Digital health device measured sleep duration and ideal cardiovascular health: an observational study

Abstract Background Studies relying on self-reported sleep data suggest that there is an association between short and long sleep duration and less than ideal cardiovascular health. Evidence regarding the feasibility of using digital health devices to measure sleep duration and assess its relationship to ideal cardiovascular health are lacking. The objective of the present study was to utilize digital health devices to record sleep duration and examine the relationship between sleep duration and ideal cardiovascular health. Methods A total of 307 participants transmitted sleep duration data from digital health devices and answered the Life’s Simple 7 survey instrument to assess ideal cardiovascular health. Sleep duration was defined as adequate (7 to < 9 h per night) or non-adequate (< 7 h and ≥ 9 h). Results We identified three sleep-cardiovascular health phenogroups: resilient (non-adequate sleep and ideal cardiovascular health), uncoupled (adequate sleep and non-ideal cardiovascular health) or concordant (sleep and cardiovascular health metrics were aligned). Participants in the resilient phenogroup (n = 83) had better cardiovascular health factor profiles (blood pressure, blood glucose and cholesterol levels) and behaviors (healthy weight, diet, exercise, smoking) than participants in the concordant (n = 171) and uncoupled (n = 53) phenogroups. This was associated with higher Life’s Simple 7 Health Scores in the resilient phenogroup compared to the concordant and uncoupled phenogroups (7.8 ± 0.8 vs. 7.0 ± 1.4 vs. 5.6 ± 0.7, P < 0.01). Conclusion This study identified three distinct sleep-ideal cardiovascular health phenogroups and highlights the advantage of incorporating sleep assessments into studies of cardiovascular health. Future studies should focus on the relationship between sleep-cardiovascular phenogroups and clinical outcomes. Clinical Trial Registration Clinicaltrials.gov NCT02958098. Date of registration: November 11, 2016.

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Data from Digital Health Devices Informs Ideal Cardiovascular Health

Journal of Personalized Medicine ◽

10.3390/jpm11030189 ◽

2021 ◽

Vol 11 (3) ◽

pp. 189

Author(s):

Jane A. Leopold ◽

Roger B. Davis ◽

Elliott M. Antman

Keyword(s):

Cardiovascular Health ◽

Digital Health ◽

Vigorous Exercise ◽

Activity Data ◽

Health Score ◽

Ideal Cardiovascular Health ◽

Digital Devices ◽

Significant Difference ◽

Life’S Simple 7 ◽

Life's Simple 7

Ideal cardiovascular health is associated with a decrease in adverse cardiovascular events. The My Research Legacy study examined ideal cardiovascular health using the Life’s Simple 7 survey and data from digital health devices. We hypothesized that digital devices provide a more objective view of overall cardiovascular health status than self-reported measures. Therefore, we analyzed weight and activity data recorded by digital devices to recalculate the Life’s Simple 7 Health Score. All study participants (n = 1561) answered the survey, while a subgroup (n = 390) provided data from digital devices. Individuals with digital devices had a lower body mass index (BMI) and higher weekly minutes of vigorous exercise than participants without digital devices (p < 0.01). Baseline Health Scores were higher in individuals with digital devices compared to those without (7.0 ± 1.6 vs. 6.6 ± 1.6, p < 0.01). Data from digital devices reveal both increases and decreases in measured vs. self-reported BMI (p < 0.04) and weekly minutes of moderate and vigorous exercise activity (p < 0.01). Using these data, a significant difference was found between the recalculated and the self-reported Life’s Simple 7 Health Score (p < 0.05). These findings suggest that incorporation of digital health devices should be considered as part of a precision medicinal approach to assessing ideal cardiovascular health.

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Obesity and Ideal Cardiovascular Health: Results from the My Research Legacy Study

Obesities ◽

10.3390/obesities1010004 ◽

2021 ◽

Vol 1 (1) ◽

pp. 36-48

Author(s):

Jane A. Leopold ◽

Elliott M. Antman

Keyword(s):

