American Heart Association's Life's Simple 7 at Middle Age and Prognosis After Myocardial Infarction in Later Life

Abstract

BackgroundThe American Heart Association recommends focusing on 7 health factors (Life's Simple 7) for primordial prevention of cardiovascular health. However, whether greater adherence to Life's Simple 7 in midlife improves prognosis after myocardial infarction (MI) in later life is unknown.Methods and ResultsIn 1277 participants who developed MI during the ARIC (Atherosclerosis Risk in Communities) Study follow‐up, a 14‐point score of Life's Simple 7 was constructed according to the status (2 points for ideal, 1 point for intermediate, and 0 points for poor) of each of 7 factors (smoking, adiposity, physical activity, diet, total cholesterol, blood pressure, and fasting glucose) at baseline (1987–1989). Hazard ratios for composite and individual adverse outcomes of all‐cause mortality, cardiovascular mortality, recurrent MI, heart failure, and stroke were calculated according to Life's Simple 7 score. During a median follow‐up of 3.3 years, 918 participants (72%) had subsequent adverse outcomes after MI. Life's Simple 7 score at middle age was inversely associated with adverse outcomes after MI (adjusted hazard ratios of composite outcome, 0.57 [95% confidence interval, 0.39–0.84] if score is ≥10, 0.78 [95% confidence interval, 0.57–1.07] if score is 7–9, and 0.82 [95% confidence interval, 0.60–1.11] if score is 4–6 versus ≤3). The association was largely independent of access to care and MI severity. Individual factors related to better prognosis after MI were ideal nonsmoking, body mass index, blood pressure, and fasting glucose.ConclusionsOptimal Life's Simple 7 at middle age was associated with better prognosis after MI in later life. Our findings suggest a secondary prevention benefit of having better cardiovascular health status in midlife.

Improving Outcomes After Myocardial Infarction in the US Population

“…In this context, the findings reported by Mok et al 11 in this issue of Journal of the American Heart Association (JAHA) are both timely and important. Leveraging prospective data from the ARIC (Atherosclerosis Risk in Communities) study, the authors show a robust and highly significant association of better cardiovascular health (as measured by a higher Life's Simple 7 score on the index visit) in middle age (45-64 years), with a decreased incidence of and improved prognosis after MI later in life.…”

“…The study by Mok et al11 adds to the growing body of evidence in support of AHA's Life's Simple 7 goals, which are based on strategies that prevent risk factor development (or primordial prevention), and use of “population strategies” to shift the entire population distribution of risk factors toward more favorable levels. When population strategies and primordial prevention are successful, small changes in population mean levels can result in large reductions in disease rates and improved outcomes.…”

“…Several important limitations of the investigation deserve mention. As Mok et al 11 acknowledge, measurement of metrics at a single time point, without exploring the effect on outcomes of changes in these metrics over time, might lead to potential bias. For diet and exercise, the authors point out that the quality of questionnaire data, which were selfreported, may have been an issue, along with the definition of the ideal AHA diet, which was prevalent in only 5% of ARIC study participants.…”

Effect of Lifestyle Changes after Percutaneous Coronary Intervention on Revascularization

“…Potential benefit of Life's Simple 7 had been investigated among myocardial infarction patients. e findings suggested ideal CV health at middle age was associated with better prognosis after MI in later life [22]. However, the impact of ideal cardiovascular health metrics among subjects with different risk strata has not been well established.…”

Ideal Cardiovascular Health Among American Adults After the Economic Recession of 2008-2009: Insights from NHANES

“…11 A poor status of Life's Simple 7 score has been associated with multiple adverse cardiovascular outcomes such as incident heart failure, 12,13 atrial fibrillation, 14 and prognosis after myocardial infarction. 15 We hypothesized that the macroeconomic fluctuations noted during the economic recession and the subsequent economic recovery would be associated with cardiovascular health metrics of US adults ages 20 years and older. Furthermore, we hypothesized that the age, sex, race, insurance status, access to health care adjusted time trends in prevalence of ideal cardiovascular health, as captured by Life's Simple 7 metrics, varied among adults from different socioeconomic strata.…”