Association between changes in cardiovascular health and the risk of multimorbidity: community-based cohort studies in the UK and Finland

Christof Prugger; Marie-Cécile Perier; Séverine Sabia; Aurore Fayosse; Thomas van Sloten; Xavier Jouven; Jaana Pentti; Mika Kivimäki; Jean-Philippe Empana

doi:10.1016/j.lanepe.2024.100922

Association between changes in cardiovascular health and the risk of multimorbidity: community-based cohort studies in the UK and Finland

Lancet Reg Health Eur. 2024 May 6:42:100922. doi: 10.1016/j.lanepe.2024.100922. eCollection 2024 Jul.

Authors

Christof Prugger¹, Marie-Cécile Perier², Séverine Sabia^{3

4}, Aurore Fayosse³, Thomas van Sloten⁵, Xavier Jouven², Jaana Pentti^{6

7

8

9}, Mika Kivimäki^{10

11}, Jean-Philippe Empana²

Affiliations

¹ Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Public Health, Seestraße 73, 13347, Berlin, Germany.
² Université Paris Cité, Paris, INSERM U970, Paris Cardiovascular Research Centre (PARCC), 56 rue Leblanc, 75015, Paris, France.
³ Université Paris Cité, INSERM U1153, Epidemiology of Aging and Neurodegenerative Diseases, 10 avenue de Verdun, 75010, Paris, France.
⁴ Department of Epidemiology and Public Health, University College London, 1-19 Torrington Pl, London, Wc1E 7Hb, United Kingdom.
⁵ Department of Vascular Medicine, University Medical Centre Utrecht, Lundlaan 4, 3584 EA, Utrecht, the Netherlands.
⁶ Clinicum, Faculty of Medicine, University of Helsinki, Haartmaninkatu 8, 00290, Helsinki, Finland.
⁷ Department of Public Health, University of Turku, Kiinamyllynkatu 8-10, 20520, Turku, Finland.
⁸ Centre for Population Health Research, Turku University Hospital, University of Turku, Kiinamyllynkatu 8-10, 20520, Turku, Finland.
⁹ Finnish Institute of Occupational Health, Topeliuksenkatu 41 b, 00250, Helsinki, Finland.
¹⁰ UCL Brain Sciences, University College London, 17 Queen Square, WC1N 3AR, London, United Kingdom.
¹¹ Clinicum, Faculty of Medicine, University of Helsinki, Tukholmankatu 8, 00290, Helsinki, Finland.

Abstract

Background: Better cardiovascular health is associated with lower risk of various chronic diseases, but its association with multimorbidity is poorly understood. We aimed to examine whether change in cardiovascular health is associated with multimorbidity risk.

Methods: The primary analysis was conducted in the Whitehall II multiwave prospective cohort study (UK) and the validation analysis in the Finnish Public Sector cohort study (Finland). Change in cardiovascular health was assessed using the American Heart Association Life's Simple 7 (LS7) and Life's Essential 8 (LE8) at baseline and re-assessments, using objective measures in Whitehall II and self-reports and pharmacy claims in the Finnish Public Sector cohort study, respectively. Multimorbidity was defined as the presence of two or more of 12 chronic diseases during follow-up. We estimated hazard ratios (HR) and 95% confidence intervals (CI) using Cox's proportional hazard models with age as time scale, adjusting for sex, education, occupation, marital status, and ethnicity.

Findings: In the primary analysis among 9715 participants, mean age was 44.8 (standard deviation 6.0) years and 67.6% participants were men at baseline. During the median follow-up of 31.4 (interquartile range 26.8-32.3) years, 2751 participants developed multimorbidity. The hazard of multimorbidity decreased by 8% (HR 0.92, 95% CI 0.88-0.96) per ideal LS7 metric increment over 5 years and by 14% (HR 0.86, 95% CI 0.80-0.93) per ten points increase in LE8 score over 10 years. These findings were replicated in the validation analysis among 75,377 participants in terms of 4-year change in cardiovascular health.

Interpretation: Improvement in cardiovascular health was associated with lower multimorbidity risk in two community-based cohort studies. Interventions improving cardiovascular health of the community may contribute to multimorbidity prevention.

Funding: None.

Keywords: Cardiovascular health; Chronic diseases; Cohort study; Multimorbidity; Prevention.