Nondietary cardiovascular health metrics with patient experience and loss of productivity among US adults without cardiovascular disease: the medical expenditure panel survey 2006 to 2015
Open accessAbstract
Background: The American Heart Association 2020 Impact Goals aimed to promote population health through emphasis on cardiovascular health (CVH). We examined the association between nondietary CVH metrics and patient‐reported outcomes among a nationally representative sample of US adults without cardiovascular disease. Methods and Results: We included adults aged ≥18 years who participated in the Medical Expenditure Panel Survey between 2006 and 2015. CVH metrics were scored 1 point for each of the following: not smoking, being physically active, normal body mass index, no hypertension, no diabetes mellitus, and no dyslipidemia, or 0 points if otherwise. Diet was not assessed in Medical Expenditure Panel Survey. Patient‐reported outcomes were obtained by telephone survey and included questions pertaining to patient experience and health‐related quality of life. Regression models were used to compare patient‐reported outcomes based on CVH, adjusting for sociodemographic factors and comorbidities. There were 177 421 Medical Expenditure Panel Survey participants (mean age, 45 [17] years) representing ~187 million US adults without cardiovascular disease. About 12% (~21 million US adults) had poor CVH. Compared with individuals with optimal CVH, those with poor CVH had higher odds of reporting poor patient‐provider communication (odds ratio, 1.14; 95% CI, 1.05–1.24), poor healthcare satisfaction (odds ratio, 1.15; 95% CI, 1.08–1.22), poor perception of health (odds ratio, 5.89; 95% CI, 5.35–6.49), at least 2 disability days off work (odds ratio, 1.39; 95% CI, 1.30–1.48), and lower health‐related quality of life scores. Conclusions: Among US adults without cardiovascular disease, meeting a lower number of ideal CVH metrics is associated with poor patient‐reported healthcare experience, poor perception of health, and lower health‐related quality of life. Preventive measures aimed at optimizing ideal CVH metrics may improve patient‐reported outcomes among this population.
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Cites
Lloyd-Jones, D. M., Hong, Y., Labarthe, D., Mozaffarian, D., Appel, L. J., Van Horn, L., Greenlund, K., Daniels, S., Nichol, G., Tomaselli, G. F., et al. (2010) · Circulation · doi:10.1161/circulationaha.109.192703 · Cited by 4,750 · see citing works
The impact of patient-centered care on outcomes.
Stewart, M., Brown, J. B., DONNER, A. P., McWhinney, I. R., Oates, J., Weston, W. W., & Jordan, J. (2000) · PubMed · Cited by 2,508 · see citing works
Yang, Q., Cogswell, M. E., Flanders, W. D., Hong, Y., Zhang, Z., Loustalot, F., Gillespie, C., Merritt, R., & Hu, F. B. (2012) · JAMA · doi:10.1001/jama.2012.339 · Cited by 802 · see citing works
Folsom, A. R., Yatsuya, H., Nettleton, J. A., Lutsey, P. L., Cushman, M., & Rosamond, W. D. (2011) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2010.11.041 · Cited by 713 · see citing works
Beach, M. C., Keruly, J. C., & Moore, R. D. (2006) · Journal of General Internal Medicine · doi:10.1111/j.1525-1497.2006.00399.x · Cited by 460 · see citing works
Ford, E. S., Greenlund, K. J., & Hong, Y. (2012) · Circulation · doi:10.1161/circulationaha.111.049122 · Cited by 378 · see citing works
Reliability and validity of the SF-12v2 in the medical expenditure panel survey
Cheak-Zamora, N. C., Wyrwich, K. W., & McBride, T. D. (2009) · Quality of Life Research · doi:10.1007/s11136-009-9483-1 · Cited by 353 · see citing works
