Dog Ownership and Cardiovascular Health: Results From the Kardiovize 2030 Project

Abstract

Objective:
To investigate the association of pet ownership, and specifically dog ownership, with cardiovascular diseases (CVD) risk factors and cardiovascular health (CVH) in the Kardiovize Brno 2030 study, a randomly selected prospective cohort in Central Europe.

Patients and methods:
We included 1769 subjects (aged from 25 to 64 years; 44.3% males) with no history of CVD who were recruited from January 1, 2013, to December 19, 2014. We compared sociodemographic characteristics, CVD risk factors, CVH metrics (ie, body mass index, healthy diet, physical activity level, smoking status, blood pressure, fasting glucose, and total cholesterol), and score between pet owners and non-pet owners or dog owners and several other subgroups.

Results:
Approximately 42% of subjects owned any type of pet: 24.3% owned a dog and 17.9% owned another animal. Pet owners, and specifically dog owners, were more likely to report physical activity, diet, and blood glucose at ideal level, and smoking at poor level, which resulted in higher CVH score than non-pet owners (median, 10; interquartile range = 3 vs median, 9; interquartile range = 3; P=0.006). Compared with owners of other pets, dog owners were more likely to report physical activity and diet at ideal level. The comparison of dog owners with non-dog owners yielded similar results. After adjustment for covariates, dog owners exhibited higher CVH scores than non-pet owners (β=0.342; SE=0.122; P=0.005), other pet-owners (β=0.309; SE=0.151; P=0.041), and non-dog owners (β=0.341; SE=0.117; P=0.004).

Conclusion:
Except for smoking, dog owners were more likely to achieve recommended level of behavioral CVH metrics (physical activity and diet) than non-dog owners, which translated into better CVH.

Full text

Dog Ownership and Cardiovascular Health:
Results From the Kardiovize 2030 Project
Andrea Maugeri, PhD; Jose R. Medina-Inojosa, MD; Sarka Kunzova, MD;
Martina Barchitta, PhD; Antonella Agodi, PhD; Manlio Vinciguerra, PhD;
and Francisco Lopez-Jimenez, MD, MSc, MBA
Abstract
Objective: To investigate the association of pet ownership, and specifically dog ownership, with cardio-
vascular diseases (CVD) risk factors and cardiovascular health (CVH) in the Kardiovize Brno 2030 study, a
randomly selected prospective cohort in Central Europe.
Patients and Methods: We included 1769 subjects (aged from 25 to 64 years; 44.3% males) with no
history of CVD who were recruited from January 1, 2013, to December 19, 2014. We compared socio-
demographic characteristics, CVD risk factors, CVH metrics (ie, body mass index, healthy diet, physical
activity level, smoking status, blood pressure, fasting glucose, and total cholesterol), and score between pet
owners and non-pet owners or dog owners and several other subgroups.
Results: Approximately 42% of subjects owned any type of pet: 24.3% owned a dog and 17.9% owned
another animal. Pet owners, and specifically dog owners, were more likely to report physical activity, diet,
and blood glucose at ideal level, and smoking at poor level, which resulted in higher CVH score than non-
pet owners (median, 10; interquartile range ¼3 vs median, 9; interquartile range ¼3; P¼0.006).
Compared with owners of other pets, dog owners were more likely to report physical activity and diet at
ideal level. The comparison of dog owners with non-dog owners yielded similar results. After adjustment
for covariates, dog owners exhibited higher CVH scores than non-pet owners (b¼0.342; SE¼0.122;
P¼0.005), other pet-owners (b¼0.309; SE¼0.151; P¼0.041), and non-dog owners (b¼0.341; SE¼0.117;
P¼0.004).
Conclusion: Except for smoking, dog owners were more likely to achieve recommended level of
behavioral CVH metrics (physical activity and diet) than non-dog owners, which translated into better
CVH.
ª2019 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND
license (http://creativecommons.org/licenses/by-nc-nd/4.0/)nMayo Clin Proc Inn Qual Out 2019;3(3):268-275
Every year, an estimated 17 million peo-
ple globally die of cardiovascular
disease (CVD), accounting for 4
million dnearly 45% of all deaths dacross
the European region in 2016.
