Cardiovascular Health and Incident Cardiovascular Disease and Cancer: The Women's Health Initiative

Randi E. Foraker*, Mahmoud Abdel-Rasoul, Lewis H. Kuller, Rebecca D. Jackson, Linda Van Horn, Rebecca A. Seguin, Monika M. Safford, Robert B. Wallace, Anna M. Kucharska-Newton, Jennifer G. Robinson, Lisa W. Martin, Golareh Agha, Lifang Hou, Norrina B. Allen, Hilary A. Tindle

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

51 Scopus citations

Abstract

Introduction The American Heart Association's "Simple 7" offers a practical public health conceptualization of cardiovascular health (CVH). CVH predicts incident cardiovascular disease (CVD) in younger populations, but has not been studied in a large, diverse population of aging postmenopausal women. The extent to which CVH predicts cancer in postmenopausal women is unknown. Methods Multivariable Cox regression estimated hazard ratios and 95% CIs for the association between CVH and incident CVD, any cancer, and cancer subtypes (lung, colorectal, and breast) among 161,809 Women's Health Initiative observational study and clinical trial participants followed from 1993 through 2010. Data were analyzed in 2013. CVH score was characterized as the number (0 [worst] to 7 [best]) of the American Heart Association's ideal CVH behaviors and factors at baseline: smoking, BMI, physical activity, diet, total cholesterol, blood pressure, and fasting glucose. Results Median follow-up was approximately 13 years. Fewer minorities and less educated women achieved ideal CVH, a common benchmark. In adjusted models, compared with women with the highest (best) CVH scores, those with the lowest (worst) CVH scores had nearly seven times the hazard of incident CVD (6.83, 95% CI=5.83, 8.00) and 52% greater risk of incident cancer (1.52, 95% CI=1.35, 1.72). Ideal CVH was most strongly inversely associated with lung cancer, then colorectal cancer, and then breast cancer. Conclusions Lower ideal CVH is more common among minority and less educated postmenopausal women and predicts increased risk of CVD and cancer in this population, emphasizing the importance of prevention efforts among vulnerable older adults.

Original languageEnglish (US)
Pages (from-to)236-240
Number of pages5
JournalAmerican Journal of Preventive Medicine
Volume50
Issue number2
DOIs
StatePublished - Feb 1 2016

Funding

The Women''s Health Initiative program is funded by the National Heart, Lung, and Blood Institute, NIH, USDHHS through contracts HHSN268201100046C, HHSN268201100001C, HHSN2 68201100002C, HHSN268201100003C, HHSN268201100004C, and HHSN271201100004C. REF has received a grant from Pfizer, Inc. RDJ has consulted with Merck on the development of an educational course, and has received grants from Pfizer and Regeneron. MMS has consulted with diaDexus, Inc., and the FDA regarding lipid assays, and has received grants from Amgen, Medscape, and Pfizer, Inc. JGR has consulted with Amgen, Hoffman LaRoche, Merck, Pfizer, and Regeneron/Sanofi, and her institution has received grants from Amarin, Amgen, Astra-Zeneca, Daiichi-Sankyo, Esai, Genetech, Glaxo-Smith Kline, Hoffman LaRoche, Merck, Pfizer, Regeneron/Sanofi, andTakeda. LWM''s institution has served as a study site for multicenter trials funded by Sanofi, Novartis, Pfizer, and Amarin. HAT has received a medical education grant from the University of California San Francisco Smoking Cessation Learning Center in partnership with Pfizer, Inc. The Women’s Health Initiative program is funded by the National Heart, Lung, and Blood Institute, NIH, USDHHS through contracts HHSN268201100046C, HHSN268201100001C, HHSN268201100002C, HHSN268201100003C, HHSN268201100004C, and HHSN271201100004C.

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health

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