Objective: The AHA Life’s Simple 7 (LS7) defines cardiovascular health with smoking, physical activity, diet quality, body mass index (BMI), blood pressure, total cholesterol, and blood glucose. We examined changes in LS7 score and its components in older adults over seven years of follow-up. Methods: We analyzed 2,234 adults aged 65+ in the Cardiovascular Health Study who had all LS7 components measured at baseline (1989) and seven years later (1996). We scored each component as ideal (2), intermediate (1), or poor (0). LS7 score was the sum of components, ranging from 0 (worst) to 14 (best), then categorized as ideal (10-14), intermediate (5-9), or poor (0-4). Results: Mean LS7 score at baseline was 8.71, declining by 0.24 points (95% CI: 0.17, 0.31) to 8.47 seven years later. At baseline, LS7 score was ideal in 35% of participants, intermediate in 63%, and poor in 1.7%. Seven years later, the distribution shifted down, with 31% scoring ideal, 67% scoring intermediate, and 2.0% scoring poor. Of those scoring ideal at baseline, 57% (95% CI: 53%, 60%) maintained ideal scores seven years later (Figure, Panel A). Of those scoring intermediate at baseline (Panel B), 18% (95% CI: 16%, 20%) improved to ideal. Of those scoring poor at baseline (Panel C), 76% (95% CI: 63%, 90%) improved to intermediate, but none improved to ideal. For components, maintenance of baseline ideal status was 95% for smoking, 86% for glucose, 80% for BMI, 77% for cholesterol, and 55% for physical activity, but only 35% for blood pressure and 7% for diet (Panel A). Decline of baseline intermediate status to poor was 33% for blood pressure and 24% for diet (Panel B). Improvement of baseline poor status to intermediate or ideal was >50% for cholesterol and physical activity and >40% for smoking and diet (Panel C). Conclusions: While cardiovascular health declined on average in an aging population, some older adults improved their cardiovascular health as they aged. Declines in diet quality and blood pressure control contributed to overall declines in cardiovascular health.

Objective: The AHA Life’s Simple 7 (LS7) defines cardiovascular health with smoking, physical activity, diet quality, body mass index (BMI), blood pressure, total cholesterol, and blood glucose. We examined associations of LS7 score and its components with cognitive decline in older adults. Methods: The Cardiovascular Heart Study is a longitudinal cohort of 5,888 adults aged 65 and above. We analyzed 4,165 who had LS7 score measured at baseline (1989), complete covariate data, and at least one Modified Mini-Mental State Examination (3MS) score during follow-up (through 1998). We scored each LS7 component as ideal (2), intermediate (1), or poor (0), summed all components to a total LS7 score ranging from 0 (worst) to 14 (best), and categorized total LS7 score as ideal (10-14), intermediate (5-9), or poor (0-4). 3MS is a measure of global cognition ranging from 0 (worst) to 100 (best) and was obtained annually during a mean follow-up of 6.8 years. Using linear mixed models, we estimated associations of LS7 score and its components with annual rate of cognitive decline, adjusted for demographic, behavioral, and clinical factors. Results: In adjusted models, mean annual decline in 3MS score was 0.83 points (95% CI: 0.61, 1.04) for those with poor LS7 scores at baseline, 0.63 points (95% CI: 0.59, 0.67) with intermediate scores, and 0.42 points (95% CI: 0.37, 0.47) with ideal scores (p < 0.0001 for difference in mean annual decline across LS7 categories). Better physical activity, diet quality, blood pressure control, and blood glucose control were all associated with slower cognitive decline (Table). BMI, however, was opposite, with obesity (poor) associated with slower decline, and normal weight (ideal) associated with faster decline (p <0.0001). Conclusions: Better cardiovascular health measured by LS7 in old age is associated with slower average cognitive decline. The role of BMI as a component of LS7 in older adults may warrant reconsideration, as lower BMI in late-life may represent frailty and increased risk for cognitive decline.

Objective: To estimate the association of rural vs urban living in the United States (US) with incident cognitive impairment (ICI), and to assess confounding, mediation, and effect heterogeneity by demographic, social, behavioral, and clinical risk factors. Methods: REGARDS is a cohort of 30,239 adults aged 45+ in the 48 contiguous states. We analyzed 20,592 participants who at baseline (2003-2007) were cognitively intact with no history of stroke and had cognition assessed an average of 7.1 years later. We used Rural-Urban Commuting Area (RUCA) codes to classify participants as urban (n = 16,436), large city/town (n = 2,420), or small/isolated rural (n = 1,736) at baseline. We defined ICI as falling ≥1.5 SD below the mean on at least two of three cognitive tests administered during follow-up: word list learning, word list delayed recall, and animal naming. Using urban as the referent, we estimated odds ratios of ICI for rural and for large city/town. Results: ICI occurred in 1,291 participants (6.3%). Rural residents had 49% higher odds of ICI adjusted for confounding by demographics (Model 2 in Table, OR = 1.49 [95% CI: 1.19, 1.85]). After further adjusting for potential mediators (Models 3-6), odds of ICI remained 25% higher for rural vs urban (Model 6, OR = 1.25 [0.99, 1.56]). In assessing effect heterogeneity, we found synergism of rural dwelling with black race, physical inactivity, and low self-rated health (all P < 0.1; see ORs in Table), but not for other ICI risk factors. We found no difference in ICI for large city/town vs urban (demographics-adjusted OR = 1.08 [0.88, 1.33]; fully adjusted OR = 0.95 [0.77, 1.18]), and no effect heterogeneity of ICI risk factors by large city/town (all P > 0.2). Conclusion: Rural living is an important social determinant of cognitive health in the US. ICI was significantly more frequent among rural dwellers than urban dwellers, partly due to confounding or mediation by ICI risk factors. Odds of ICI were highest for rural dwelling combined with black race, physical inactivity, or low self-rated health.