1
Primary pre-
vention of CVD is achievable through early
identification and modification of behavioral
risk factors such as tobacco use, unhealthy
diet, physical inactivity, and adherence to
medications to treat hypertension, diabetes,
and hypercholesterolemia. To face this issue,
the American Heart Association (AHA) pro-
posed a definition of seven ideal health behav-
iors and health factors to estimate, promote,
and monitor cardiovascular health (CVH) at
the population level.
2
Those components d
specifically body mass index (BMI), healthy
diet, physical activity, smoking status,
blood pressure, blood glucose, and total
cholesterol dcan be computed to create the
CVH score, which helps identify individuals
with poor CVH at higher risk of CVD.
3
More recently, it has been proposed that
owning a pet might prevent obesity,
4e6
improve lipid profiles,
4,7
and reduce systemic
blood pressure,
4,6,8e10
thereby reducing risk
of mortality and CVD events.
11e14
Among all
pets, dogs appear to positively influence phys-
ical activity and to provide social support,
which in turn is a predictor of adoption and
maintenance of behavior changes.
15
Previous
studies have shown that people who own a
dog engage in more physical activity than
non-owners.
16e21
Although several studies
For editorial
comment, see
page 249
From the International Clinical
Research Center, St Anne’s
University Hospital, Brno,
Czech Republic (A.M., S.K.,
M.V.); the Department of
Medical and Surgical Sciences
and Advanced Technologies
"GF Ingrassia," University of
Catania, Catania, Italy (A.M.,
M.B., A.A.); and the Division of
Preventive Cardiology,
Department of Cardiovascular
Medicine, Mayo Clinic,
Rochester, MN (J.R.M.-I., F.L.-J.).
ORIGINAL ARTICLE
268 Mayo Clin Proc Inn Qual Out nSeptember 2019;3(3):268-275 nhttps://doi.org/10.1016/j.mayocpiqo.2019.07.007
www.mcpiqojournal.org nª2019 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. This is an open access article under
the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

have suggested health benefits of owning a
pet, other studies have produced inconclusive
findings.
22
In 2013, a scientific statement from
the AHA concluded that pet ownership d
particularly dog ownership dis probably
associated with decreased CVD risk, with
convincing evidence for a relationship with
increased physical activity.
23
However, further
research is encouraged to address this topic,
including analysis of population-based studies
that account for socioeconomic factors, behav-
iors, and well-defined medical conditions, and
using robust statistical methodologies. Since
the relationship between dog ownership and
CVH has not been reported previously, we
used data from the Kardiovize Brno cohort, a
random urban sample population in Central
Europe,
24
to investigate the association of
dog ownership with CVH and its individual
components.
PATIENTS AND METHODS
Study Design and Participants
The Kardiovize Brno 2030 cohort prospec-
tively recruited a random sample of residents
(aged 25 to 64 years) of the city of Brno, Czech
Republic; protocol and baseline findings have
been previously described.
24
Briefly, baseline
examinations started on January 1, 2013,
and lasted until December 19, 2014, with
planned follow-up at 5-year intervals until
2030. The baseline study protocol was
approved by the ethics committee of St Anne’s
University Hospital, Brno, Czech Republic
(reference 2 G/2012), in accordance with the
Declaration of Helsinki, and all participants
signed an informed consent to participate in
the study. Face-to-face health comprehensive
interviews were performed on (1) demo-
graphic and socioeconomic status (age, sex,
educational level, employment, and marital
status), (2) behaviors (smoking status, diet,
and physical activity), and (3) personal history
(diseases and medications).
24
Physical activity
was assessed using the long version of the In-
ternational Physical Activity Questionnaire
translated into Czech.
25,26
Dietary data were
collected using 24-hour recall and food and
nutrient intakes were assessed by NutriDan
software.
27e29
Physical examinations and
anthropometric measurements were per-
formed by trained nurses according to
standardized techniques and protocols.
24,30,31
In this cross-sectional analysis, we used data
from Kardiovize members with complete
assessment of pet ownership and CVH, and
no previous or current history of CVD.
Pet Ownership Assessment
During the face-to-face interview, Kardiovize
members were asked to indicate whether
they have any pets, followed by items about
specific pets (dog, cat, horse, or other). The
last three groups were collapsed owing to a
low prevalence of ownership. For the purpose
of our analysis, we compared pet owners with
non-pet owners and dog owners with non-dog
owners, other pet owners, or non-pet owners.
