Abstract P278: Life's Simple 7 and Risk of Incident Stroke in Black and White Americans: REasons for Geographic And Racial Differences in Stroke (REGARDS) Study

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Ambar Kulshreshtha ◽  
Suzanne Judd ◽  
Viola Vaccarino ◽  
Virginia Howard ◽  
William McClellan ◽  
...  
Keyword(s):  
Racial Differences ◽  
Lower Risk ◽  
Cardiovascular Health ◽  
Cox Regression ◽  
Disease Incidence ◽  
Heart Association ◽  
P Value ◽  
Life’S Simple 7 ◽  
Blacks And Whites ◽  
Life's Simple 7

Background: The American Heart Association has developed Life’s Simple 7 (LS-7) as a measure of cardiovascular health. In a recent study, LS-7 showed a graded relationship with cardiovascular disease incidence. The association of LS-7 with incident stroke has not been reported previously. Methods: We analyzed data from REGARDS, a national population-based cohort of 30,239 blacks and whites, aged ≥ 45 years of age, sampled from US population between 2003 and 2007. Data for LS-7 was collected by telephone, mail questionnaires, and an in-home exam. Participants were contacted every 6 months for possible stroke, which was validated by physicians using medical record review. LS-7 components (blood pressure, cholesterol, glucose, BMI, smoking, physical activity, diet) were each coded as: poor (1 point), intermediate (2 points) and ideal (3 points). An overall LS-7 score, created by summing the 7 component scores (possible range: 7 to 21), was categorized as: highest (17–21), medium (12–16) and lowest (7–11) cardiovascular health. Cox regression was used to model LS-7 score categories with stroke events. Results: There were 22,914 participants with data on LS-7 and no previous CVD. Mean age was 65 years, 40% were black, and 55% female. Over 4.9 years of follow-up, there were 432 incident strokes. Mean (SD) LS-7 score was 13.5 (2.5). After adjustment for age and sex, mean LS-7 scores were lower for blacks (12.9 ± 0.02) than whites (14.3 ± 0.02). LS-7 categories were associated with incident stroke in a graded fashion (figure). After adjusting for age, race, sex, income, and education, each better health category was associated with a 25% lower risk of incident stroke (HR=0.75, 95% CI = 0.63, 0.90). In stratified analyses, HR was similar for blacks and whites (p-value = 0.55). Conclusion: Blacks had lower levels of cardiovascular health factors than whites. Better cardiovascular health based on LS-7 score was associated with a lower risk of stroke. Results suggest that efforts to improve the LS-7 score may be useful for stroke prevention.

Abstract MP35: The American Heart Association’s Life’s Simple 7 and Mortality by Race and Sex in the U.S.: the REasons for Geographic And Racial Differences in Stroke (REGARDS) Cohort

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Mary Cushman ◽  
Suzanne E Judd ◽  
Virginia J Howard ◽  
Neil A Zakai ◽  
Brett Kissela ◽  
...  
Keyword(s):  
Racial Differences ◽  
Mortality Risk ◽  
Lower Risk ◽  
Population Sample ◽  
White Men ◽  
The United States ◽  
Risk Of Death ◽  
Life’S Simple 7 ◽  
Life's Simple 7 ◽  
The Impact

Background: The Life’s Simple 7 (LSS) metric is being used by AHA to track the cardiovascular health of the United States population and move toward a 2020 impact goal for improvement. Levels of LSS are associated with mortality risk but there are limited data on whether this association differs by race or sex. Hypothesis: There will be sex and race differences in the association of LSS with mortality in the REGARDS cohort study. Methods: We studied 29,692 REGARDS participants; a population sample of black and white men and women aged 45-98 from across the US, enrolled in 2003-7. Extensive baseline risk factor data were measured in participants’ homes. The 7 LSS components (blood pressure, cholesterol, glucose, body-mass index, smoking, physical activity, diet) were each scored in AHA-defined categories of poor (0 points), intermediate (1 point) and ideal (2 points), and were summed to yield scores ranging from poor for all (0) to ideal for all (14). With 6.4 years follow up there were 3709 deaths. Results: The LSS score was normally distributed with mean (SD) of 7.9 (2.0) in whites and 6.9 (2.0) in blacks. The age, region, income and education adjusted hazard ratio (HR) of death for a 1-unit worse LSS score, stratified by race and sex, are shown in the table. Race and sex interactions were tested individually in separate models. While better scores for LSS were strongly associated with lower mortality, associations differed by race and sex, being weaker in blacks than whites and in men than women. Conclusion: There were large associations of LSS with mortality risk in the REGARDS national sample; 1 point difference in score, corresponding to movement from poor to intermediate or intermediate to ideal for 1 of the 7 factors, was associated with a 16% lower risk of death in white women, 14% lower risk in white men or black women, but only an 11% lower risk in black men. Observed differences in the association of LSS with mortality by race and sex should be considered in efforts to gauge the impact of LSS interventions on health disparities.