Dong, C., Rundek, T., Wright, C. B., Anwar, Z., Elkind, M. S. V., & Sacco, R. L. (2012) · Circulation · doi:10.1161/circulationaha.111.081083 · Cited by 338 · see citing works
Ideal Cardiovascular Health Is Inversely Associated With Incident Cancer
Rasmussen‐Torvik, L. J., Shay, C. M., Abramson, J. G., Friedrich, C. A., Nettleton, J. A., Prizment, A. E., & Folsom, A. R. (2013) · Circulation · doi:10.1161/circulationaha.112.001183 · Cited by 303 · see citing works
Younus, A., Aneni, E. C., Spatz, E. S., Osondu, C. U., Roberson, L., Ogunmoroti, O., Malik, R., Ali, S. S., Aziz, M., Feldman, T., et al. (2016) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2016.01.019 · Cited by 252 · see citing works
Self-citationAngell, S. Y., McConnell, M. V., Anderson, C. A. M., Bibbins-Domingo, K. B., Boyle, D. S., Capewell, S., Ezzati, M., de Ferranti, S. D., Gaskin, D. J., Goetzel, R. Z., et al. (2020) · Circulation · doi:10.1161/cir.0000000000000758 · Cited by 193 · see citing works
Heisler, M., Cole, I., Weir, D. R., Kerr, E. A., & Hayward, R. A. (2007) · The Journals of Gerontology Series A · doi:10.1093/gerona/62.12.1435 · Cited by 166 · see citing works
Ideal Cardiovascular Health, Mortality, and Vascular Events in Elderly Subjects
Gaye, B., Canonico, M., Perier, M., Samieri, C., Berr, C., Dartigues, J., Tzourio, C., Elbaz, A., & Empana, J. P. (2017) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2017.05.011 · Cited by 157 · see citing works
DeVoe, J. E., Wallace, L. S., & Fryer, G. E. (2009) · Health Expectations · doi:10.1111/j.1369-7625.2008.00516.x · Cited by 133 · see citing works
Ogunmoroti, O., Allen, N. B., Cushman, M., Michos, E. D., Rundek, T., Rana, J. S., Blankstein, R., Blumenthal, R. S., Blaha, M. J., Veledar, E., et al. (2016) · Journal of the American Heart Association · doi:10.1161/jaha.116.003954 · Cited by 130 · see citing works
Self-citationEnserro, D. M., Vasan, R. S., & Xanthakis, V. (2018) · Journal of the American Heart Association · doi:10.1161/jaha.118.008741 · Cited by 118 · see citing works
Life's Simple 7 and Incident Heart Failure: The Multi‐Ethnic Study of Atherosclerosis
Ogunmoroti, O., Oni, E., Michos, E. D., Spatz, E. S., Allen, N. B., Rana, J. S., Virani, S. S., Blankstein, R., Aronis, K. N., Blumenthal, R. S., et al. (2017) · Journal of the American Heart Association · doi:10.1161/jaha.116.005180 · Cited by 107 · see citing works
Self-citationIdeal Cardiovascular Health and Cognitive Aging in the Northern Manhattan Study
Gardener, H. E., Wright, C. B., Dong, C., Cheung, K., DeRosa, J. T., Nannery, M., Stern, Y., Elkind, M. S. V., & Sacco, R. L. (2016) · Journal of the American Heart Association · doi:10.1161/jaha.115.002731 · Cited by 94 · see citing works
Kronish, I. M., Carson, A. P., Davidson, K. W., Muntner, P., & Safford, M. M. (2012) · PLoS ONE · doi:10.1371/journal.pone.0052771 · Cited by 93 · see citing works
Okunrintemi, V., Spatz, E. S., Capua, P. D., Salami, J., Elizondo, J. V., Warraich, H. J., Virani, S. S., Blaha, M. J., Blankstein, R., Butt, A. A., et al. (2017) · Circulation Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.117.003635 · Cited by 81 · see citing works
Self-citationCardiovascular Health and Incident Cardiovascular Disease and Cancer
Foraker, R. E., Abdel‐Rasoul, M., Kuller, L. H., Jackson, R. D., Horn, L. V., Seguin‐Fowler, R. A., Safford, M. M., Wallace, R. B., Kucharska‐Newton, A., Robinson, J. G., et al. (2015) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2015.07.039 · Cited by 71 · see citing works
