Association Between Ideal Cardiovascular Health and Carotid Intima-Media Thickness: A Twin Study

• Type of Material: Article
• Authors: Ambar Kulshreshtha, Emory University; Abhinav Goyal, Emory University; Emir Veledar, Emory University; William McClellan, Emory University; Suzanne Judd, University of Alabama Birmingham; Silvia C. Eufinger, Emory University; James Bremner, Emory University; Jack Goldberg, Vietnam Era Twin Registry; Viola Vaccarino, Emory University
• Language: English
• Date: 2014-02-01
• Publisher: American Heart Association: JAHA
• Publication Version: Final Published Version
• Copyright Statement: © 2013 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.
• License: Creative Commons Attribution-Noncommercial 3.0 Unported
• Final Published Version (URL): http://dx.doi.org/10.1161/JAHA.113.000282
• Title of Journal or Parent Work: Journal of the American Heart Association
• ISSN: 2047-9980
• Volume: 3
• Issue: 1
• Start Page: e000282
• End Page: e000282
• Grant/Funding Information: This study was supported by K24HL077506, R01 HL68630, and R01 AG026255 to Dr Vaccarino, and by K24 MH076955, R01 MH056120, and R01 HL088726 to Dr Bremner from the National Institutes of Health; by the Emory University General Clinical Research Center MO1‐RR00039 and by grant 0245115N from the American Heart Association.; The United States Department of Veterans Affairs has provided financial support for the development and maintenance of the Vietnam Era Twin (VET) Registry.; Dr Eufinger is supported on F31 HL107080.; Numerous organizations have provided invaluable assistance, including: VA Cooperative Study Program; Department of Defense; National Personnel Records Center, National Archives and Records Administration; the Internal Revenue Service; National Opinion Research Center; National Research Council, National Academy of Sciences; and the Institute for Survey Research, Temple University.
• Keywords: WALL THICKNESS; Life Sciences & Biomedicine; prevention; MIDDLE-AGED MEN; Cardiac & Cardiovascular Systems; NORTHERN MANHATTAN; risk factors; Cardiovascular System & Cardiology; AMERICAN-HEART-ASSOCIATION; RISK-FACTORS; DISEASE INCIDENCE; MYOCARDIAL-INFARCTION; PHYSICAL-ACTIVITY; ATHEROSCLEROSIS RISK; Science & Technology; ARTERY INTIMA; epidemiology
• Research Categories: Psychology, General; Health Sciences, Epidemiology

Abstract

The American Heart Association (AHA) recently developed the Cardiovascular Health Index (CVHI), a health metric consisting of 7 modifiable risk factors. The relationship of the CVHI with preclinical markers, such as carotid intima-media thickness (CIMT) has not been assessed. We examined 490 male monozygotic and dizygotic twins without overt cardiovascular disease. CIMT was measured using B-mode ultrasonography. Each of the 7 CVHI components (blood pressure, fasting glucose, total cholesterol, body mass index, physical activity, healthy diet, and smoking) was given a point score of 0, 1, or 2 to represent poor, intermediate, or ideal health, respectively. A CVHI summation score was computed (range 0 to 14) and categorized as inadequate (0 to 4), average (5 to 9), or optimum (10 to 14) cardiovascular health. Mixed-model regression was used to examine the association of the CVHI with CIMT. The mean age of the twins was 55.4 years, and 61% were monozygotic. The mean CIMT was 0.75 (± 0.11) mm and the mean CVHI score was 7.7 (± 2.1). There was an inverse correlation between CVHI and CIMT (Spearman r=-0.22, P<0.01). For every 5-unit increase in overall CVHI score (indicating better cardiovascular health category), CIMT decreased by 0.045 mm (P<0.001) after adjusting for demographic variables and other confounders. Within monozygotic twin pairs, a 5-unit increment in CVHI score was associated with a 0.05 mm lower CIMT (P<0.001). The CVHI is independently associated with CIMT and the association is not confounded by shared genetic and other familial factors.