Abstract P130: Ideal Cardiovascular Health and Incident Cardiovascular Disease: Heterogeneity Across Event Phenotype and Contribution of Multiple Biomarkers. The Prime Study

Background: To which extent the association between ideal cardiovascular health (CVH) and incident vascular events differ by main coronary heart disease (CHD) and main stroke phenotype is currently unknown. Furthermore, data on potential mediating factors underlying the association of ideal CVH with outcomes are lacking. Aims: We aimed to 1) quantify the association between ideal CVH and incident CHD and stroke, 2) to assess for potential heterogeneity across main CHD and main stroke phenotypes and between CHD and stroke; and 3) to assess the mediating effect of a selected panel of key circulatory biomarkers from different relevant disease pathways. Methods and Results: A total of 9312 men middle-aged men (50-59 years) free of CHD and stroke were recruited in the framework of WHO MONICA centres in Lille, Strasbourg, Toulouse (France) and Belfast (Northern Ireland) between 1991 and 1993 and enrolled in the PRIME study. According to the American Heart Association, men with 0-2, 3-4 and 5-7 metrics at the ideal level were categorized as having poor, intermediate and ideal CVH respectively. Hazards ratios (HRs) were estimated using Cox proportional hazards regression and were adjusted for age, centre, education, living alone, marital status, family history of CHD and blood fibrinogen. The contribution of baseline circulating, endothelial inflammatory and haemostatic biomarkers was explored in a case control study nested within the PRIME cohort and settled after 10 years of follow-up. An ideal CVH was observed in 7% of the participants. After a median follow-up of 10 years, 614 first CHD events (myocardial infarction, angina, coronary death) and 117 first stroke events (ischaemic and non ischaemic) were adjudicated. Compared to those with poor CVH, those with an ideal CVH at baseline had a 72% lower risk of CHD (HR=0.28; 95% CI: 0.17; 0.46) and a 76% lower risk of stroke (HR=0.24; 95% CI: 0.06; 0.98) in multivariate analysis. No heterogeneity was detected across main CHD and main stroke phenotypes. While significantly lower mean concentrations of hs-CRP, IL-6, ICAM-1, fibrinogen and von Willbrandt factor were noted in subjects with ideal or intermediate as compared to poor CVH status in the controls, none of these biomarkers contribute to the association of CVH with future CHD. Conclusion: In this study ideal CVH was associated with a substantially lower risk of CHD and stroke, without any difference across phenotypes. Neither inflammatory, endothelial nor haemostatic biomarkers explained the lower risk of CHD in men with ideal CVH.