scholarly journals Life’s Simple 7 and Incident Hypertension: The REGARDS Study

2020 ◽  
Vol 9 (19) ◽  
Author(s):  
Timothy B. Plante ◽  
Insu Koh ◽  
Suzanne E. Judd ◽  
George Howard ◽  
Virginia J. Howard ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Lower Risk ◽  
Cardiovascular Health ◽  
Incident Hypertension ◽  
Black And White ◽  
Stroke Study ◽  
Life’S Simple 7 ◽  
Life's Simple 7 ◽  
Regards Study ◽  
White Adults

Background The Life’s Simple 7 (LS7) metric incorporates health behaviors (body mass index, diet, smoking, physical activity) and health factors (blood pressure, cholesterol, glucose) to estimate an individual’s level of cardiovascular health. The association between cardiovascular health and incident hypertension is unresolved. Hypertension’s threshold was recently lowered and it is unclear if better cardiovascular health is associated with lower risk of incident hypertension with the updated threshold or in a multirace cohort. We sought to assess the association between better LS7 score and risk of incident hypertension among Black and White adults using a 130/80 mm Hg hypertension threshold. Methods and Results We determined the association between LS7 metric and incident hypertension in the REGARDS (Reasons for Geographic and Racial Disparities in Stroke) study, including participants free of baseline hypertension (2003–2007) who completed a second visit between 2013 and 2016. Hypertension was defined as systolic/diastolic blood pressure ≥130/80 mm Hg or antihypertensive medication use. Each LS7 component was assigned 0 (poor), 1 (intermediate), or 2 (ideal) points. We generated a 14‐point score by summing points. Among 2930 normotensive participants (20% Black, 80% White), the median (25th–75th percentiles) LS7 total score was 9 (8–10) points. Over a median follow‐up of 9 years, 42% developed hypertension. In the fully adjusted model, each 1‐point higher LS7 score had a 6% lower risk of incident hypertension (risk ratio, 0.94 per 1 point; 95% CI, 0.92–0.96). Conclusions Better cardiovascular health was associated with lower risk of incident hypertension using a 130/80 mm Hg hypertension threshold among Black and White adults.

scholarly journals Life’s Simple 7 Cardiovascular Health Metrics and Progression of Coronary Artery Calcium in a Low-Risk Population

2019 ◽  
Vol 39 (4) ◽  
pp. 826-833 ◽  
Author(s):  
Seolhye Kim ◽  
Yoosoo Chang ◽  
Juhee Cho ◽  
Yun Soo Hong ◽  
Di Zhao ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Calcium ◽  
Cardiovascular Health ◽  
Subclinical Atherosclerosis ◽  
Heart Association ◽  
Healthy Adults ◽  
Inverse Association ◽  
Life Habits ◽  
Life’S Simple 7 ◽  
Life's Simple 7

Objective— We examined the association of cardiovascular health (CVH) metrics with the development and progression of coronary artery calcium (CAC) among apparently healthy adults. Approach and Results— This cohort study included 65 494 men and women 30 years of age and older free of cardiovascular disease at baseline who underwent a comprehensive exam including CAC scoring. CVH metrics were defined according to the American Heart Association Life’s Simple 7 metrics based on smoking, diet, physical activity, body mass index, blood pressure, total cholesterol, and fasting glucose. CVH scores range from 0 (all metrics considered unhealthy) to 7 (all metrics considered healthy). Participants were followed-up for a maximum of 6.6 years. Compared with participants with ideal CVH scores 0–1, the multivariable-adjusted difference in the change in geometric means of CAC scores over 5 years of follow-up were −0.40 (−0.62 to −0.19), −0.83 (−1.03 to −0.63), −1.06 (−1.25 to −0.86), −1.22 (−1.42 to −1.03), and −1.05 (−1.42 to −0.69) in participants with ideal CVH scores 2, 3, 4, 5, and 6–7, respectively. The inverse association between CVH scores and progression of CAC was observed both in participants with no CAC and in those with CAC detectable at baseline. Conclusions— A higher ideal CVH metrics score was strongly associated with a lower prevalence of CAC and with lower progression of CAC in males and females in a large cohort of healthy adults. Our findings suggest that maintaining a healthy life habits could help reduce the development and progression of subclinical atherosclerosis and ultimately prevent clinically cardiovascular event.

