Background and aims: Acute myocardial infarction (AMI) is associated with high mortality globally and remains a public health burden. We sought to investigate the relation between the American Heart Association’s cardiovascular health metrics (CVH) and the risk of AMI among middle-aged Finnish men.

Methods: We used the ongoing population-based Kuopio Ischaemic Heart Disease cohort study comprising men aged 40 to 62 years at baseline. The CVH metrics was computed among 2584 participants at baseline with health scores ranging from 0 to 7. This was categorized into three groups of CVH metrics as poor (0-2), intermediate (3-4) and ideal (≥5). Multivariate Cox regression models were used to estimate the hazard ratios (HR) and 95% confidence intervals (CIs) of CVH metrics for AMI.

Results: During a median follow-up period of 25.2 years, 513 cases of AMI were recorded. Only one participant was able to achieve all the seven ideal health metrics. The risk of AMI decreased continuously with increasing number of CVH metrics across the range 2-7 (for non-linearity, p=0.07). Men with ideal CVH metrics had a HR (95% CI) for AMI of 0.28 (CI 0.15 – 0.55, p<0.001) compared to those with poor CVH metrics after adjustment for age, alcohol intake and socioeconomic status.The associations remained consistent following further adjustment for history of coronary heart disease and history of type 2 diabetes.

Conclusions: Ideal CVH metrics was strongly and linearly associated with reduced risk of AMI among middle-aged Finnish men.