Cardiovascular Health ◽

Digital Health ◽

Normal Weight ◽

Ideal Cardiovascular Health ◽

Increased Risk ◽

Diet And Exercise ◽

Obese Subjects ◽

Life’S Simple 7 ◽

Life's Simple 7 ◽

Using Data

Obesity is associated with increased risk for cardiovascular diseases compared to normal-weight and overweight status. We hypothesized that obese subjects would have lower ideal cardiovascular health than normal-weight and overweight subjects, but a subset among the obese would have a favorable cardiovascular health profile. Differences in ideal cardiovascular health between normal-weight (n = 523), overweight (n = 378), and obese (n = 660) subjects were examined using data from the Life’s Simple 7 survey and digital health devices. Obese participants were more likely to have prevalent cardiovascular disease, diabetes mellitus, hypertension, and hypercholesterolemia compared to normal weight and overweight (all p < 0.01). Life’s Simple 7 Health Scores, a measure of ideal cardiovascular health, were lower in obese than in normal-weight and overweight groups (5.6 ± 1.2 vs. 8.0 ± 1.1 vs. 6.8 ± 1.1, p < 0.01). A subset of obese with ideal cardiovascular health scores was identified (n = 103). Compared to obese with non-ideal health scores (n = 557), these individuals were more likely to have ideal cardiovascular risk factor status, diet, and exercise profiles. These findings indicate that there is heterogeneity among obese persons and suggest that an assessment of cardiovascular health factors and behaviors can identify areas for intervention beyond weight reduction alone to optimize cardiovascular health.

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Ideal Cardiovascular Health in Former Smokers

Journal of Clinical Medicine ◽

10.3390/jcm10112450 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2450

Author(s):

Jane A. Leopold ◽

Elliott M. Antman

Keyword(s):

Cardiovascular Health ◽

Digital Health ◽

Health Data ◽

Ideal Cardiovascular Health ◽

Increased Risk ◽

Life’S Simple 7 ◽

Former Smokers ◽

Life's Simple 7 ◽

Never Smokers ◽

And Behavior

Former smokers remain at increased risk for cardiovascular diseases compared to never smokers, but have lower risk than current smokers. We therefore hypothesized that former smokers would have an ideal cardiovascular health phenotype that was intermediate between current and never smokers. Differences in ideal cardiovascular health between never (n = 1025), former (n = 428), and current (n = 108) smokers were evaluated in the My Research Legacy study, which collected cardiovascular health data from the Life’s Simple 7 survey and digital health devices. Former smokers had a higher burden of prevalent cardiovascular disease, hypertension, diabetes mellitus, and hypercholesterolemia compared to current and never smokers (all p < 0.01). Former smokers’ Life’s Simple 7 Health Scores, a measure of ideal cardiovascular health, were intermediate between current and never smokers (4.9 ± 1.3 vs. 6.3 ± 1.5 vs. 7.0 ± 1.4, p < 0.01). As former smokers shared similarities with both current and never smokers, we performed a cluster analysis, which identified two phenogroups of former smokers. The phenogroups differed significantly across all 7 cardiovascular health and behavior categories (all p < 0.01). These findings suggest that former smokers are a heterogeneous group and increased attention to cardiovascular health factors and behaviors is warranted to achieve ideal cardiovascular health.

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Abstract P196: Insomnia Symptoms And Ideal Cardiovascular Health In Older Women: Data From The Women’S Health Study

Circulation ◽

10.1161/circ.143.suppl_1.p196 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Cameron Hicks ◽

Jonathan Butler ◽

Natalie B Slopen ◽

David Williams ◽

Dayna A Johnson ◽

...

Keyword(s):