Abstract P001: Life′s Simple 7 in Middle-age and Prognosis After Myocardial Infarction in Later Life

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Yejin Mok ◽  
Yingying Sang ◽  
Shoshana H Ballew ◽  
Casey M Rebholz ◽  
Gerardo Heiss ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Lower Risk ◽  
Cardiovascular Health ◽  
Middle Age ◽  
Later Life ◽  
Adverse Outcomes ◽  
Dietary Quality ◽  
Life’S Simple 7 ◽  
Life's Simple 7

Background: The AHA recommends focusing on seven traditional risk factors (Life’s Simple 7) for cardiovascular health promotion, primarily based on their impact on the risk of incident cardiovascular disease. However, the contribution of Life’s simple 7 in mid-life to prognosis after myocardial infarction (MI) in later life is unknown. Methods: In 13,500 participants from the Atherosclerosis Risk in Communities (ARIC) study (age 45-64 years) at Visit 1 (1987-1989), a 14-point score of Life’s simple 7 was constructed according to the status of each of seven factors (smoking, body mass index, physical activity, dietary quality, total cholesterol, blood pressure, and fasting glucose). We quantified the association between this score and adverse outcomes after validated incident hospitalized MI occurring during ARIC follow-up, using Cox proportional hazards models adjusting for age at MI, gender, race, and year of MI occurrence. Results: 1,341 participants had a definite or probable hospitalized MI after the ARIC baseline visit (median elapsed time between baseline and MI occurrence, 24.4 years [IQR 17.5-25.4]). Of these, 807 (60%) had cardiovascular outcomes of interest after MI during a median follow-up of 3.0 years. Higher Life’s Simple 7 score (better cardiovascular health) in middle-age was associated with lower risk of adverse outcomes after MI in later life (Table). For example, individuals with Life’s Simple 7 score ≥10 had 50-80% lower risk of cardiovascular mortality, recurrent MI, and heart failure compared to those with score ≤3. The associations were largely consistent across years of MI occurrence and when we restricted the follow-up after MI to 1-3 years. Conclusion: A better AHA Life’s Simple 7 in middle-age was associated not only with lower incidence but also with a lower risk of adverse outcomes after MI in later life. Our findings suggest a secondary prevention benefit of striving for ideal CV health status in mid-life, further supporting AHA promotion of Life’s Simple 7.

scholarly journals Life"s simple 7 and the risk of stroke in Finnish men: a prospective cohort study

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
N Isiozor ◽  
SK Kunutsor ◽  
A Voutilainen ◽  
S Kurl ◽  
J Kauhanen ◽  
...  
Keyword(s):  
Heart Disease ◽  
Ischaemic Stroke ◽  
Lower Risk ◽  
Cardiovascular Health ◽  
Cox Regression ◽  
Smoking Status ◽  
Population Based ◽  
P Value ◽  
Cardiovascular Research ◽  
History Of

