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 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 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.

Abstract 92: Stroke Survivors Experience Greater Decline in Life’s Simple 7 Score for Cardiovascular Health Over 10-Year Follow-Up

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Chelsea Liu ◽  
David L Roth ◽  
Orla C Sheehan ◽  
Marcela D Blinka ◽  
Rebecca Gottesman
Keyword(s):  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Racial Differences ◽  
Cardiovascular Health ◽  
Lifestyle Modification ◽  
Cognitive Status ◽  
Stroke Survivors ◽  
Life’S Simple 7 ◽  
Life's Simple 7

Introduction: Life’s Simple 7 (LS7) is a measure of cardiovascular health based on seven domains of smoking, diet, physical activity, body mass index, blood pressure, total cholesterol, and fasting glucose. Due to secondary prevention efforts, stroke survivors may experience improvements in LS7 scores over time compared to those who did not experience a stroke. Methods: We included participants over 45 years of age enrolled in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study who had LS7 data at baseline and 10-year follow-up and did not report a history of stroke at baseline (N=7568). Of these, 361 had an adjudicated ischemic stroke between the LS7 assessments. Scores on each domain of LS7 range from 1-3 for a maximum total score of 21, where a higher score represents better cardiovascular health. A general linear model was used to test the association of having an ischemic stroke on the change in LS7 score. Covariates included the LS7 score at baseline, age, race, gender, cognitive status, and education. Results: Findings indicated that those who were younger, African American, and had lower levels of education, experienced significant decline in LS7 scores from baseline to follow-up (Table 1). Those who had a stroke also experienced, on average, 0.25 points more decline in total LS7 scores than those who did not have a stroke (p=0.048). Conclusions: Stroke survivors did not experience improvements in cardiovascular health due to secondary prevention after an ischemic stroke. On the contrary, they experienced significantly greater decline, indicating the need for greater efforts in lifestyle modification and secondary prevention after a stroke.

Abstract P326: Apparent Treatment Resistant Hypertension and Risk for Stroke, Coronary Heart Disease and All-cause Mortality

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Marguerite R Irvin ◽  
John N Booth III ◽  
Daichi Shimbo ◽  
Daniel T Lackland ◽  
Suzanne Oparil ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Racial Differences ◽  
Resistant Hypertension ◽  
Antihypertensive Medication ◽  
Treatment Resistant ◽  
Hazard Ratios ◽  
All Cause Mortality ◽  
History Of

Apparent treatment resistant hypertension (aTRH) is characterized as uncontrolled hypertension (HTN) with the use of 3 or more antihypertensive medication classes or controlled HTN while treated with 4 or more antihypertensive medication classes. Few data are available on the association of aTRH with cardiovascular disease outcomes in comparison to more easily controlled HTN. We evaluated the risk for stroke, coronary heart disease (CHD) and all-cause mortality among 2,043 participants with aTRH and 9,519 participants with controlled HTN (systolic blood pressure < 140 mm Hg and diastolic blood pressure < 90 mm Hg) treated with < 4 antihypertensive medication classes from the population-based REasons for Geographic And Racial Differences in Stroke (REGARDS) study. aTRH was further categorized as controlled aTRH (≥ 4 antihypertensive medication classes and controlled HTN) and uncontrolled aTRH (≥ 3 antihypertensive medication classes and uncontrolled HTN). Participants with and without aTRH, respectively, were 68±9 and 66±9 years of age, 60.5% (1236 0f 2043) and 46.8% (4455 of 9519) black, and 49.2% (1005 of 2043) and 40.8% (3884 of 9519) male. After adjusting for demographic, clinical and comorbid factors, the hazard ratio (HR) for stroke, CHD, and all-cause mortality associated with aTRH (vs. controlled HTN and < 4 medication classes) was 1.29 (95% CI 0.96-1.73), 1.90 (95% CI 1.40-2.58), and 1.36 (95% CI 1.20-1.55), respectively. Compared to those with controlled hypertension, the multivariable-adjusted HR for stroke, CHD and all-cause mortality was increased for those with uncontrolled aTRH but not those with controlled aTRH (Table 1). Compared to those with controlled aTRH, uncontrolled aTRH was associated with CHD (HR 2.33; 95% CI: 1.21 [[Unable to Display Character: &#8211;]] 4.48) but not stroke (HR 1.05; 95% CI: 0.61 [[Unable to Display Character: &#8211;]] 1.81) or all-cause mortality (HR 1.15; 95% CI: 0.91 [[Unable to Display Character: &#8211;]] 1.45). We conclude achieving blood pressure control within aTRH is paramount to decrease risk for events similarly to other patients with more easily controlled HTN. Table 1. Hazard ratios for stroke, coronary heart disease, and all-cause mortality associated with apparent treatment resistant hypertension (aTRH). *< 4 antihypertensive medication classes Models are adjusted for age, race, gender, and geographic region of residence, waist circumference, smoking status, physical activity, alcohol consumption, C - reactive protein, statin use, Morisky score for medication adherence, total cholesterol, HDL-cholesterol, and hypertension duration, estimated glomerular filtration rate < 60 ml/min/1.73m 2 , albuminuria, and diabetes. Hazard ratios for stroke were also adjusted for history of coronary heart disease. Hazard ratios for coronary heart disease were also adjusted for history of stroke. Hazard ratios for all-cause mortality were also adjusted for history of coronary heart disease and stroke.