Women’S Health ◽

Women's Health ◽

Older Women ◽

Sleep Duration ◽

Cardiovascular Health ◽

Health Study ◽

Lower Odds ◽

Ideal Cardiovascular Health ◽

The Relationship ◽

Insomnia Symptoms

Introduction: While insomnia is associated with an increased risk of incident cardiovascular disease (CVD), its relationship with ideal cardiovascular health (ICH) is less certain. Given that sleep disturbances increase with age, we examined the relationship between insomnia symptoms and ICH in older women. Methods: Among women participating in the ongoing Women’s Health Study stress cohort with no apparent history of CVD [N= 2588; Mean age= 72.5 ± 6.3], insomnia symptoms were characterized as self-reported difficulty falling asleep or waking up multiple times a night, three or more times per week. Ideal cardiovascular health, as defined by the American Heart Association’s 2020 Impact goals, included standard optimal targets for blood pressure, total cholesterol, glucose, body mass index, physical activity, diet, and smoking. We examined the relationship between insomnia symptoms and ICH using logistic regression, adjusting for clinical and demographic variables. Results: Of the 26588 participants, 52% reported insomnia symptoms, and 38% had ICH. Women with insomnia symptoms had significantly lower odds of ICH after full adjustment for age, race/ethnicity, education, income, depression/anxiety, marital status, and sleep duration (OR [95% CI]: 0.73 [0.64-0.83]). Moreover, compared to women without insomnia symptoms, those with insomnia symptoms were significantly more likely to have hypertension, diabetes, hypercholesterolemia, depression, anxiety, currently smoke, drink one or more alcoholic beverages per day, have a BMI >30, or exercise less frequently. Conclusion: In older women, insomnia symptoms were significantly associated with lower odds of ideal cardiovascular health even after adjusting for socioeconomic status, psychosocial factors, and sleep duration. These results suggest insomnia screening may be an important component of cardiovascular health promotion in this patient population. Further research is needed to evaluate the effects of sleep behavioral interventions on improving ICH.

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Examining Optimism, Psychosocial Risks, and Cardiovascular Health Using Life's Simple 7 Metrics in the Multi-Ethnic Study of Atherosclerosis and the Jackson Heart Study

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.788194 ◽

2021 ◽

Vol 8 ◽

Author(s):

Jee Won Park ◽

Akilah J. Dulin ◽

Belinda L. Needham ◽

Mario Sims ◽

Eric B. Loucks ◽

...

Keyword(s):

Cardiovascular Health ◽

Jackson Heart Study ◽

Ethnic Study ◽

Psychosocial Risks ◽

Adjusted Risk ◽

Effect Measure ◽

Heart Study ◽

Life’S Simple 7 ◽

Life's Simple 7 ◽

The Relationship

Background: Optimism has been shown to be positively associated with better cardiovascular health (CVH). However, there is a dearth of prospective studies showing the benefits of optimism on CVH, especially in the presence of adversities, i.e., psychosocial risks. This study examines the prospective relationship between optimism and CVH outcomes based on the Life's Simple 7 (LS7) metrics and whether multilevel psychosocial risks modify the aforementioned relationship.Methods: We examined self-reported optimism and CVH using harmonized data from two U.S. cohorts: Multi-Ethnic Study of Atherosclerosis (MESA) and Jackson Heart Study (JHS). Modified Poisson regression models were used to estimate the relationship between optimism and CVH using LS7 among MESA participants (N = 3,520) and to examine the relationship of interest based on four biological LS7 metrics (body mass index, blood pressure, cholesterol, and blood glucose) among JHS and MESA participants (N = 5,541). For all CVH outcomes, we assessed for effect measure modification by psychosocial risk.Results: Among MESA participants, the adjusted risk ratio (aRR) for ideal or intermediate CVH using LS7 comparing participants who reported high or medium optimism to those with the lowest level of optimism was 1.10 [95% Confidence Interval (CI): 1.04–1.16] and 1.05 (95% CI: 0.99–1.11), respectively. Among MESA and JHS participants, the corresponding aRRs for having all ideal or intermediate (vs. no poor) metrics based on the four biological LS7 metrics were 1.05 (0.98–1.12) and 1.04 (0.97–1.11), respectively. The corresponding aRRs for having lower cardiovascular risk (0–1 poor metrics) based on the four biological LS7 metrics were 1.01 (0.98–1.03) and 1.01 (0.98–1.03), respectively. There was some evidence of effect modification by neighborhood deprivation for the LS7 outcome and by chronic stress for the ideal or intermediate (no poor) metrics outcome based on the four biological LS7 metrics.Conclusion: Our findings suggest that greater optimism is positively associated with better CVH based on certain LS7 outcomes among a racially/ethnically diverse study population. This relationship may be effect measure modified by specific psychosocial risks. Optimism shows further promise as a potential area for intervention on CVH. However, additional prospective and intervention studies are needed.

