Context

Recent recommendations from the American Heart Association aim to improve cardiovascular health by encouraging the general population to meet 7 cardiovascular health metrics: not smoking; being physically active; having normal blood pressure, blood glucose and total cholesterol levels, and weight; and eating a healthy diet.

Objective

To examine time trends in cardiovascular health metrics and to estimate joint associations and population-attributable fractions of these metrics in relation to all-cause and cardiovascular disease (CVD) mortality risk.

Design, Setting, and Participants

Study of a nationally representative sample of 44 959 US adults (≥20 years), using data from the National Health and Nutrition Examination Survey (NHANES) 1988–1994, 1999–2004, and 2005–2010 and the NHANES III Linked Mortality File (through 2006).

Main Outcome Measures

All-cause, CVD, and ischemic heart disease (IHD) mortality.

Results

Few participants met all 7 cardiovascular health metrics (2.0% [95% CI, 1.5%–2.5%] in 1988–1994, 1.2% [95% CI, 0.8%–1.9%] in 2005–2010). Among NHANES III participants, 2673 all-cause, 1085 CVD, and 576 IHD deaths occurred (median follow-up, 14.5 years). Among participants who met 1 or fewer cardiovascular health metrics, age- and sex-standardized absolute risks were 14.8 (95% CI, 13.2–16.5) deaths per 1000 person-years for all-cause mortality, 6.5 (95% CI, 5.5–7.6) for CVD mortality, and 3.7 (95% CI, 2.8–4.5) for IHD mortality. Among those who met 6 or more metrics, corresponding risks were 5.4 (95% CI, 3.6–7.3) for all-cause mortality, 1.5 (95% CI, 0.5–2.5) for CVD mortality, and 1.1 (95% CI, 0.7–2.0) for IHD mortality. Adjusted hazard ratios were 0.49 (95% CI, 0.33–0.74) for all-cause mortality, 0.24 (95% CI, 0.13–0.47) for CVD mortality, and 0.30 (95% CI, 0.13–0.68) for IHD mortality, comparing participants who met 6 or more vs 1 or fewer cardiovascular health metrics. Adjusted population-attributable fractions were 59% (95% CI, 33%–76%) for all-cause mortality, 64% (95% CI, 28%–84%) for CVD mortality, and 63% (95% CI, 5%–89%) for IHD mortality.

Conclusion

Meeting a greater number of cardiovascular health metrics was associated with a lower risk of total and CVD mortality, but the prevalence of meeting all 7 cardiovascular health metrics was low in the study population.