Abstract MP69: Prevalence of Treatment Resistant Hypertension Among Individuals with Chronic Kidney Disease: Results from the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Rikki M Tanner ◽  
David A Calhoun ◽  
Emmy K Bell ◽  
C. B Bowling ◽  
Orlando M Gutiérrez ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Racial Differences ◽  
Resistant Hypertension ◽  
Antihypertensive Medication ◽  
Treatment Resistant ◽  
High Prevalence ◽  
Regards Study ◽  
Multivariable Adjustment

Hypertension requiring treatment with multiple antihypertensive medications is common among individuals with chronic kidney disease (CKD). Small clinic-based studies have reported a high prevalence of treatment resistant hypertension (TRH) among patients with CKD. However, the prevalence of TRH has not been estimated for people with CKD in population-based studies. We hypothesized that lower estimated glomerular filtration rate (eGFR) and higher albumin-to-creatinine ratio (ACR) would be associated with a higher prevalence of TRH. We determined the prevalence of TRH among REasons for Geographic And Racial Differences in Stroke (REGARDS) study participants (n=30,239) by eGFR and ACR and evaluated clinical and demographic correlates of TRH in those with CKD. Blood pressure was measured twice, pill bottles were inspected, and serum creatinine and an ACR were measured during an in-home study visit. TRH was defined as systolic/diastolic blood pressure ≥140/90 mmHg with concurrent use of ≥3 antihypertensive medication classes or use of ≥4 antihypertensive medication classes. CKD was defined as an ACR ≥30 mg/g or a CKD-EPI equation-derived eGFR <60 ml/min/1.73m 2 . The mean age of the 11,285 REGARDS participants treated for hypertension was 66.0 (SD=9.0) years, 56.9% were women and 48.8% were black. The prevalence of TRH was 14.5%, 23.5%, and 31.2% for those with an eGFR ≥60, 45-59, and <45 mL/min/1.73m 2 , respectively. The prevalence of TRH was 11.3%, 18.8%, 25.5%, and 44.5% for ACR <10, 10-29, 30-299, and ≥300 mg/g, respectively. A graded association between lower eGFR and higher ACR with TRH remained present after multivariable adjustment (Table 1). Also, after multivariable adjustment, black race, a larger waist circumference, diabetes, and history of myocardial infarction and stroke were associated with TRH among individuals with CKD. In conclusion, individuals with CKD have a high prevalence of TRH. Strategies are needed to improve blood pressure control in this population and reduce cardiovascular disease risk.

scholarly journals Underutilization of Treatment for Black Adults With Apparent Treatment-Resistant Hypertension

Hypertension ◽  
2020 ◽  
Vol 76 (5) ◽  
pp. 1600-1607
Author(s):  
Aisha T. Langford ◽  
Oluwasegun P. Akinyelure ◽  
Tony L. Moore ◽  
George Howard ◽  
Yuan-I Min ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Resistant Hypertension ◽  
Mineralocorticoid Receptor ◽  
Antihypertensive Medication ◽  
Healthy Lifestyle ◽  
Lifestyle Factors ◽  
Mineralocorticoid Receptor Antagonists ◽  
Treatment Resistant ◽  
Black Adults

