Association between ideal cardiovascular health and risk of sudden cardiac death and all-cause mortality among middle-aged men in Finland.

BACKGROUND Strong associations have been demonstrated between the American Heart Association's cardiovascular health (CVH) metrics and various cardiovascular outcomes, but the association with sudden cardiac death (SCD) is uncertain. We examined the associations between these CVH metrics and the risks of SCD and all-cause mortality among men in Finland. METHODS AND RESULTS We used the prospective population-based Kuopio Ischaemic Heart Disease cohort study, which consists of men between 42 and 60 years of age at baseline. CVH metrics were computed for 2577 men with CVH scores at baseline ranging from 0 to 7, categorized into CVH scores of 0-2 (poor), 3-4 (intermediate) and 5-7 (ideal). Multivariate Cox regression models were used to estimate the hazards ratios (HRs) and 95% confidence intervals (CIs) of ideal CVH metrics for SCD and all-cause mortality. During a median follow-up period of 25.8 years, 280 SCDs and 1289 all-cause mortality events were recorded. The risks of SCD and all-cause mortality decreased continuously with increasing number of CVH metrics across the range 2-7 (p value for non-linearity for all <0.05). In multivariable analyses, men with an ideal CVH score had an 85% reduced risk of SCD compared with men with a poor CVH score (HR 0.15; 95% CI 0.05-0.48; p = 0.001). For all-cause mortality, there was a 67% lower risk among men with an ideal CVH score compared with those with a poor CVH score (HR 0.33; 95% CI 0.23-0.49; p <0.001). CONCLUSIONS Ideal CVH metrics were strongly and linearly associated with decreased risks of SCD and all-cause mortality among middle-aged men in Finland.

[1]  A. Voutilainen,et al.  Ideal cardiovascular health and risk of acute myocardial infarction among Finnish men. , 2019, Atherosclerosis.

[2]  A. Voutilainen,et al.  American heart association’s cardiovascular health metrics and risk of cardiovascular disease mortality among a middle-aged male Scandinavian population , 2019, Annals of medicine.

[3]  J. Laukkanen,et al.  Marriage Dissatisfaction and the Risk of Sudden Cardiac Death Among Men. , 2019, The American journal of cardiology.

[4]  Zengwu Wang,et al.  Ideal Cardiovascular Health Status and Risk of Cardiovascular Disease or All-Cause Mortality in Chinese Middle-Aged Population , 2018, Angiology.

[5]  David Murphy,et al.  Sudden death: Neurogenic causes, prediction and prevention , 2017, European journal of preventive cardiology.

[6]  J. Dartigues,et al.  Ideal Cardiovascular Health, Mortality, and Vascular Events in Elderly Subjects: The Three-City Study. , 2017, Journal of the American College of Cardiology.

[7]  G. Fonarow,et al.  2016 AHA/ACC Clinical Performance and Quality Measures for Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. , 2017, Journal of the American College of Cardiology.

[8]  Menglin Jiang,et al.  Ideal cardiovascular health metrics and risk of cardiovascular disease or mortality: A meta-analysis. , 2016, International journal of cardiology.

[9]  R. Peters,et al.  Ideal cardiovascular health and risk of cardiovascular events in the EPIC-Norfolk prospective population study , 2016, European journal of preventive cardiology.

[10]  L. Mitchell,et al.  Sudden cardiac death , 2015, Current problems in cardiology.

[11]  Shou-Ling Wu,et al.  The Ideal Cardiovascular Health Metrics Associated Inversely with Mortality from All Causes and from Cardiovascular Diseases among Adults in a Northern Chinese Industrial City , 2014, PloS one.

[12]  T. Mäkikallio,et al.  Impaired Fasting Plasma Glucose and Type 2 Diabetes Are Related to the Risk of Out-of-Hospital Sudden Cardiac Death and All-Cause Mortality , 2013, Diabetes Care.

[13]  R. Sacco,et al.  Ideal Cardiovascular Health Predicts Lower Risks of Myocardial Infarction, Stroke, and Vascular Death Across Whites, Blacks, and Hispanics: The Northern Manhattan Study , 2012, Circulation.

[14]  E. Frohlich,et al.  Salt consumption and cardiovascular, renal, and hypertensive diseases: clinical and mechanistic aspects , 2011, Current opinion in lipidology.

[15]  Wojciech Zareba,et al.  Risk Stratification for Arrhythmic Sudden Cardiac Death: Identifying the Roadblocks , 2011, Circulation.

[16]  D. Mozaffarian,et al.  Defining and Setting National Goals for Cardiovascular Health Promotion and Disease Reduction: The American Heart Association's Strategic Impact Goal Through 2020 and Beyond , 2010, Circulation.

[17]  J. Manson,et al.  Triggering of sudden death from cardiac causes by vigorous exertion. , 2000, The New England journal of medicine.

[18]  P. Grambsch,et al.  Modeling Survival Data: Extending the Cox Model , 2000 .

[19]  Heikki Korpela,et al.  High Stored Iron Levels Are Associated With Excess Risk of Myocardial Infarction in Eastern Finnish Men , 1992, Circulation.

[20]  H. Kohl,et al.  Physical activity, physical fitness, and sudden cardiac death. , 1992, Epidemiologic reviews.

[21]  J. Salonen,et al.  Is there a continuing need for longitudinal epidemiologic research? The Kuopio Ischaemic Heart Disease Risk Factor Study. , 1988, Annals of clinical research.