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): North Savo Regional Fund and Finnish Foundation for Cardiovascular Research Background Population-wide preventive measures constitute important approaches toward reducing stroke risk and its associated burden. We sought to examine the association between American Heart Association’s (AHA) Life’s Simple7 (LS7) score and the risk of stroke in men. Methods The study is based on the prospective population-based Kuopio Ischaemic Heart Disease cohort comprising men (42-60 years) without pre-existing history of stroke at baseline. LS7 was computed from AHA’s cardiovascular health metrics for 2520 men and includes data on diet, physical activity, body mass index, smoking status, blood pressures, total cholesterol and blood glucose. Participants were classified into three LS7 groups based on the number of ideal metrics: inadequate (0–2), average (3–4) and optimal (5–7). Multivariable Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of LS7 scores for total and ischaemic stroke. Results During a median follow-up of 26years, 428 total and 362 ischaemic incident stroke events were recorded. The risk of both stroke outcomes decreased continuously with increasing LS7 scores across the range 2 to 6. Men with optimal LS7 had 48% (HR: 0.52; 95%CI: 0.32–0.86) lower risk of total stroke when compared with those with inadequate LS7. The association was similar for the risk of ischaemic stroke, with 50% (HR: 0.50; 95%CI: 0.29–0.87) lower risk among men with an optimal LS7 compared with those with inadequate LS7. Conclusion LS7 was strongly, inversely and linearly associated with risk of total and ischaemic strokes among a middle-aged male Caucasian population. Life’s Simple 7 and the risk of stroke Total Stroke Ischaemic Stroke LS7 score 0-2† (inadequate) 3-4 (average) 5-7 (optimal) 0-2† (inadequate) 3-4 (average) 5-7 (optimal) n/N 224/1109 187/1273 17/138 192/1109 156/1273 14/138 Model 1 HR (95%CI) 1 0.65 (0.53 - 0.79) 0.49 (0.30 - 0.81) 1 0.63 (0.51 - 0.78) 0.47 (0.27 - 0.82) p value* <0.001 0.005 <0.001 0.007 Model 2 HR (95%CI) 1 0,69 (0.56 - 0.84) 0.52 (0.32 - 0.86) 1 0.67 (0.54 - 0.84) 0.50 (0.29 - 0.87) p value* <0.001 0.01 <0.001 0.014 n/N, number of events/Total; HR, hazard ratio; CI, Confidence interval *p-values for the HRs <0.05 are considered statistically significant †Reference category Model 1: adjusted for age, alcohol consumption and socioeconomic status Model 2: Model 1 plus history of coronary heart disease and history of type 2 diabetes mellitus

Abstract 14594: Association Between Life's Simple 7 and Cardiovascular Disease in Cancer Patients Compared to Noncancer Controls in the Aric Cohort

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Evelyn J Song ◽  
Sui Zhang ◽  
Ana E Prizment ◽  
Elizabeth J Polter ◽  
Elizabeth Selvin ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cancer Survivors ◽  
Cancer Diagnosis ◽  
Cardiovascular Health ◽  
Cox Regression ◽  
Smoking History ◽  
Incidence Density ◽  
Cvd Risk ◽  
Life’S Simple 7 ◽  
Life's Simple 7

Introduction: Cancer survivors have greater cardiovascular disease (CVD) risk through unclear mechanisms. Little is known about whether Life’s Simple 7 (LS7) metrics differ between persons with and without cancer and if the link between LS7 and CVD is similar in cancer survivors compared to persons without prior cancer. Hypothesis: Persons who develop cancer have poorer LS7 metrics compared to noncancer controls, and an ideal LS7 score is less protective against CVD events in persons with versus those without prior cancer. Methods: A total of 2950 ARIC participants who developed cancer were matched at the time of cancer diagnosis (incidence density sampling) on age, sex, race, and study center, to 5900 noncancer controls. We compared LS7 metrics in individuals who developed cancer (assessed prior to cancer diagnosis) and in matched controls. We used Cox regression to evaluate the prospective association between LS7 score and CVD events (coronary heart disease, heart failure or stroke) stratified by cancer status, with test for interaction between LS7 and cancer. Results: Compared to matched noncancer controls, those who developed cancer were less likely to have an ideal smoking history, body mass index, glucose control, physical activity levels, and diet (defined by LS7 metrics; Table ). Overall those with cancer were less likely to have an ideal LS7 score than noncancer controls (18 vs 23% p<0.0001). Compared to inadequate, an ideal LS7 score was similarly associated with lower CVD risk in persons with and without cancer (HRs 0.37 [95% CI: 0.26-0.52] and 0.40 [95% CI: 0.32-0.50], respectively), with no interaction between LS7 score and cancer status (p = 0.59). Conclusions: Individuals who develop cancer have poorer overall cardiovascular health as reflected by the LS7 score, but an ideal LS7 score is associated with similar cardio-protection in those with and without cancer. Cancer survivors may benefit from interventions targeting cardiovascular health metrics.

scholarly journals Cardiovascular Health and Transition From Controlled Blood Pressure to Apparent Treatment Resistant Hypertension