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A precision medicine approach to sex-based differences in ideal cardiovascular health

Scientific Reports ◽

10.1038/s41598-021-93966-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Jane A. Leopold ◽

Elliott M. Antman

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Cardiovascular Health ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

Cardiovascular Disease Risk Factor ◽

Study Cohort ◽

Ideal Cardiovascular Health ◽

Life’S Simple 7 ◽

Life's Simple 7

AbstractCardiovascular disease risk factor profiles and health behaviors are known to differ between women and men. Sex-based differences in ideal cardiovascular health were examined in the My Research Legacy study, which collected cardiovascular health and lifestyle data via Life’s Simple 7 survey and digital health devices. As the study overenrolled women (n = 1251) compared to men (n = 310), we hypothesized that heterogeneity among women would affect comparisons of ideal cardiovascular health. We identified 2 phenogroups of women in our study cohort by cluster analysis. The phenogroups differed significantly across all 7 cardiovascular health and behavior domains (all p < 0.01) with women in phenogroup 1 having a lower Life’s Simple 7 Health Score than those in phenogroup 2 (5.9 ± 1.3 vs. 7.6 ± 1.3, p < 0.01). Compared to men, women in phenogroup 1 had a higher burden of cardiovascular disease risk factors, exercised less, and had lower ideal cardiovascular health scores (p < 0.01). In contrast, women in phenogroup 2 had fewer cardiovascular risk factors but similar exercise habits and higher ideal cardiovascular health scores than men (p < 0.01). These findings suggest that heterogeneity among study participants should be examined when evaluating sex-based differences in ideal cardiovascular health.

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The Association of Life’s Simple 7 with Aldosterone among African Americans in the Jackson Heart Study

Nutrients ◽

10.3390/nu11050955 ◽

2019 ◽

Vol 11 (5) ◽

pp. 955 ◽

Cited By ~ 1

Author(s):

Veena Kesireddy ◽

Yubo Tan ◽

David Kline ◽

Guy Brock ◽

James B. Odei ◽

...

Keyword(s):

African Americans ◽

Cardiovascular Health ◽

Heart Association ◽

Jackson Heart Study ◽

Ideal Cardiovascular Health ◽

The Poor ◽

Heart Study ◽

Serum Aldosterone ◽

Life’S Simple 7 ◽

Life's Simple 7

Background: Among African Americans (AAs), attaining higher levels of American Heart Association (AHA) ideal cardiovascular health (Life’s Simple 7 [LS7]) is associated with lower risk of diabetes and cardiovascular disease (CVD). We previously showed that aldosterone is associated with higher risk of diabetes and CVD in AAs. Thus, we investigated the association of LS7 metrics with aldosterone in the Jackson Heart Study (JHS). Methods: Ideal metrics were defined by AHA 2020 goals for health behaviors (smoking, dietary intake, physical activity, and body mass index) and health factors (total cholesterol, blood pressure, and fasting glucose). The number of ideal LS7 metrics attained at baseline were summed into a continuous score (0–7) and categorical groups (Poor: 0–1, Intermediate: 2–3, and Ideal: ≥4 ideal LS7 metrics). Multivariable linear regression was used. Results: Among 4,095 JHS participants (mean age 55 ± 13 years, 65% female), median serum aldosterone was 4.90, 4.30, and 3.70 ng/dL in the poor (n = 1132), intermediate (n = 2288) and ideal (n = 675) categories respectively. Aldosterone was 15% [0.85 (0.80, 0.90)] and 33% [0.67 (0.61, 0.75)] lower in the intermediate and ideal LS7 categories compared to the poor LS7 category. Each additional LS7 metric attained on continuous LS7 score (0–7) was associated with an 11% [0.89 (0.86, 0.91)] lower aldosterone level with variation by sex with women having a 15% lower aldosterone vs. 5% in men. Conclusions: Higher attainment of ideal LS7 metrics was associated with lower serum aldosterone among AAs with a greater magnitude of association among women compared to men.

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Association of dispositional optimism with Life’s Simple 7’s Cardiovascular Health Index: results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study (SCAS)

BMJ Open ◽

10.1136/bmjopen-2017-019434 ◽

2018 ◽

Vol 8 (3) ◽

pp. e019434 ◽

Cited By ~ 10

Author(s):

Rosalba Hernandez ◽

Hector M González ◽

Wassim Tarraf ◽

Judith T Moskowitz ◽

Mercedes R Carnethon ◽

...

