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Am J Prev Med. 2015 Nov;49(5):678-685. doi: 10.1016/j.amepre.2015.03.034. Epub 2015 Jun 30.

Association of Ideal Cardiovascular Health and Long-term Healthcare Costs.

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The Cooper Institute, Dallas, Texas. Electronic address:
The Cooper Institute, Dallas, Texas.
Vanderbilt University School of Medicine, Nashville, Tennessee.
Center for Health Services Research, University of Texas School of Public Health, Houston, Texas.
Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Department of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas.



The American Heart Association's (AHA's) 2020 Strategic Impact Goals introduced the concept of ideal cardiovascular (CV) health based on seven health factors and behaviors associated with lower CV disease (CVD) risk. The association between CV health and healthcare costs has not been reported; therefore, we evaluated the association between CV health profile and later-life healthcare costs.


Cooper Center Longitudinal Study participants (N=4,906; mean age, 56 years) receiving Medicare coverage from 1999 to 2009 were included. CV health behaviors (diet, physical activity, BMI, smoking) and CV health factors (blood pressure, total cholesterol, blood glucose) were categorized as unfavorable (zero to two ideal components); intermediate (two to four); and favorable (five to seven). Healthcare costs were cumulated from Medicare claims data, adjusted for inflation. Associations between midlife CV health status and non-CVD and CVD-related costs were estimated using multivariable quantile regression. Analyses were conducted in 2013 and 2014.


Favorable CV health was prevalent in 14.8% of men and 30.1% of women, with <1% having ideal levels of all health metrics. After 31,945 person-years of Medicare follow-up, individuals with favorable CV health exhibited 24.9% (95% CI=11.7%, 36.0%) lower median annual non-CVD costs and 74.5% (57.5%, 84.7%) lower median CVD costs than those with unfavorable CV health. Annualized differences were greater for non-CVD costs than for CVD costs ($1,175 vs $566).


Having more ideal CV health components in middle age, as outlined by the AHA 2020 Goals, is associated with lower non-CVD and CVD healthcare costs in later life.

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