | 0.54 (0.48–0.62) | ||
| Intermediate to ideal | 1116 (11.1) | 266 (23.8) | 0.38 (0.32–0.45) | 383 (34.32) | 0.55 (0.48–0.64) | ||
| Ideal to poor or intermediate | 1588 (15.8) | 436 (27.5) | 0.45 (0.38–0.52) | 532 (33.50) | 0.58 (0.50–0.66) | ||
| Ideal to ideal | 3849 (38.3) | 776 (20.2) | 0.33 (0.29–0.38) | 1054 (27.38) | 0.49 (0.44–0.56) | ||
| Total cholesterol | <0.001 | 0.005 | |||||
| Poor to poor | 1173 (11.7) | 367 (31.3) | 1.00 (ref) | 433 (36.91) | 1.00 (ref) | ||
| Poor to intermediate or ideal | 1187 (11.8) | 400 (33.7) | 1.06 (0.92–1.23) | 497 (41.87) | 1.15 (1.01–1.30) | ||
| Intermediate to poor | 568 (5.7) | 160 (28.2) | 1.02 (0.85–1.24) | 180 (31.69) | 1.05 (0.88–1.25) | ||
| Intermediate to intermediate | 2183 (21.7) | 571 (26.2) | 0.83 (0.73–0.95) | 699 (32.02) | 0.90 (0.80–1.01) | ||
| Intermediate to ideal | 1084 (11.0) | 300 (27.7) | 0.85 (0.73–1.00) | 406 (37.45) | 1.05 (0.91–1.20) | ||
| Ideal to poor or intermediate | 1014 (10.1) | 239 (23.6) | 0.86 (0.73–1.02) | 290 (28.60) | 0.98 (0.84–1.13) | ||
| Ideal to ideal | 2829 (28.2) | 659 (23.3) | 0.75 (0.65–0.85) | 926 (32.73) | 1.01 (0.90–1.14) | ||
| Blood pressure | <0.001 | <0.001 | |||||
| Poor to poor | 1788 (17.8) | 735 (41.1) | 1.00 (ref) | 873 (48.83) | 1.00 (ref) | ||
| Poor to intermediate or Ideal | 534 (5.3) | 206 (38.6) | 0.98 (0.83–1.14) | 236 (44.19) | 1.02 (0.88–1.18) | ||
| Intermediate to poor | 1061 (10.6) | 378 (35.6) | 0.85 (0.75–0.96) | 441 (41.56) | 0.87 (0.77–0.97) | ||
| Intermediate to Intermediate | 1514 (15.1) | 416 (27.5) | 0.64 (0.57–0.73) | 528 (34.87) | 0.76 (0.68–0.84) | ||
| Intermediate to ideal | 545 (5.4) | 117 (21.5) | 0.51 (0.42–0.63) | 175 (32.11) | 0.75 (0.64–0.88) | ||
| Ideal to poor or intermediate | 1561 (15.5) | 369 (23.6) | 0.59 (0.52–0.67) | 457 (29.28) | 0.72 (0.65–0.81) | ||
| Ideal to ideal | 3035 (30.2) | 475 (15.6) | 0.40 (0.36–0.45) | 721 (23.76) | 0.62 (0.56–0.69) | ||
ROC values of CVD models and mortality models: smoking (0–69), BMI (0–68), total cholesterol (0–67), blood glucose (0–69), blood pressure (0–69), physical activity (0–67), and diet (0–67). The time‐dependent ROC values were computed using cumulative case/dynamic control ROC prediction models. Respective AIC values of CVD unadjusted and the adjusted model for smoking (44051 vs 43795), BMI (44036 vs 43814), total cholesterol (44204 vs 43915), blood glucose (43849 vs 43659), blood pressure (43847 vs 43674), physical activity (44137 vs 43898), and diet (44214 vs 43952). Respective AIC values of mortality unadjusted and the adjusted model for smoking (56923 vs 56657), BMI (57243 vs 56971), total cholesterol (57333 vs 57042), blood glucose (57109 vs 56884), blood pressure (57185 vs 56958), physical activity (57275 vs 57003), and diet (57321 vs 57052). AIC indicates Akaike information criterion; BMI, body mass index; CVD, cardiovascular disease; CVH, cardiovascular health; HR, hazard ratio; and ROC, receiver operating characteristic curve.
HRs were estimated using Cox proportional hazards regression with age as the time scale and adjusted for sex, year of birth, education, and race.
Overall type 3 P values.