Dynamic Change of Cardiovascular Health Metrics and Long‐Term Risk of Sudden Cardiac Death: The ARIC Study

BACKGROUND: The change of cardiovascular health (CVH) status has been associated with risk of cardiovascular disease. However, no studies have explored the change patterns of CVH in relation to risk of sudden cardiac death (SCD). We aim to examine the link between baseline CVH and change of CVH over time with the risk of SCD. METHODS AND RESULTS: Analyses were conducted in the prospective cohort ARIC (Atherosclerosis Risk in Communities) study, started in 1987 to 1989. ARIC enrolled 15 792 individuals 45 to 64 years of age from 4 US communities (Forsyth County, North Carolina; Jackson, Mississippi; suburbs of Minneapolis, Minnesota; and Washington County, Maryland). Subjects with 0 to 2, 3 to 4, and 5 to 7 ideal metrics of CVH were categorized as having poor, intermediate, or ideal CVH, respectively. Change in CVH over 6 years between 1987 to 1989 and 1993 to 1995 was considered. The primary study outcome was physician adjudicated SCD. The study population consisted of 15 026 subjects, of whom 12 207 had data about CVH change. Over a median follow‐up of 23.0 years, 583 cases of SCD were recorded. There was a strong inverse association between baseline CVH metrics and time varying CVH metrics with risk of SCD. Compared with subjects with consistently poor CVH, risk of SCD was lower in those changed from poor to intermediate/ideal (hazard ratio [HR], 0.67 [95% CI, 0.48–0.94]), intermediate to poor (HR, 0.73 [95% CI, 0.54–0.99]), intermediate to ideal (HR, 0.49 [95% CI, 0.24–0.99]), ideal to poor/intermediate CVH (HR, 0.23 [95% CI, 0.10–0.52]), or those with consistently intermediate (HR, 0.49 [95% CI, 0.36–0.66]) or consistently ideal CVH (HR, 0.31 [95% CI, 0.13–0.76]). Similar results were also observed for non‐SCD. CONCLUSIONS: Compared with consistently poor CVH, other patterns of change in CVH were associated with lower risk of SCD. These findings highlight the importance of promotion of ideal CVH in the primordial prevention of SCD.