Cardiovascular Health in a Southern Mediterranean European Country A Nationwide Population-Based Study

A lthough mortality rates from cardiovascular disease (CVD) have declined in Western countries during the last decades, CVD remains the leading cause of death and an important cause of morbidity, 1,2 contributing to escalating healthcare costs. 2,3 Moreover, the decline in CVD death rates could be threatened by the increasing prevalence of obesity and diabetes mellitus 1,2 and by the suboptimal management of traditional CVD risk factors such as unhealthy lifestyle, hyper­ tension, and dyslipidemia. 2,4–9 In this regard, the American Heart Association (AHA) recently published recommenda­ tions aimed to improve cardiovascular health and reduce CVD mortality by encouraging the general population to meet 7 defined ideal cardiovascular health behaviors or factors: not smoking; being physically active; having normal blood pres­ sure (BP), blood glucose, total cholesterol levels, and weight; and eating a healthy diet. 10 These recommendations represent an important shift in the approach to CVD control because the objectives go beyond preventing cardiovascular deaths to attaining good cardiovascular health. Accordingly, we report the prevalence of ideal cardio­ vascular health in Spain. This is the first study to report population­based data on cardiovascular health in an entire European country. Data were taken from the Study on Nutrition and Cardiovascular Risk in Spain, whose methods have been reported elsewhere. 13 This cross­ sectional study was conducted from June 2008 through October 2010 in a representative sample of the noninstitutionalized population of Spain ≥18 years of age. Study participants were selected by multistage clustered random sampling. The sample was first stratified by province and size of mu­ nicipality. Clusters were then randomly selected in 2 stages: municipal­ ities and census sections. Finally, the households within each section were selected by random telephone dialing. Subjects in the households were selected proportionally to the distribution of the population of Spain by sex and age. Information was collected in 3 sequential stages: (1) Computer­assisted telephone interview, with a structured question­ naire always conducted in the same order, which mean duration was 35 minutes; (2) first home visit, to obtain blood and urine samples; and (3) second home visit, to measure anthropometric variables and BP and to take a dietary history, which mean duration was 2 hours. Persons who collected information (nurses to obtain biological sam­ ples and nonhealth personnel for the remaining task) received specific Background—There are no published data on cardiovascular health from a national representative sample in a European country. Methods and …