Ideal Cardiovascular Health Score
CVH score, as defined by the AHA,
2,3
was
computed first as the sum of seven metrics:
BMI, healthy diet, physical activity level,
smoking status, blood pressure, blood
glucose, and total cholesterol. Each metric
was scored from 0 to 2 (0 ¼poor, 1 ¼inter-
mediate, and 2 ¼ideal); thus, the overall CVH
score ranged from 0 to 14 (Supplemental
Table 1, available online at http://www.
mayoclinicproceedings.org). Ideal CVH status
was categorized as having all seven metrics be-
ing at ideal levels; intermediate CVH as having
at least one metric at intermediate level, but no
poor metrics; and poor CVH as having at least
one of seven metrics at poor level.
32
Statistical Analyses
All statistical analyses were performed using
the SPSS software (version 22.0, SPSS, Chi-
cago, IL). The Kolmogorov-Smirnov test was
used to assess the normal distribution of vari-
ables. Continuous variables were reported as
median and interquartile range (IQR), and
compared using the Mann-Whitney U test.
Categorical variables were reported as fre-
quency and percentage, and compared using
the c
2
test. To assess the independent effect
of dog ownership on CVH score, multiple
linear regression analyses were used to esti-
mate bcoefficients with accompanying
95% CIs. Regression models were adjusted
for those variables significantly associated
with dog ownership and not included in the
CVH score (ie, age, sex, and educational level).
To test the robustness of our results, we
DOG OWNERSHIP AND CARDIOVASCULAR HEALTH
Mayo Clin Proc Inn Qual Out nSeptember 2019;3(3):268-275 nhttps://doi.org/10.1016/j.mayocpiqo.2019.07.007
www.mcpiqojournal.org 269

performed a sensitivity analysis by excluding
people who owned dogs and other pets. We
also investigated the interactions of dog
ownership with age, sex, and educational level
on CVH score using a general linear model. All
statistical tests were two-sided, and Pvalues
less than 0.05 were considered statistically
significant.
RESULTS
A total of 1769 Kardiovize members (aged
25-64 years; 44.3% males) who satisfied the
selection criteria were included in the current
analysis. Approximately 42% of subjects
owned any type of pet: 429 (24.3%) owned
a dog (ie, 328 owned exclusively dogs and
101 owned dogs and other pets), whereas
317 (17.9%) owned another animal. In gen-
eral, pet owners were younger, less likely to
be men, less educated, and more likely to
smoke tobacco and perform more physical ac-
tivity than non-owners (Table 1). Pet owners
also exhibited higher high-density lipoprotein
(HDL) cholesterol and lower prevalence of dia-
betes. With respect to CVH metrics, people
who owned a pet were more likely to report
physical activity, diet, and blood glucose at
higher level, and smoking at a poorer level
(Figure 1). We also observed higher CVH
scores among pet owners compared with par-
ticipants who did not own a pet (median, 10;
IQR¼3 vs. median, 9; IQR¼3; P¼0.007).
