Association between Cardiovascular Health Score and Carotid Intima-Media Thickness: Cross-Sectional Analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) Baseline Assessment

J Am Soc Echocardiogr. 2016 Dec;29(12):1207-1216.e4. doi: 10.1016/j.echo.2016.09.001. Epub 2016 Oct 20.


Background: The American Heart Association aims to reduce the burden of cardiovascular disease in this decade by improving seven ideal cardiovascular health (CVH) characteristics in the population. The aim of this study was to quantify the association between the American Heart Association's CVH score and values for carotid intima-media thickness (CIMT) in the Brazilian Longitudinal Study of Adult Health baseline assessment.

Methods: The Brazilian Longitudinal Study of Adult Health is a multicenter cohort study of civil servants aged 35 to 74 years in Brazil. In this study, the investigators analyzed 9,662 individuals with no previous cardiovascular disease. The distribution of CIMT values (categorized into age-, sex-, and race-specific quartiles) was analyzed according to CVH scores using χ2 trend tests. Linear and multinomial regression models were built to evaluate the association between CIMT and CVH score.

Results: A significant increase was observed in the proportion of individuals within the first and second CIMT quartiles, as well as a decrease within the fourth quartile with higher CVH score strata (P for trend < .001). A 1-point increase in CVH score was associated in adjusted models with a decrease of 0.011 mm in CIMT and an odds ratio of 0.79 (95% CI, 0.77-0.81) of having CIMT in the fourth quartile. However, nearly 16% of individuals with optimal CVH scores had CIMT values in the highest quartile.

Conclusions: In this study, significant associations were found between CIMT and CVH score in a large sample of middle-aged adults. However, a high CVH score did not warrant the absence of a significant subclinical atherosclerotic burden.

Keywords: Cardiovascular risk factors; Cross-sectional; Lifestyle; Subclinical atherosclerosis.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Age Distribution
  • Aged
  • Brazil / ethnology
  • Cardiovascular Diseases / diagnostic imaging*
  • Cardiovascular Diseases / ethnology*
  • Cardiovascular Diseases / prevention & control
  • Carotid Intima-Media Thickness / statistics & numerical data*
  • Cross-Sectional Studies
  • Female
  • Health Status Indicators
  • Health Status*
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Prevalence
  • Racial Groups / statistics & numerical data*
  • Risk Factors
  • Sex Distribution
  • Statistics as Topic