A Prospective Study of Ideal Cardiovascular Health and Depressive Symptoms
España‐Romero, V., Artero, E. G., Lee, D.-C., Sui, X., Baruth, M., Ruiz, J. R., Pate, R. R., & Blair, S. N. (2013) · Psychosomatics · doi:10.1016/j.psym.2013.06.016 · Cited by 71 · see citing works
Ideal Cardiovascular Health and Incident Cardiovascular Events
Ommerborn, M. J., Blackshear, C. T., Hickson, D. A., Griswold, M. E., Kwatra, J., Djoussé, L., & Clark, C. R. (2016) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2016.07.003 · Cited by 66 · see citing works
Life's Simple 7 and the risk of atrial fibrillation: The Multi-Ethnic Study of Atherosclerosis
Ogunmoroti, O., Michos, E. D., Aronis, K. N., Salami, J., Blankstein, R., Virani, S. S., Spatz, E. S., Allen, N. B., Rana, J. S., Blumenthal, R. S., et al. (2018) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2018.05.050 · Cited by 66 · see citing works
Self-citationEffoe, V. S., Carnethon, M. R., Echouffo-Tcheugui, J. B., Chen, H., Joseph, J. J., Norwood, A. F., & Bertoni, A. G. (2017) · Journal of the American Heart Association · doi:10.1161/jaha.116.005008 · Cited by 65 · see citing works
Aneni, E. C., Crippa, A., Osondu, C. U., Elizondo, J. V., Younus, A., Nasir, K., & Veledar, E. (2017) · Journal of the American Heart Association · doi:10.1161/jaha.117.006904 · Cited by 61 · see citing works
Association Between Ideal Cardiovascular Health and Carotid Intima‐Media Thickness: A Twin Study
Kulshreshtha, A., Goyal, A., Veledar, E., McClellan, W., Judd, S. E., Eufinger, S. C., Bremner, J. D., Goldberg, J. H., & Vaccarino, V. (2014) · Journal of the American Heart Association · doi:10.1161/jaha.113.000282 · Cited by 52 · see citing works
Ogunmoroti, O., Osibogun, O. I., Kolade, O. B., Ying, W., Sharma, G. V., Vaidya, D. M., & Michos, E. D. (2019) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2019.07.001 · Cited by 51 · see citing works
Self-citationValero-Elizondo, J., Salami, J. A., Ogunmoroti, O., Osondu, C. U., Aneni, E. C., Malik, R., Spatz, E. S., Rana, J. S., Virani, S. S., Blankstein, R., et al. (2016) · Circulation: Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.115.002616 · Cited by 51 · see citing works
Self-citationRobbins, J., Petrone, A. B., Carr, J. J., Pankow, J. S., Hunt, S. C., HEISS, G. M., Arnett, D. K., Ellison, R. C., Gaziano, J. M., & Djoussé, L. (2015) · American Heart Journal · doi:10.1016/j.ahj.2014.12.017 · Cited by 48 · see citing works
Dhamoon, M. S., Dong, C., Elkind, M. S. V., & Sacco, R. L. (2015) · Journal of the American Heart Association · doi:10.1161/jaha.114.001322 · Cited by 45 · see citing works
Psychological Factors and Their Association with Ideal Cardiovascular Health Among Women and Men
Mathews, L. M., Ogunmoroti, O., Nasir, K., Blumenthal, R. S., Utuama, O. A., Rouseff, M., Das, S., Veledar, E., Feldman, T., Agatston, A. S., et al. (2018) · Journal of Women s Health · doi:10.1089/jwh.2017.6563 · Cited by 45 · see citing works
Self-citationAssociation Between Cardiovascular Health and Cognitive Performance: A Twins Study
Kulshreshtha, A., Goetz, M., Alonso, Á., Shah, A. J., Bremner, J. D., Goldberg, J. H., & Vaccarino, V. (2019) · Journal of Alzheimer s Disease · doi:10.3233/jad-190217 · Cited by 44 · see citing works
Osibogun, O. I., Ogunmoroti, O., Tibuakuu, M., Benson, E., & Michos, E. D. (2019) · BMJ Open · doi:10.1136/bmjopen-2019-031414 · Cited by 25 · see citing works
Self-citationOsibogun, O. I., Ogunmoroti, O., Spatz, E. S., Burke, G. L., & Michos, E. D. (2018) · Clinical Cardiology · doi:10.1002/clc.22995 · Cited by 23 · see citing works