Hypertension ◽  
2020 ◽  
Vol 76 (6) ◽  
pp. 1953-1961
Author(s):  
Oluwasegun P. Akinyelure ◽  
Swati Sakhuja ◽  
Calvin L. Colvin ◽  
Donald Clark ◽  
Byron C. Jaeger ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Racial Differences ◽  
Resistant Hypertension ◽  
Antihypertensive Medication ◽  
Cardiovascular Health ◽  
Treatment Resistant ◽  
Stroke Study ◽  
Life’S Simple 7 ◽  
Life's Simple 7

Almost 1 in 5 US adults with hypertension has apparent treatment resistant hypertension (aTRH). Identifying modifiable risk factors for incident aTRH may guide interventions to reduce the need for additional antihypertensive medication. We evaluated the association between cardiovascular health and incident aTRH among participants with hypertension and controlled blood pressure (BP) at baseline in the Jackson Heart Study (N=800) and the Reasons for Geographic and Racial Differences in Stroke study (N=2316). Body mass index, smoking, physical activity, diet, BP, cholesterol and glucose, categorized as ideal, intermediate, or poor according to the American Heart Association’s Life’s Simple 7 were assessed at baseline and used to define cardiovascular health. Incident aTRH was defined by uncontrolled BP, systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg, while taking ≥3 classes of antihypertensive medication or controlled BP, systolic BP <130 mm Hg and diastolic BP <80 mm Hg, while taking ≥4 classes of antihypertensive medication at a follow-up visit. Over a median 9 years of follow-up, 605 (19.4%) participants developed aTRH. Incident aTRH developed among 25.8%, 18.2%, and 15.7% of participants with 0 to 1, 2, and 3 to 5 ideal Life’s Simple 7 components, respectively. No participants had 6 or 7 ideal Life’s Simple 7 components at baseline. The multivariable adjusted hazard ratios (95% CIs) for incident aTRH associated with 2 and 3 to 5 versus 0 to 1 ideal components were 0.75 (0.61–0.92) and 0.67 (0.54–0.82), respectively. These findings suggest optimizing cardiovascular health may reduce the pill burden and high cardiovascular risk associated with aTRH among individuals with hypertension.

scholarly journals Change in Life’s Simple 7 Measure of Cardiovascular Health After Incident Stroke

Stroke ◽  
2021 ◽  
Author(s):  
Chelsea Liu ◽  
David L. Roth ◽  
Rebecca F. Gottesman ◽  
Orla C. Sheehan ◽  
Marcela D. Blinka ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Racial Differences ◽  
Sex Education ◽  
Cardiovascular Health ◽  
Stroke Survivors ◽  
Stroke Event ◽  
Life’S Simple 7 ◽  
Life's Simple 7

Background and Purpose: Life’s Simple 7 (LS7) is a metric for cardiovascular health based on the 7 domains of smoking, diet, physical activity, body mass index, blood pressure, total cholesterol, and fasting glucose. Because they may be targeted for secondary prevention purposes, we hypothesized that stroke survivors would experience improvement in LS7 score over time compared with people who did not experience a stroke. We addressed this hypothesis in the REGARDS study (Reasons for Geographic and Racial Differences in Stroke) cohort of Black and White adults enrolled between 2003 and 2007. Methods: Participants who had LS7 data at baseline, were stroke-free at baseline, had a 10-year follow-up visit, and either did not have a stroke or had an ischemic stroke >1 year before follow-up were included (N=7569). Among these participants, 149 (2.0%) had an adjudicated ischemic stroke between the LS7 assessments. LS7 scores were classified as 0 to 2 points for each domain for a maximum score of 14, with higher scores representing better health. Multivariable linear regression was used to test the association of ischemic stroke with change in LS7 score. Covariates included baseline LS7 score, age, race, sex, education, and geographic region. Results: The 149 stroke survivors had an average of 4.9 years (SD=2.5) of follow-up from the stroke event to the second LS7 assessment. After adjusting for covariates, participants who experienced an ischemic stroke showed 0.28 points more decline in total LS7 score ( P =0.03) than those who did not experience a stroke. Conclusions: Stroke survivors did not experience improvements in cardiovascular health due to secondary prevention after ischemic stroke. On the contrary, they experienced significantly greater decline, indicating the need for greater efforts in secondary prevention after a stroke.

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