Resistant hypertension, defined as blood pressure levels above goal while taking ≥3 classes of antihypertensive medication or ≥4 classes regardless of blood pressure level, is associated with increased cardiovascular disease risk. The 2018 American Heart Association Scientific Statement on Resistant Hypertension recommends healthy lifestyle habits and thiazide-like diuretics and mineralocorticoid receptor antagonists for adults with resistant hypertension. The term apparent treatment-resistant hypertension (aTRH) is used when pseudoresistance cannot be excluded. We estimated the use of healthy lifestyle factors and recommended antihypertensive medication classes among US Black adults with aTRH. Data were pooled for Black participants in the JHS (Jackson Heart Study) in 2009 to 2013 (n=2496) and the REGARDS study (Reasons for Geographic and Racial Differences in Stroke) in 2013 to 2016 (n=3786). Outcomes included lifestyle factors (not smoking, not consuming alcohol, ≥75 minutes of vigorous-intensity or ≥150 minutes of moderate or vigorous physical activity per week, and body mass index <25 kg/m 2 ) and recommended antihypertensive medications (thiazide-like diuretics and mineralocorticoid receptor antagonists). Overall, 28.3% of participants who reported taking antihypertensive medication had aTRH. Among participants with aTRH, 14.5% and 1.2% had ideal levels of 3 and 4 of the lifestyle factors, respectively. Also, 5.9% of participants with aTRH reported taking a thiazide-like diuretic, and 9.8% reported taking a mineralocorticoid receptor antagonist. In conclusion, evidence-based lifestyle factors and recommended pharmacological treatment are underutilized in Black adults with aTRH. Increased use of lifestyle recommendations and antihypertensive medication classes specifically recommended for aTRH may improve blood pressure control and reduce cardiovascular disease–related morbidity and mortality among US Black adults. Graphic Abstract A graphic abstract is available for this article.

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.

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 10922: Relationship of the AHA Impact Goals (Life’s Simple 7) With Risk of Chronic Kidney Disease: Results From the ARIC Cohort Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Casey M Rebholz ◽  
Cheryl A Anderson ◽  
Morgan E Grams ◽  
Lydia A Bazzano ◽  
Deidra C Crews ◽  
...  
Keyword(s):  
Physical Activity ◽  
Blood Pressure ◽  
Body Mass Index ◽  
Blood Glucose ◽  
Body Mass ◽  
Cardiovascular Health ◽  
Blood Cholesterol ◽  
Health Factors ◽  
Life’S Simple 7 ◽  
Life's Simple 7

Introduction: As part of its 2020 Impact Goals, the AHA developed the Life’s Simple 7 metric for cardiovascular health promotion. The metric consists of ideal categories for smoking, physical activity, diet, body mass index, blood pressure, blood cholesterol, and blood glucose; and its relationship with risk of chronic kidney disease (CKD) is unknown. Hypothesis: Ideal levels of health factors and the overall Life’s Simple 7 metric are associated with lower risk of developing CKD. Methods: We prospectively analyzed 15,436 Atherosclerosis Risk in Community study participants without CKD at baseline (1987-1989). Ideal levels of health factors were: non-smoker or quit >1 year ago; body mass index <25 kg/m 2 ; ≥150 minutes/week of physical activity; dietary pattern which is high in fruits and vegetables, fish, and fiber-rich whole grains, and low in sodium and sugar-sweetened beverages; total cholesterol <200 mg/dL; blood pressure <120/90 mmHg; and blood glucose <100 mg/dL. Incident CKD was defined as development of estimated glomerular filtration rate <60 mL/min/1.73 m 2 accompanied by 25% decline from baseline, hospitalization or death due to CKD, or end-stage renal disease defined by linkage with the U.S. Renal Data System. Cox regression was used to estimate associations between health factors, the overall metric, and CKD risk while adjusting for age, sex, race, and baseline kidney function. Results: At baseline, mean age was 54 years, 55% were women, and 26% were African-American. There were 2,861 incident CKD cases over a median follow-up of 22 years. Smoking, body mass index, physical activity, blood pressure, and blood glucose were associated with lower CKD risk (all p≤0.01), but diet and blood cholesterol were not. CKD risk was inversely related to the number of ideal health factors ( Figure ; p-trend<0.001; AUC: 0.7001 vs. 0.6804, p<0.001). Conclusions: The AHA Life’s Simple 7 metric, developed to measure and promote cardiovascular health, predicts reduced CKD risk.

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