Self-citationZullig, L. L., Shaw, R., Shah, B. R., Peterson, E. D., Lindquist, J. H., Crowley, M. J., Grambow, S. C., & Bosworth, H. B. (2015) · Patient Preference and Adherence · doi:10.2147/ppa.s75393 · Cited by 21 · see citing works
Brundage, M., Wu, A. W., Rivera, Y. M., & Snyder, C. F. (2020) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2020.01.022 · Cited by 19 · see citing works
Alcohol and ideal cardiovascular health: The Multi‐Ethnic Study of Atherosclerosis
Ogunmoroti, O., Osibogun, O. I., McClelland, R. L., Burke, G. L., Nasir, K., & Michos, E. D. (2018) · Clinical Cardiology · doi:10.1002/clc.23125 · Cited by 17 · see citing works
Self-citationRana, J. S., Liu, J. Y., Moffet, H. H., Karter, A. J., Nasir, K., Solomon, M. D., Jaffe, M. G., Ambrosy, A. P., Go, A. S., & Sidney, S. (2020) · European Journal of Preventive Cardiology · doi:10.1177/2047487320905025 · Cited by 15 · see citing works
Flagged first, then by citations
1 of the 40 references couldn’t be matched to a known paper.
Research works printed but not linked: 1
- [1]Lloyd‐Jones DM, Hong Y, Labarthe D, Mozaffarian D, Appel LJ, Van Horn L, Greenlund K, Daniels S, Nichol G, Tomaselli GF, et al. Defining and setting national goals for cardiovascular health promotion and disease reduction. Circulation. 2010; 586– 613. 20089546
Cited by
Sorted by citations
Bundy, J. D., Zhu, Z., Ning, H., Zhong, V. W., Paluch, A. E., Wilkins, J. T., Lloyd‐Jones, D. M., Whelton, P. K., He, J., & Allen, N. B. (2021) · Journal of the American Heart Association · doi:10.1161/jaha.120.019681 · Cited by 68 · see citing works
Further understanding of ideal cardiovascular health score metrics and cardiovascular disease
Michos, E. D., & Khan, S. S. (2021) · Expert Review of Cardiovascular Therapy · doi:10.1080/14779072.2021.1937127 · Cited by 47 · see citing works
Self-citationIncome disparity and utilization of cardiovascular preventive care services among U.S. adults
Shahu, A., Okunrintemi, V., Tibuakuu, M., Khan, S. U., Gulati, M., Marvel, F., Blumenthal, R. S., & Michos, E. D. (2021) · American Journal of Preventive Cardiology · doi:10.1016/j.ajpc.2021.100286 · Cited by 44 · see citing works
Self-citationOkunrintemi, V., Tibuakuu, M., Virani, S. S., Sperling, L. S., Volgman, A. S., Gulati, M., Cho, L., Leucker, T. M., Blumenthal, R. S., & Michos, E. D. (2020) · Journal of the American Heart Association · doi:10.1161/jaha.120.018764 · Cited by 36 · see citing works
Self-citationCardiovascular Health, 2010 to 2020: A Systematic Review of a Decade of Research on Life's Simple 7
Aguayo, L., Cotoc, C., Guo, J. W., Labarthe, D. R., Allen, N. B., Marino, B. S., Davis, M. M., Uttal, S. E., Lloyd‐Jones, D. M., & Perak, A. M. (2025) · Journal of the American Heart Association · doi:10.1161/jaha.124.038566 · Cited by 17 · see citing works
The Association Between Multiparity and Adipokine Levels: The Multi-Ethnic Study of Atherosclerosis
Rodriguez, C. P., Ogunmoroti, O., Quispe, R., Osibogun, O. I., Ndumele, C. E., Tcheugui, J. E., Minhas, A., Bertoni, A. G., Allison, M., & Michos, E. D. (2021) · Journal of Women s Health · doi:10.1089/jwh.2021.0091 · Cited by 16 · see citing works
Self-citationAssociation between plasma polyunsaturated fatty acids and depressive among US adults
Wang, M., Yan, X., Li, Y., Li, Q., Xu, Y., Huang, J., Gan, J., & Yang, W. (2024) · Frontiers in Nutrition · doi:10.3389/fnut.2024.1342304 · Cited by 16 · see citing works
Enyeji, A. M., Barengo, N. C., Ramı́rez, G., Ibrahimou, B., & Arrieta, A. (2023) · Cureus · doi:10.7759/cureus.44121 · Cited by 13 · see citing works
