Association of ideal cardiovascular health with cardiovascular events and risk advancement periods in a Mediterranean population-based cohort

Background The American Heart Association recommends Life's Simple 7 as ideal cardiovascular health (ICVH) to reduce cardiovascular risk. Rate advancement period (RAP), a useful tool to quantify and communicate exposure impact on risks, may enhance communication about the benefits of achieving ICVH. We aimed to examine whether greater adherence to ICVH metrics was associated with reduced incidence of cardiovascular risk in a population-based cohort and estimate its impact on the timing of occurrence using RAP. Methods Prospective analyses of 3826 participants, initially free from cardiovascular disease at baseline, enrolled in the Vascular Risk in Navarra Study (RIVANA), a Mediterranean population-based cohort of Spanish adults. ICVH metrics were defined using participants' baseline information as follows: never-smoker or quitting > 12 months ago, body mass index < 25 kg/m(2), >= 150 min/week of moderate physical activity or equivalent, healthy dietary pattern (>= 9 points on a validated 14-item Mediterranean diet adherence screener), untreated cholesterol < 200 mg/dL, untreated blood pressure < 120/80 mmHg, and untreated fasting blood glucose < 100 mg/dL. Participants were assigned 1 point for each achieved metric and were grouped according to their number of accumulated metrics in <= 2, 3, 4, and >= 5. The primary endpoint was major cardiovascular events (composite of myocardial infarction, stroke, or death from cardiovascular causes). Cox proportional hazard ratios (HRs) and RAPs with their corresponding 95% confidence intervals (95% CI) adjusted for potential confounders were calculated. Results During a median follow-up of 12.8 years (interquartile range 12.3-13.1), a total of 194 primary endpoints were identified. Compared to participants with <= 2 ideal metrics, HR (95% CI) for major cardiovascular events among participants meeting >= 5 metrics was 0.32 (0.17-0.60) with RAP (95% CI) of - 14.4 years (- 22.9, - 5.9). Conclusions Greater adherence to ICVH metrics was associated with lower cardiovascular risk among Spanish adults of the RIVANA cohort. Adherence to ideal metrics may substantially delay cardiovascular risk.