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Background  Data on the temporal trends in ideal cardiovascular health ( CVH ) as well as on their association with subclinical/overt cardiovascular disease ( CVD ) and death are limited.    Methods and Results  This study included 3460 participants attending ≥1 of 4 consecutive exams of the Framingham Heart Study (1991–2008, mean age 55.4 years,  CVH  score ranged 0–14). We created 4 groups describing changes in  CVH  score between examination cycles 5 and 8, using first and last exams attended (high‐high: starting  CVH  score ≥8, last score of ≥8, referent; high‐low: ≥8 start and ≤7 last; low‐high: ≤7 start and ≥8 last; and low‐low: ≤7 start and ≤7 last) and related them to subclinical  CVD  cross‐sectionally, and incident  CVD  and death. Fewer people have ideal  CVH  scores over the past 20 years (8.5% for 1991–1995, 5.9% for 2005–2008,  P =0.002), because of decreases in those with ideal status of body mass index, blood glucose, and serum cholesterol levels ( P <0.05 for all). The odds of subclinical disease and risk of  CVD  and death were higher for all compared with the high‐high group (428  CVD  and 367 death events, median follow‐up 5.1 years, hazard ratios for  CVD : 1.39, 1.73, 1.9 and death: 1.12, 1.57, 1.4 and odds ratios for subclinical disease: 1.61, 1.98, 2.86 for high‐low, low‐high, and low‐low, respectively).    Conclusions  The decreased presence of ideal  CVH  scores over the past 20 years resulted in increasing odds of subclinical disease and risk of  CVD  and death, emphasizing the importance of maintaining ideal  CVH  over the life course.

journal of the american heart association

Twenty‐Year Trends in the American Heart Association Cardiovascular Health Score and Impact on Subclinical and Clinical Cardiovascular Disease: The Framingham Offspring Study