TABLE 1. Characteristics of Study Population (N¼1769) According to Pet Ownership
a
Characteristics
Median (Interquartile Range) or % Pet Owners (n¼746) Non-pet Owners (n¼1023) PValue
Age, y 44.0 (16.0) 50.0 (17.0) <0.001
Sex (% male) 41.0 46.6 0.019
Educational level (% low
b
) 21.7 16.7 <0.001
Marital status (% living alone) 38.1 38.2 0.950
Employment (% unemployed) 18.2 18.2 0.641
Income (% less than 30,000 CZK) 39.3 42.0 0.401
Smoking (% current smokers) 29.9 24.6 0.044
Physical activity, MET-min/wk 4265 (5685) 2805 (4176) <0.001
Weight, kg 76.0 (24.0) 77.0 (24.0) 0.115
Body mass index, kg/m
2
25.0 (6.4) 25.4 (6.0) 0.115
Waist circumference, cm 87.0 (21.0) 89.0 (20.0) 0.042
Central obesity
c
(%) 28.4 32.2 0.088
Systolic blood pressure, mm Hg 117.5 (18.5) 118.5 (19.8) 0.206
Diastolic blood pressure, mm Hg 79.0 (12.5) 79.5 (13.0) 0.584
History of hypertension (%) 27.5 32.9 0.016
Fasting glucose, nmol/L 4.9 (0.8) 4.9 (0.7) 0.357
History of diabetes mellitus (%) 7.3 10.0 0.046
Triglycerides, nmol/L 1.04 (0.80) 1.05 (0.80) 0.876
Total cholesterol, nmol/L 5.1 (1.3) 5.1 (1.3) 0.889
HDL cholesterol, nmol/L 1.5 (0.5) 1.4 (0.5) 0.021
LDL cholesterol, nmol/L 3.0 (1.2) 3.1 (1.2) 0.334
Total cholesterol/HDL-cholesterol ratio 3.3 (1.5) 3.4 (1.4) 0.054
History of hypercholesterolemia (%) 26.3 29.5 0.139
CVH score
d
10 (3) 9 (3) 0.007
Number of ideal CVH metrics 4 (2) 4 (1) 0.105
a
CVH ¼cardiovascular health; CZK ¼Czech koruna; HDL ¼high-density lipoprotein; LDL ¼low-density lipoprotein; MET ¼metabolic
equivalent for task.
b
Primary education or apprenticeship.
c
Defined as waist circumference 102 cm in men and 88 cm in women.
d
Computed as the sum of seven metrics defined by the American Heart Association.
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However, multivariable linear regression anal-
ysis did not confirm the association of pet
ownership with CVH scores after adjusting
for age, sex, and educational level.
We next compared dog owners with peo-
ple who did not own any pet or who owned
other pets (Table 2). Specifically, dog owners
were less likely to be men, less educated,
more likely to smoke tobacco and to perform
more physical activity than people who did
not own any pet (Table 2). With respect to
CVH metrics, they reported physical activity,
diet, and blood glucose CVH metrics at higher
level and smoking CVH metric at poorer level
(Figure 2). They also exhibited higher CVH
scores than people who did not own any pet
(median, 10; IQR¼3 vs. median, 9; IQR¼3;
P¼0.006) in bivariate analysis, and after
adjusting for age, sex, and educational level
(b¼0.342; SE¼0.122; P¼0.005). Compared
with other pet owners, dog owners were
younger, less educated, and more likely to
smoke tobacco and to perform more physical
activity. With respect to CVH metrics, they
reported physical activity and diet at higher
level (Figure 2). After adjusting for age, sex,
and educational level, they also exhibited 0.3
points higher on CVH scores than owners of
other pets (b¼0.309; SE¼0.151; P¼0.041).
The comparison of dog owners with people
who did not own dogs yielded similar results
(Supplemental Table 2 and Supplemental
Figure 1, available online at http://www.
mayoclinicproceedings.org), with 0.3 points
higher on CVH scores among dog owners after
adjusting for covariates (b¼0.341; SE¼0.117;
P¼0.004).
For each comparison, sensitivity analysis
confirmed the robustness of previous findings
by excluding people who owned dogs and
other pets (data not shown). Finally, no inter-
actions of dog ownership with age, sex, or
educational level were evident (P¼0.323,
P¼0.287, and P¼0.563, respectively).
DISCUSSION
To the best of our knowledge, our analysis on
the Kardiovize cohort is the first showing the
association between pet ownership and CVH,
as defined by the AHA.
2,3
People who owned
a pet, and specifically a dog, were more likely
to report physical activity, diet, and blood
Non-pet owners
Non-pet owners
Pet owners
Total
Physical
activity Smoking Diet
Body mass
index
Blood
pressure Cholesterol Glucose
Pet owners
Non-pet owners
Pet owners
Non-pet owners
Pet owners
Non-pet owners
Pet owners
Non-pet owners
Pet owners
Non-pet owners
Pet owners
Non-pet owners
Pet owners
0% 10% 20%
13,6% 83,6%2,8%
17,9% 80,1%2,0%
40,3% 45,3%14,4%
44,6% 40,4%15,0%
53,1% 24,2%22,7%
50,9% 23,3%25,8%
32,5% 49,7%17,8%
34,8% 47,3%17,9%
86,1% 4,5%9,4%
80,3% 3,3%16,4%
1,8% 70,9%27,3%
1,6% 76,6%21,8%
28,6% 61,8%9,6%
35,4% 47,7%16,9%
38,2% 0,3%61,5%
61,7% 38,3% 0,0%
***
30% 40% 50% 60% 70% 80% 90% 100%
*
***
*
Poor Intermediate Ideal
FIGURE 1. Distribution of cardiovascular health metrics according to pet ownership. *P<0.05, and ***P<0.001 based on the c
2
test.