Keyword(s):

Community Health ◽

Psychological Functioning ◽

Cardiovascular Health ◽

Dispositional Optimism ◽

Health Study ◽

Ancillary Study ◽

Hispanic Community ◽

Life’S Simple 7 ◽

Life's Simple 7 ◽

The Relationship

ObjectivesMounting evidence links positive psychological functioning to restorative health processes and favourable medical outcomes. However, very little is known about the relationship between optimism, an indicator of psychological functioning and the American Heart Association (AHA)-defined concept of cardiovascular health (CVH), particularly in Hispanics/Latinos of diverse backgrounds. To address limitations of existing literature, this study investigated the association between dispositional optimism and CVH in a heterogeneous sample of Hispanics/Latinos residing in the USA.DesignCross-sectional study.Participants and settingData were analysed from 4919 adults ages 18–75 of the Hispanic Community Health Study/Study of Latinos parent study and the Sociocultural Ancillary Study.Main outcome measuresOptimism was assessed using the 6-item Life Orientation Test-Revised (range from 6 to 30). AHA classification standards were used to derive an additive CVH score with operationalisation of indicators as Ideal, Intermediate and Poor. The overall CVH score included indicators of diet, body mass index, physical activity, cholesterol, blood pressure, fasting glucose and smoking status. Multivariate linear and logistic regressions were used to examine associations of optimism with CVH (Life’s Simple 7), after adjusting for sociodemographic factors and depressive symptoms.ResultsEach increase in the optimism total score was associated with a greater CVH score (β=0.03 per unit increase, 95% CI 0.01 to 0.05). When modelling tertiles of optimism, participants with moderate (β=0.24 to 95% CI 0.06 to 0.42) and high (β=0.12, 95% CI 0.01 to 0.24) levels of optimism displayed greater CVH scores when compared with their least optimistic peers.ConclusionThis study offers preliminary evidence for an association between optimism and CVH in a large heterogeneous group of Hispanic/Latino adults. Our study adds scientific knowledge of psychological assets that may promote CVH and suggests a novel therapeutic target for consideration. Future studies are needed to explore causality and potential mechanism underlying the relationship between positive emotion and heart health.

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Abstract P119: Assessment of Cardiovascular Health among Older Women in Primary Care

Circulation ◽

10.1161/circ.129.suppl_1.p119 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Randi E Foraker ◽

Abigail B Shoben ◽

Marcelo A Lopetegui ◽

Albert M Lai ◽

Philip R Payne ◽

...

Keyword(s):

Primary Care ◽

Cardiovascular Health ◽

Primary Care Clinic ◽

Primary Care Providers ◽

Continuous Variables ◽

Care Providers ◽

Care Clinic ◽

Female Patients ◽

Life’S Simple 7 ◽

Life's Simple 7

In 2010, the American Heart Association (AHA) launched the groundbreaking Life’s Simple 7™ campaign to improve the cardiovascular health (CVH) of Americans. Five of the 7 [smoking, body mass index (BMI), blood pressure, cholesterol, and glucose] are commonly recorded in electronic medical records (EMRs). Although CVH components are often included in patient-provider discussions, to date there has been no formal attempt to characterize CVH from EMR data. We characterized the CVH of 160 female patients ages 65 and older seen in an Ohio State University primary care clinic from May 1 through July 31, 2013. We defined CVH according to AHA criteria, and assigned each behavior and factor to either an “ideal”, “intermediate”, or “poor” category. We calculated an overall CVH score ranging from 0 (worst) to 10 (best) by summing across behaviors and factors as follows: poor, 0; intermediate, 1; and ideal, 2. We calculated means and standard deviations (sd) of continuous variables and report frequencies within CVH categories. Patients were an average of 74.2 (sd=6.7) years old, and 35% were black. Among the 126 (79%) women who had data available on all 5 factors, mean CVH score was 6.0 (sd=1.3). Among all women, the mean fractional score (actual score/maximum possible) was 0.63 (sd=0.14), and it did not differ significantly by race. Greater than 10% of data were missing for BMI (13%) and cholesterol (11%). Figure 1 shows the distribution of ideal, intermediate, poor, and missing CVH values for each behavior and factor. We have demonstrated that a majority of Life’s Simple 7™ components are easily queried from EMRs. These data indicate that older female patients seen in the primary care setting have less-than-ideal CVH. There exists great potential to leverage the EMR for patient-provider communication and engagement around CVH. As such, we are implementing an automated assessment of CVH targeted to primary care providers and their older female patients. Following the intervention, CVH values will be compared to these baseline data. Figure 1. Percent of older female patients (n=160) who were seen in a primary care clinic by category of CVH: behaviors and factors*. *Diabetes was defined as either treated by a glucose-lowering medication (intermediate) or not (ideal), since over 90% of data were missing for fasting glucose or hemoglobin A1c.

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