Date of Award

5-2019

Document Type

Open Access Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

First Advisor

Laura L. Hayman

Second Advisor

Philimon Gona

Third Advisor

Eileen Stuart-Shor

Abstract

Background: Ideal cardiovascular health (iCVH) is defined as the simultaneous presence of seven health metrics-physical activity, not-smoking, healthy diet, healthy body weight, and blood cholesterol, blood pressure, and blood glucose levels as defined by evidence-based guidelines. Evidence suggests familial aggregation of single cardiovascular disease (CVD) risk factors but research on clustering of seven iCVH metrics and CVD disability-adjusted life years (CVD DALYs) within families is lacking.

Purpose: To examine trends and relationship of parental iCVH and offspring iCVH and CVD DALYs at similar age across the lifespan.

Methods: A secondary data analysis of the Framingham Heart Study (FHS) Dataset-Original and Offspring Cohorts. Pearson correlations and multivariate linear regressions were used to assess linear relationships of iCVH; T-test and chi-square were used to test differences between iCVH metrics and CVD DALYs. Proportional odds model was used for assessing relationships of ordered iCVH categories. Brant test and gologit2 command in Stata©14 were used to test the parallel assumptions of the proportional odds model. CVD disability weights were derived from the Global Burden of Disease Study (GBD) 2015 DALYs and Health Adjusted Life Expectancy (HALE) Collaborators.

Results: At total of 2734 parents and 3492 offspring met inclusion criteria with 1,044 distinct families with a mean of 2 children per family. Women participants were slightly higher than men in both cohorts (p<0.001). Offspring iCVH was positively correlated with the parents iCVH (r≤0.25). “Ideal” parental iCVH increased the odds of offspring attaining “ideal” iCVH by two-to-fourfold. Offspring of parents with high iCVH had lower mean CVD DALYs compared with offspring of parents with lower iCVH. iCVH was inversely associated with CVD DALYs. The mean CVD DALYs of Offspring Cohort was 5.5 (95% CI 5.2-5.9) compared with 1.8 (95% CI 1.6-1.9) in Original Cohort (p<0.001).

Conclusion: Results indicate familial clustering of iCVH metrics over the lifespan, with positive parental-offspring iCVH relationship and inverse relationship of iCVH and CVD DALYs. This study fuels the impetus for systems approaches in implementation of family-based interventions that combine multiple iCVH metrics with the ultimate goal of improving cardiovascular health for families and communities.

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