DOG OWNERSHIP AND CARDIOVASCULAR HEALTH
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www.mcpiqojournal.org 271

glucose components at higher level, and
smoking at poor level. This translated into
higher CVH score among owners of dogs or
other pets than non-owners. In fact, dog
owners exhibited better CVH even than non-
dog owners, including owners of other pets.
This is in line with the scientific statement
from the AHA that reported benefits of owning
a dog in terms of physical activity engagement
and CVD risk.
23
We first assessed bivariate associations
between pet ownership and several CVD risk
factors. Particularly, pet owners exhibited higher
HDL cholesterol and lower prevalence of dia-
betes than non-owners. Although data are
limited on the association of pet ownership
with lipid profile, a previous study showed that
people who owned a pet had significantly lower
levels of triglycerides than those who did not.
7
Similarly, an analysis by Anderson et al
8
of
5741 participants attending a free screening
clinic showed that men who owned a dog had
significantly lower levels of total cholesterol
and triglycerides than non-owners. Benefits of
TABLE 2. Comparison of Characteristics Between Dog Owners, Non-Pet Owners, and Owners of Other Pets
a
Characteristics
Median (IQR) or %
Dog owners
(n¼429)
Non-pet owners
(n¼1023) Pvalue
Owners of pets other than dogs
(n¼317) Pvalue
Age, y 47.0 (18.0) 50.0 (17.0) 0.183 44.0 (15.0) 0.001
Sex (% male) 39.4 46.6 0.011 43.2 0.294
Educational level (% low
b
) 22.6 16.7 <0.001 20.5 0.003
Marital status (% living alone) 38.8 38.2 0.844 37.1 0.649
Employment (% unemployed) 19.6 18.2 0.596 16.4 0.562
Income (% less than 30,000
CZK)
38.1 42.0 0.254 40.8 0.808
Smoking (% current smokers) 31.9 24.6 0.007 27.1 0.035
Physical activity, MET-min/wk 4833 (5631) 2805 (4176) <0.001 3217 (4331) <0.001
Weight, kg 76.0 (24.0) 77.0 (24.0) 0.367 77.0 (23.0) 0.863
Body mass index, kg/m
2
25.0 (6.6) 25.4 (6.0) 0.441 25.1 (5.8) 0.882
Waist circumference, cm 87.0 (20.3) 89.0 (20.0) 0.063 88.0 (21.0) 0.857
Central obesity
c
(%) 29.2 32.2 0.263 37.3 0.570
Systolic blood
pressure, mm Hg
118.0 (17.5) 118.5 (19.8) 0.550 117.0 (20.5) 0.396
Diastolic blood
pressure, mm Hg
79.5 (11.0) 79.5 (13.0) 0.839 78.0 (14.0) 0.539
History of hypertension (%) 28.4 32.9 0.096 26.3 0.519
Fasting glucose, nmol/L 4.9 (0.8) 4.9 (0.7) 0.872 4.9 (0.8) 0.342
History of diabetes mellitus (%) 6.9 10.0 0.064 7.7 0.675
Triglycerides, nmol/L 1.04 (0.80) 1.05 (0.80) 0.952 1.05 (0.80) 0.838
Total Cholesterol, nmol/L 5.1 (1.3) 5.1 (1.3) 0.590 5.1 (1.3) 0.839
HDL Cholesterol, nmol/L 1.5 (0.5) 1.4 (0.5) 0.225 1.5 (0.6) 0.635
LDL Cholesterol, nmol/L 3.0 (1.2) 3.1 (1.2) 0.777 3.0 (1.2) 0.560
Total cholesterol/HDL-
cholesterol ratio
3.4 (1.4) 3.4 (1.4) 0.556 3.3 (1.5) 0.342
History of
hypercholesterolemia (%)
26.8 29.5 0.301 25.6 0.709
CVH score
d
10 (3) 9 (3) 0.006 9 (3) 0.314
Number of ideal CVH metrics 4 (2) 4 (1) 0.324 4 (2) 0.809
a
CVH ¼cardiovascular health; CZK ¼Czech koruna; HDL ¼high-density lipoprotein; IQR ¼interquartile range; LDL ¼low-density
lipoprotein; MET ¼metabolic equivalent for task;
b
Primary education or apprenticeship.
c
Defined as waist circumference 102 cm in men and 88 cm in women.
d
Computed as the sum of seven metrics defined by the American Heart Association.
