Estimated impact of achieving optimal cardiovascular health among us adults on cardiovascular disease events

Joshua D. Bundy*, Zhengbao Zhu, Hongyan Ning, Victor W. Zhong, Amanda E. Paluch, John T. Wilkins, Donald M. Lloyd-Jones, Paul K. Whelton, Jiang He, Norrina B. Allen

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

28 Scopus citations


BACKGROUND: Better cardiovascular health (CVH) scores are associated with lower risk of cardiovascular disease (CVD). However, estimates of the potential population-level impact of improving CVH on US CVD event rates are not currently available. METHODS AND RESULTS: Using data from the National Health and Nutrition Examination Survey 2011 to 2016 (n=11 696), we estimated the proportions of US adults in CVH groups. Levels of 7 American Heart Association CVH metrics were scored as ideal (2 points), intermediate (1 point), or poor (0 points), and summed to define overall CVH (low, 0– 8 points; moderate, 9–11 points; or high, 12–14 points). Using individual-level data from 7 US community-based cohort studies (n=30 447), we estimated annual incidence rates of major CVD events by levels of CVH. Using the combined data sources, we estimated population attributable fractions of CVD and the number of CVD events that could be prevented annually if all US adults achieved high CVH. High CVH was identified in 7.3% (95% CI, 6.3%– 8.3%) of US adults. We estimated that 70.0% (95% CI, 56.5%–79.9%) of CVD events were attributable to low and moderate CVH. If all US adults attained high CVH, we estimated that 2.0 (95% CI, 1.6– 2.3) million CVD events could be prevented annually. If all US adults with low CVH attained moderate CVH, we estimated that 1.2 (95% CI, 1.0–1.4) million CVD events could be prevented annually. CONCLUSIONS: The potential benefits of achieving high CVH in all US adults are considerable, and even a partial improvement in CVH scores would be highly beneficial.

Original languageEnglish (US)
Article numbere019681
JournalJournal of the American Heart Association
Issue number7
StatePublished - 2021


  • Cardiovascular disease
  • Epidemiology
  • Health status disparities
  • Prevention
  • Risk factors

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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