Abstract P047: The Role of the Healthy Heart Score in the Primordial Prevention of CVD Among Women

Background: Currently, clinical practice focuses on primary prevention of CVD by treating individuals at high risk of CVD based on the presence of clinical risk factors, rather than preventing the development of clinical risk factors through maintenance or adoption of a healthy lifestyle. We recently derived and validated the Healthy Heart Score, which estimates the 20-year risk of CVD based on modifiable lifestyle factors. The Healthy Heart Score in mid-adulthood effectively predicted CVD events; however whether this risk score can play an important role in the prevention of clinical CVD risk factor development, or primordial prevention of CVD, is not known. Methods: We conducted a prospective analysis among 69,264 women, in the Nurses’ Health Study II, aged 26-45 years at study baseline in 1991 and free of CVD, diabetes, hypertension and hypercholesterolemia. Diet and lifestyle factors were first assessed in 1991 and were updated by questionnaires every 2-4 years. The Healthy Heart Score was calculated at study baseline as the 20-year risk of CVD, based on a prediction model that includes age, smoking, BMI, hours of moderate to vigorous exercise, alcohol intake and a composite diet score (fruit & vegetables, sugar-sweetened beverages, red/processed meats, cereal fiber, nuts). Self-reported diabetes was validated by supplementary questionnaires. Physician-diagnosed hypertension and hypercholesterolemia were self-reported from biennial questionnaires. Cox proportional hazards models were used to calculate hazard ratio (HR) for developing clinical CVD risk factors (diabetes, hypertension, hypercholesterolemia), adjusting for parental history of MI, aspirin use, menopausal status, postmenopausal hormone use, parity, and oral contraceptive use. Results: Through 2011 (996,553 person-years of follow-up), we documented 2,745 diabetes, 16,605 hypertension and 20,926 hypercholesterolemia cases. The median 20 year risk of CVD based on the Healthy Heart Score was 0.8% at baseline (mean age 36). Compared to women in the lowest quintile of the Healthy Heart Score (median CVD risk: = 0.35%), women in the highest quintile (median CVD risk: 2.5%) had a HR (95%CI) of 5.1 (4.2, 6.2) for diabetes; 2.1 (1.9, 2.2) for hypertension and 1.4 (1.3, 1.5) for high cholesterol. The HR (95%CI) for developing ≥1 risk factor across quintiles was Q1: 1.0 (ref); Q2: 1.22 (1.16, 1.28); Q3: 1.34 (1.27, 1.40); Q4:1.48 (1.41, 1.56); Q5: 1.51 (1.43, 1.58); P-trend Conclusion: The Healthy Heart Score in early adulthood was strongly associated with the development of CVD risk factors among middle-aged women. Therefore, the Healthy Heart Score may be a useful tool in the clinic or community-based setting to evaluate the primordial prevention of CVD and help maintain ideal cardiovascular health among women.