MAYO CLINIC PROCEEDINGS: INNOVATIONS, QUALITY & OUTCOMES
272 Mayo Clin Proc Inn Qual Out nSeptember 2019;3(3):268-275 nhttps://doi.org/10.1016/j.mayocpiqo.2019.07.007
www.mcpiqojournal.org

dog ownership on lipid profile, including those
on HDL cholesterol, might be explained by an
increased engagement in physical activity of peo-
ple who own a dog. Indeed, dog walking
appeared to be associated with lower total
cholesterol levels and diabetes.
4
Regarding dia-
betes, however, evidence is currently controver-
sial, as a previous study reported higher
likelihood of diabetes in pet owners compared
with non-owners, an inverse association prob-
ably due to confounding by indication.
10
Ander-
sen et al
8
also showed that pet owners had
significantly lower systolic blood pressure than
non-owners, with slight differences between
men and women. In line with this evidence, an
online electronic survey reported higher risk of
hypertension in dog non-owners compared to
dog owners.
4
Nevertheless, conflicting data exist,
as observed by Wright et al
10
:althoughblood
pressure and incidence of hypertension
appeared to be lower in pet owners than in
non-owners, no associations were maintained
after adjusting for potential confounders such
as age, sex, BMI, antihypertensive treatment,
physical activity, and diagnosis of diabetes.
Other studies
33
including our analysis of the Kar-
diovize cohort, showed similar blood pressure
levels between pet owners and non-owners.
Other pet owners
Non-pet owners
Dog owners
Total
Other pet owners
Non-pet owners
Dog owners
Physical
activity
Other pet owners
Non-pet owners
Dog owners
Smoking
Other pet owners
Non-pet owners
Dog owners
Diet
Other pet owners
Non-pet owners
Dog owners
Body mass
index
Other pet owners
Non-pet owners
Dog owners
Blood
pressure
Other pet owners
Non-pet owners
Dog owners
Cholesterol
Other pet owners
Non-pet owners
Dog owners
Glucose
0% 10% 20%
13,3% 84,7%3,0%
17,9% 80,1%2,0%
15,3% 82,1%2,6%
39,7% 46,2%24,1%
44,6% 40,4%15,0%
41,0% 44,0%15,0%
56,2% 23,4%20,4%
50,9% 23,3%25,8%
48,9% 25,4%25,7%
29,9% 50,1%20,0%
34,8% 47,3%17,9%
35,8% 49,2%15,0%
88,8% 4,6%6,6%
80,3% 3,3%16,4%
82,4% 4,2%13,4%
2,4% 68,4%29,2%
1,6% 76,6%21,8%
1,0% 74,3%24,7%
26,3% 67,2%6,5%
35,4% 47,7%16,9%
31,6% 54,7%13,7%
40,1% 0,5%59,4%
38,3% 0,0%61,7%
35,5% 0,0%64,5%
30% 40% 50% 60% 70% 80% 90% 100%
*
***
*
***
**
***
Poor Intermediate Ideal
FIGURE 2. Distribution of cardiovascular health metrics and comparison between dog owners, non-pet owners, and owners of other
pets. *P<0.05, **P<0.01, and ***P<0.001 based on the c
2
test.
DOG OWNERSHIP AND CARDIOVASCULAR HEALTH
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These controversies might be attributed either to
unmeasured factors or comorbid medical condi-
tions; hence, future research should account for
confounders using robust statistical analytical
methodologies.
23
For instance, in the Kardiovize
cohort, there were differences in social and
behavioral factors between pet owners and
non-owners that might partially explain our
inconclusive findings on blood pressure. Partic-
ularly, people who owned pets, and specifically
a dog, were less educated and more likely to
smoke tobacco.
