• epidemiology
• global health
• cardiac risk factors and prevention

Cardiovascular health (CVH) is a concept developed by the American Heart Association (AHA) in 2010 when the organisation set its impact goals for the next decade: ‘By 2020, to improve the cardiovascular health of all Americans by 20%, while reducing deaths from cardiovascular diseases and stroke by 20%’. The rationale of creating the concept of CVH was to change the focus on disease prevention and treatment to incorporate and enhance health promotion. Ideal CVH was then defined by the presence of four ideal health behaviours (non-smoking, body mass index <25 kg/m², regular physical activity and adopting a healthy diet) and three ideal health factors (untreated total cholesterol <200 mg/dL, blood pressure <120/80 mm Hg and fasting blood glucose <100 mg/dL) in individuals free of cardiovascular diseases.1 For each metric, the individual could otherwise be classified as having intermediate or poor health and a score based on these metrics—the Cardiovascular Health Score—has also been proposed (table 1).

Since then, many studies have been published using the AHA metrics. In the US population, data from the National Health and Nutrition Examination Survey have shown that the number of ideal metrics is inversely related to all-cause and cardiovascular disease mortality. Individuals who met ≥5 metrics had 88% reduction in the mortality of cardiovascular diseases (adjusted HR 0.12; 95% CI 0.03 to 0.57) compared with individuals who met ≤2 metrics.2 The number of ideal CVH metrics is also related to incident cardiovascular events and subclinical cardiovascular disease. In the Multiethnic Study of Atherosclerosis, for example, adults with high or moderate CVH scores were 67% (95% CI 41% to 82%) and 37% (95% CI 22% to 49%) less likely to experience a cardiovascular disease event after 10.3 years of follow-up than adults with low scores.3 Findings from other populations worldwide are also …