Background Cardiovascular health (CVH) – defined by the American Heart Association according to levels of established risk factors (body mass index (BMI), blood pressure (BP), glucose, cholesterol, physical activity (PA), smoking and diet, known collectively as Life’s Simple 7 (LS7)), is associated with reduced risk of cardiovascular diseases (CVD) such as stroke and coronary heart disease (CHD). However, South Asians (SA) have higher burden of CVD and differing relative contributions of risk factors compared to other ethnicities. Additionally, less is known on how CVH specifically influences stroke risk in SA. In a British cohort of SA and Europeans (EU), we examined long-term associations of CVH with stroke and CHD separately.
Methods In the Southall and Brent Revisited study SA (n=1353) and EU (n=1860) participants (40–69y) recruited from age-sex stratified general practice lists and workplaces, free from CVD, provided baseline information on LS7 metrics via questionnaires and examination. Participants were followed for a median of 20y. Points assigned to levels of LS7 metrics; poor-0, intermediate-1 and ideal-2 were added to generate a CVH score (0 worst – 14 best). In Cox models stratified by ethnicity and adjusted for age, sex, social class and alcohol intake; risk of fatal and non-fatal stroke and CHD events was estimated as hazard ratios (HRs) [95% CI], for CVH as a continuous score and categories (Inadequate:0–4, Average:5–9 and Optimal:10–14).
Results In SA (mean age 51y, 82% men) and EU (mean age 53y, 76% men) respectively, incidence (/1000 person-years [95% CI]) of stroke was: 5.1 [4.3–6.0] and 4.2 [3.6–5.0]; and CHD: 21.4 [19.6–23.4] and 13.1 [11.9–14.4]. Prevalence (%) of ideal LS7 levels in SA (vs EU) was BMI 40 (42); BP 32 (40); glucose 55 (64); cholesterol 26 (23); PA 18 (29); never smoked 79 (32); and fruit/vegetable intake 61 (55). Mean CVH score (range) was SA 8.7 (2–14) and EU 8.5 (1–14). A point increment in CVH score was associated with (1) similarly reduced stroke risk in SA: 0.84 [0.77–0.92] and EU: 0.91 [0.83–0.99]; and (2) a similar reduction in CHD risk in both groups, SA: 0.83 [0.80–0.87] and EU: 0.84 [0.80–0.88]. With reference to participants in the inadequate CVH category, HR of both outcomes for SA and EU with average and optimal CVH showed comparable protective trends.
Conclusion Better CVH is associated with similar reductions in both stroke and CHD risk in SA and EU. This emphasises the importance of CVD prevention strategies to promote risk factor modification among SA.
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