Overall, these findings suggested a positive ef-
fect of owning a dog on several behavioral and
clinical CVD risk factors. However, CVDs are
often multifactorial and previous studies did not
evaluate the potential relationship between pet
or dog ownership with CVH status, a composite
measure that takes into account both clinical pa-
rameters (ie, BMI, blood pressure, blood glucose,
and total cholesterol) and behaviors (ie, diet,
physical activity, and smoking status).
3
To fill
this gap, we first assessed the bivariate association
between pet ownership and CVH, showing
higher CVH scores among pet owners compared
with people who did not own a pet. Particularly,
pet owners were more likely to report CVH com-
ponents at better levels, including physical activ-
ity, diet, and blood glucose, whereas smoking
was more common. However, the association be-
tween pet ownership and higher CVH was not
maintained after adjusting for age, sex, and educa-
tional level, suggesting that those confounding
factors play a more important role in CVH than
pet ownership. By contrast, owning a dog was
associated with higher CVH score than people
who did not own any pet even after adjusting
for covariates. Indeed, except for smoking, dog
owners were more likely to achieve the recom-
mended intermediate/ideal level of behavioral
(physical activity and diet) and clinical (blood
glucose) CVH metrics than non-owners of pets,
which translated into better CVH.
Dog owners exhibited better CVH even than
non-owners of dogs, including owners of other
pets, association mediated through more engage-
ment in physical activity and healthier diet.
Although the positive association between dog
ownership and physical activity has been dis-
cussed previously, the association between pet
ownership and dietary habits has not been exten-
sively assessed. To our knowledge, only the study
by Heuberger et al
34
reported differences in eating
patterns among older adults owning or not own-
ing a dog. How pet ownership may favor a health-
ier diet is yet to be determined.
Our study has several strengths. First, it was
based on a randomly selected sample of the ur-
ban population of Brno, Czech Republic. Sec-
ond, comprehensive health interviews and
examinations were performed using standard-
ized and validated protocols, which allowed
use of a composite measure of CVH. Finally,
the majority of the results are robust, as they
were confirmed after adjusting for known con-
founders, and also by excluding people who
owned dogs and other pets. Some limitations
that warrant discussion include its cross-
sectional design that precluded assessing cau-
sality of observed relationships. Moreover, we
did not collect information about the duration
of pet ownership. Thus, experimental studies
will help to determine if pet ownership fosters
better CVH and its components or if the owning
a dog is only a marker of healthier lifestyle.
Moreover, the effect of unmeasured socio-
demographic factors, behaviors, and comor-
bidities cannot be completely excluded.
Additionally, pet ownership was self-reported
and could not be validated in our survey.
CONCLUSION
In conclusion, pet ownership, especially dog
ownership, is associated with CVH. Dog
owners are more likely to achieve the recom-
mended level of behavioral CVH metrics
such as physical activity and diet than non-
owners of dogs. The higher smoking rates
among dog owners attenuate the association
between dog ownership and CVH.
SUPPLEMENTAL ONLINE MATERIAL
Supplemental material can be found online at
http://www.mayoclinicproceedings.org. Sup-
plemental material attached to journal articles
has not been edited, and the authors take
responsibility for the accuracy of all data.
Abbreviations and Acronyms: AHA = American Heart
Association; BMI = body mass index; CVD = cardiovascular
disease; CVH = cardiovascular health; IQR = interquartile
range
Potential Competing Interests: The authors report no
conflicts of interest.
MAYO CLINIC PROCEEDINGS: INNOVATIONS, QUALITY & OUTCOMES
274 Mayo Clin Proc Inn Qual Out nSeptember 2019;3(3):268-275 nhttps://doi.org/10.1016/j.mayocpiqo.2019.07.007
www.mcpiqojournal.org

Grant Support: This work was supported by the National
Program of Sustainability II (MEYS CR) (no. LQ1605), and
by the European Regional Development Fund - Project
ENOCH (No. CZ.02.1.01/0.0/0.0/16_019/0000868).
Correspondence: Address to Francisco Lopez-Jimenez,
MD, MSc, MBA, Division of Preventive Cardiology, Depart-
ment of Cardiovascular Medicine, Mayo Clinic, 200 First
Street SW, Rochester, MN 55905 (lopez@mayo.edu).
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