Correlates of ideal cardiovascular health in European adolescents: The HELENA study

Highlights

• Little is known about the correlates of adolescent iCVH (ideal cardiovascular health).

• This study included 637 European adolescents from the multi-center HELENA study.

• Younger age (<15 y) and less TV viewing (<2 h/day) was related to greater iCVH.

• Adolescents of mothers with medium/high education, compared to low, had higher iCVH.

• These correlates may be useful for promoting cardiovascular health in adolescence.

Abstract

Background and aims

The ideal cardiovascular health (iCVH) construct consists of 4 health behaviors (smoking status, body mass index, physical activity and diet) and 3 health factors (total cholesterol, blood pressure and fasting glucose). A greater number of iCVH components in adolescence are related to better cardiovascular health, but little is known about the correlates of iCVH in adolescents. Thus, the aim of the study was to examine correlates of iCVH in European adolescents.

Methods and results

The study comprised 637 European adolescents with complete iCVH data. Participants were part of the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study, a cross-sectional, multicenter study conducted in 9 different European countries. Correlates investigated were sex and age, family affluence scale, maternal education, geographic location, sleep time, television viewing, duration of pregnancy, birth weight and breastfeeding. Younger adolescents, those whose mothers had medium/high education or those who watched television less than 2 h per day had a greater number of iCVH components compared to those who were older, had a mother with low education or watched television 2 h or more daily (P ≤ 0.01).

Conclusion

Since in our study older adolescents had worse iCVH than younger adolescents, early promotion of cardiovascular health may be important. Future studies may also investigate the usefulness of limiting television viewing to promote iCVH. Finally, since adolescents of mothers with low education had poorer iCVH, it may be of special interest to tailor public health promotion to adolescents from families with low socioeconomic status.

Introduction

Cardiovascular disease is a major cause of mortality and morbidity worldwide [1], [2]. In 2010, the American Heart Association (AHA) launched a new construct to monitor cardiovascular health named ideal cardiovascular health (iCVH). It combines 4 health behaviors (smoking status, body mass index (BMI), physical activity and diet) and 3 traditional cardiovascular risk factors (cholesterol, blood pressure and glucose). Cut-offs to define ideal status of these behaviors and risk factors have been published both for children and adults [1]. To date, a number of studies have reported that a greater number of iCVH components at ideal level in adulthood is associated with better health outcomes [3], [4]. For instance, in a recent meta-analysis, adults with the greatest number of iCVH components had considerably lower risk of all-cause and cardiovascular mortality, as well as cardiovascular disease and stroke than adults with the least number of iCVH components [3].

The importance of obtaining iCVH early in life has been stressed [4], [5], and previous studies have reported that a higher iCVH already in adolescence is related to better current and later cardiovascular health [6], [7], [8], [9], [10]. In this regard, longitudinal studies have reported that higher iCVH in adolescence is associated with a more favorable cardiac structure and function [9], as well as a substantially lower risk of hypertension and metabolic syndrome in adulthood [8]. Despite the importance of iCVH already in youth, few studies have examined iCVH in contemporary adolescents. We have previously reported that the prevalence of iCVH, especially the behavioral components, were low in European adolescents from 9 different countries [11]. These results are in agreement with previous reports of iCVH in US adolescents [12], and in urban Chinese children and adolescents in whom adverse trends in the prevalence of iCVH have been observed [13]. Although previous studies have indicated that sex, age, socioeconomic status, sleep, television viewing and early life factors (i.e. duration of pregnancy, birth weight and breastfeeding) may be related to cardiovascular risk factors [10], [14], [15], [16], [17], [18], [19], [20], there is limited data regarding whether these variables are associated with iCVH in youth. This is of importance, since a greater understanding of which factors are associated with iCVH may be useful in order to identify groups of children and adolescents at special risk, as well as to tailor interventions to promote iCVH. Hence, the aim of the present study was to examine the correlates of iCVH in European adolescents. To address this aim we utilized data from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study, which has detailed data of iCVH and several of its potential correlates.