Modest Gains Confer Large Impact: Achievement of Optimal Cardiovascular Health in the US Population
Michos, E. D., & Khan, S. S. (2021) · Journal of the American Heart Association · doi:10.1161/jaha.121.021142 · Cited by 7 · see citing works
Self-citationWare, L. J., Vermeulen, B., Maposa, I., Flood, D., Brant, L. C. C., Khandelwal, S., Singh, K., Soares, S., Jessen, N., Perman, G., et al. (2023) · CJC Open · doi:10.1016/j.cjco.2023.11.021 · Cited by 6 · see citing works
Lee, H., Jhee, J. H., Kim, E., Son, D., Kim, H. C., Lloyd‐Jones, D. M., & Lee, H. (2025) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2025.03.024 · Cited by 3 · see citing works
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Park, S., Nguyen, A. M., Lindenfeld, Z., & Chang, J. E. (2025) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2025.01.018 · Cited by 3 · see citing works
Enyeji, A. M., Barengo, N. C., Ibrahimou, B., Ramı́rez, G., & Arrieta, A. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20095743 · Cited by 2 · see citing works
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Enyeji, A. M., Ibrahimou, B., Barengo, N. C., Ramı́rez, G., & Arrieta, A. (2023) · Population Health Management · doi:10.1089/pop.2023.0142 · Cited by 1 · see citing works
Michos, E. D., & WENGER, N. K. (2023) · Elsevier eBooks · doi:10.1016/b978-0-323-88286-6.00032-7
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Enyeji, A. M., Stegall, A., Davis, J., Mainer, S., Surani, R., McMackin, E., McElveen, K., Forbes, J. A., Nimi, T., & Wetzell, D. L. (2025) · Journal of Health Population and Nutrition · doi:10.1186/s41043-025-00984-2
Park, S., Fendrick, A. M., & Kim, D. D. (2026) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2026.108289
Bastan, M.-M., Heidari‐Foroozan, M., Jafary, H., Behnoush, A. H., Khalaji, A., Malekpour, M., & Nejadghaderi, S. A. (2026) · Journal of Diabetes & Metabolic Disorders · doi:10.1007/s40200-025-01842-y
- Authors
- Tibuakuu, M., Okunrintemi, V., Savji, N., Stone, N. J., Virani, S. S., Blankstein, R., Thamman, R., Blumenthal, R. S., & Michos, E. D.
- Affiliations
- Johns Hopkins University (US)
- East Carolina University (US)
- Northwestern University (US)
- Michael E. DeBakey VA Medical Center (US)
- Brigham and Women's Hospital (US)
- University of Pittsburgh (US)
- Corresponding author
- Michos, Erin D.
- ORCID
- Venue
- Journal of the American Heart Association
- Published
- 2020-10-06
- Volume
- 9
- Issue
- 19
- Pages
- e016744-e016744
- ISSN
- 2047-9980 (ISSN-L)
- PMC
- PMC7792398
- OpenAlex
- W3091540642
- Cited by
- 20
- References
- 40
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 1 · 2023: 5 · 2021: 5 · 2020: 2
- FWCI
- 1.86
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Journal of the American Heart Association (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- eCommons - AKU (Aga Khan University) (submittedVersion, cc-by-nc-nd)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Keywords
- cardiovascular health, patient-reported outcomes, health-related quality of life, patient-provider communication, health care satisfaction, health perception, labor productivity, smoking, physical activity, hypertension, diabetes mellitus, dyslipidemia, body mass index, cardiovascular disease prevention
- MeSH terms
- Patient Reported Outcome Measures, Heart Disease Risk Factors, Health Expenditures, Female, Health Surveys, Humans, Male, Middle Aged, Quality of Life, Self Concept, United States, Quality Indicators, Health Care, Diagnostic Self Evaluation
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