Prevalence of ideal cardiovascular health in European adolescents: The HELENA study
Introduction
Cardiovascular disease is a leading cause of death worldwide [1], [2]. In 2010, the American Heart Association (AHA) presented a new construct, ideal cardiovascular health (iCVH), which incorporated health behaviours and traditional cardiovascular risk factors to assess cardiovascular health [3]. iCVH was defined as the simultaneous presence of 7 ideal components, consisting of 4 health behaviours (non-smoking status and ideal body mass index (BMI), physical activity and diet) and 3 health factors (ideal total cholesterol, blood pressure and fasting glucose). Cut-offs to define ideal status were provided for children and adults [3].
Numerous studies have used the iCVH construct and reported that a higher number of iCVH components are related to better health [4]. For instance, iCVH components in adulthood have been related to lower morbidity and mortality from cardiovascular diseases [5], [6] as well as all-cause mortality [5], [6]. The importance of having an iCVH early in life has been pointed out previously [4], [7], [8], [9]. In adolescents, a higher number of iCVH components were associated with higher levels of cardiorespiratory fitness [9], an important marker of health [10], [11], and with aortic elasticity [8]. Laitinen et al. [7] found a strong association between adolescent and adult iCVH and also reported that each number of additional iCVH component in adolescence was associated with a 34% lower risk of hypertension and metabolic syndrome 21 years later. Taken together, these findings indicate that iCVH, already in adolescence, is of great importance not only for present but also for future health.
Although previous studies have provided important knowledge regarding cardiovascular risk factors in various adolescent populations [12], [13], [14], there is a great lack of data of the prevalence of iCVH in contemporary European adolescents. This data could contribute to the development of effective prevention programs, counselling, and public health policies.
Therefore, data obtained within the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study provide an excellent opportunity to study the iCVH of European adolescents. The HELENA study was designed to provide reliable data on nutrition and health-related variables in a relatively large sample of European adolescents from 9 different countries and includes the components of the iCVH construct [9]. Thus, in this study we examined the prevalence of iCVH and its components in European adolescents.
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Study participants
Detailed information regarding sampling procedures and study methods in the HELENA study has been published previously [15], [16], [17]. Since randomized sampling of the entire European adolescent population was not feasible, the HELENA study investigated 10 European cities in countries all across Europe. As described previously [16], countries were chosen according to their socioeconomic status, cultural reference and geographical locations of Europe (north, south, central, east, west). Hence,
Results
Fig. 1 shows the prevalence of the individual iCVH components for all adolescents, and detailed estimates and results stratified by sex and age are presented in Table 1. Most adolescents had ideal plasma glucose (88.8%) whereas only 1.7% had ideal status for the diet component. As shown in Table 2, few adolescents also had ideal status for the individual ideal dietary indicators. More than half of the adolescents had ideal status for non-smoking (60.9%), BMI (76.8%), physical activity (62.1%),
Discussion
This study reports the iCVH of contemporary European adolescents from the HELENA study. Overall, the prevalence of iCVH behaviours was low. For instance, 62.1% of participants had ideal physical activity levels and only 1.7% had an ideal diet.
Funding
The HELENA project was supported by the European Community Sixth RTD Framework Programme (contract FOOD-CT-2005-007034). The data for this study was gathered under the aegis of the HELENA project, and further analysis was additionally supported by the Spanish Ministry of Economy and Competitiveness (grants RYC-2010-05957 and RYC-2011-09011), the Spanish Ministry of Health: Maternal, Child Health and Development Network (grant RD16/0022), the Fondo Europeo de Desarrollo Regional (MICINN-FEDER)
Conflict of interest
The authors report no relationships that could be construed as a conflict of interest.
Acknowledgements
We thank the adolescents who participated in the study and their parents and teachers for their collaboration. We also acknowledge the members involved in fieldwork for their efforts.
HELENA study group members are attached as supplementary material. Author responsibilities were as follows: PH and JRR conceived and designed the current study; LGM, FBO, IL, IH, VER, YM, KW, JD, MGG, LAM, MJC, and JRR designed the research and acquired the data. PH, HH and JRR drafted the manuscript which was
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Ideal Cardiovascular Health in adolescents: Findings from Study of Cardiovascular Risks in Adolescents
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2021, Nutrition, Metabolism and Cardiovascular DiseasesCardiovascular health behaviors and associations of sex, age, and education in adolescents - Results from the EVA Tyrol study
2021, Nutrition, Metabolism and Cardiovascular DiseasesCitation Excerpt :In line with previous evaluations in adolescents in Europe, USA and China, in our cohort, the prevalence of ideal CVH behaviors was generally low with 78.3% of study participants in an ideal BMI range, 42.5% with ideal physical activity and 70.4% being non-smokers [9,21–23]. The adolescents of similar age participating in the Healthy Lifestyle in Europe by Nutrition in Adolescence cross-sectional study in 10 larger European cities showed comparable results in terms of ideal BMI levels (76.8%), yet higher levels of ideal physical activity (62.1%), and a lower prevalence of non-smokers (60.9%) and of ideal diet (1.7%) [24]. The difference to our cohort might in part be explained that 61.2% of our cohort reside in rural areas.
- 1
This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
- 2
This author acquired the data, critically revised the manuscript for key intellectual content and approved the final manuscript.
- 3
HELENA study group members are attached as supplementary material.