Relationship between cardiovascular health score trajectory and incident stroke in patients with hypertension.

Five distinct cardiovascular health (CVH) score trajectories were identified among hypertensive patients over a 2006–2010 exposure period.

• Trajectories were: low-stable (n=1190; score range 43.7–41.0), moderate-increasing (n=1035; mean increase from 46.9 to 56.1), moderate-decreasing (n=4520; mean decrease from 56.6 to 52.1), high-stable I (n=8551; score range 62.3–63.0), and high-stable II (n=2335; score range 68.7–71.5).
• Latent mixed models were used to determine trajectories, with the Bayesian information criterion (BIC) used to fit the model and confirm five patterns as the best fit.
• The CVH score was calculated by averaging eight key cardiovascular health indicators: blood pressure, plasma glucose, blood lipids, BMI, smoking, sleep duration, physical activity, and diet, each scored 0–100.
• The study included 17,631 hypertensive participants from the Kailuan study who attended three consecutive health checks and had no history of stroke or cancer.

Higher or improving CVH score trajectories were each associated with significantly lower stroke risk compared to the low-stable trajectory.

• During a median follow-up of 10.94 years, 1,499 cases of incident stroke were identified.
• Compared to the low-stable group, the HR (95% CI) for stroke in the moderate-increasing group was 0.76 (0.59, 0.97).
• The moderate-decreasing group had an HR of 0.72 (95% CI: 0.60, 0.87).
• The high-stable I group had an HR of 0.51 (95% CI: 0.42, 0.61), and the high-stable II group had an HR of 0.32 (95% CI: 0.25, 0.41).
• All HRs were adjusted for potential confounders and calculated using Cox proportional hazards models.

The study population consisted predominantly of middle-aged males with hypertension enrolled from the Kailuan study cohort.

• Total sample size was 17,631 hypertensive participants.
• Mean age was 56.45 ± 11.07 years.
• 14,585 participants were male (82.72%) and 3,046 were female (17.28%).
• Participants were required to have attended three consecutive health checks in 2006, 2008, and 2010, and to have no history of stroke or cancer at baseline.

Even a moderate increase in CVH score over time was associated with a statistically significant reduction in stroke risk among hypertensive patients.

• The moderate-increasing group showed a mean CVH score increase from 46.9 to 56.1 over the 2006–2010 period.
• This group had an HR for stroke of 0.76 (95% CI: 0.59, 0.97) compared to the low-stable group, indicating a 24% lower risk.
• The moderate-decreasing group, despite starting at a higher score (56.6), ended lower (52.1) and still showed a 28% lower risk (HR 0.72, 95% CI: 0.60, 0.87) compared to the low-stable group.
• These findings suggest that both the level and direction of change in CVH score over time are relevant to stroke risk prediction.

Maintaining a high CVH score over time was associated with the greatest reduction in stroke risk, with the highest-scoring group showing a 68% lower hazard compared to the low-stable group.

• The high-stable II group maintained scores ranging from 68.7 to 71.5 and had an HR of 0.32 (95% CI: 0.25, 0.41).
• The high-stable I group maintained scores ranging from 62.3 to 63.0 and had an HR of 0.51 (95% CI: 0.42, 0.61).
• This dose-response pattern across trajectory groups suggests a graded relationship between CVH score level and stroke risk.
• Cox proportional hazards models were used to calculate HRs and 95% CIs, suited for time-to-event data with censored observations.