Greater Adherence to Life’s Simple 7 Is Associated With Less Arterial Stiffness: the Atherosclerosis Risk in Communities (ARIC) Study

Abstract

Background Greater arterial stiffness is associated independently with increased cardiovascular disease risk. The American Heart Association (AHA) has recommended following “Life’s Simple 7 (LS7)” to optimize cardiovascular health; we tested whether better LS7 in middle age is associated with less arterial stiffness in later life. Methods We studied 4,232 black and white participants aged 45–64 years at the baseline (1987–89) visit of the Atherosclerosis Risk in Communities Study cohort who also had arterial stiffness measured in 2011–13 (mean ± SD interval: 23.6 ± 1.0 years). We calculated a 14-point summary score for baseline LS7 and classified participants as having “poor” (0–4), “average” (5–9), or “ideal” (10–14) cardiovascular health. We used logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (95% CI) for arterial stiffening: a high carotid-femoral pulse wave velocity (cfPWV, ≥13.23 m/s) or a high central pulse pressure (central PP, ≥ 82.35 mm Hg). Results The age, race, sex, and heart rate-adjusted ORs (95% CI) for high cfPWV in the “ideal,” “average,” and “poor” LS7 summary categories were 1 (Reference), 1.30 (1.11, 1.53), and 1.68 (1.10,2.56), respectively (P-trend = 0.0003). Similarly, the adjusted ORs (95% CI) for high central PP across LS7 summary categories were 1 (Reference), 1.48 (1.27, 1.74), and 1.63 (1.04, 2.56), respectively (P-trend <0.0001). Conclusion Greater LS7 score in middle age is associated with less arterial stiffness 2–3 decades later. These findings further support the AHA recommendation to follow LS7 for cardiovascular disease prevention.

Heart Disease and Stroke Statistics—2022 Update: A Report From the American Heart Association

“…Findings include strong inverse, stepwise associations in the United States of the number of CVH components at ideal levels with all-cause mortality, CVD mortality, IHD mortality, CVD, and HF; with subclinical measures of atherosclerosis such as carotid IMT, arterial stiffness, and CAC prevalence and progression; with physical functional impairment and frailty; with cognitive decline and depression; and with longevity. 3–8 Similar relationships have also been seen in non-US populations. 3,4,9–22…”

“…Better CVH as defined by the AHA is associated with lower incidence of HF, 3,5–7,22 less subclinical vascular disease, 8,15,17,33,34 better global cognitive performance and cognitive function, 16,35,36 lower hazard of subsequent dementia, 37,38 lower prevalence 39 and incidence 40 of depressive symptoms, lower loss of physical functional status, 41 longer leukocyte telomere length, 42 less ESRD, 43 less pneumonia, less chronic obstructive pulmonary disease, 44 less VTE/PE, 45 lower prevalence of aortic sclerosis and stenosis, 46 lower risk of calcific aortic valve stenosis, 47 better prognosis after MI, 48 lower risk of AF, 49 and lower odds of having elevated resting heart rate. 50 Using the CVH scoring approach, the FHS demonstrated significantly lower odds of prevalent hepatic steatosis associated with more favorable CVH scores, and the decrease of liver fat associated with more favorable CVH scores was greater among people with a higher GRS for NAFLD.…”

Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association

“…Findings include strong inverse, stepwise associations in the United States of the number of CVH components at ideal levels with all-cause mortality, CVD mortality, IHD mortality, CVD, and HF; with subclinical measures of atherosclerosis such as carotid IMT, arterial stiffness, and CAC prevalence and progression; with physical functional impairment and frailty; with cognitive decline and depression; and with longevity. 4–9 Similar relationships have also been seen in non-US populations. 4,10–24…”

“…Better CVH as defined by the AHA is associated with a lower incidence of HF, 4,6–8,22 less subclinical vascular disease, 9,15,17,41,42 better global cognitive performance and cognitive function, 16,43 lower hazard of subsequent dementia, 44–46 fewer depressive symptoms, 47–49 longer leukocyte telomere length, 50 less ESRD, 51 less pneumonia, 52 less chronic obstructive pulmonary disease, 53 lower prevalence of aortic sclerosis and stenosis, 54 lower risk of calcific aortic valve stenosis, 55 better prognosis after MI, 56 lower risk of AF, 57,58 and lower odds of having elevated resting heart rate. 59 Using the CVH scoring approach, the FHS demonstrated significantly lower odds of prevalent hepatic steatosis associated with more favorable CVH scores, and the decrease of liver fat associated with more favorable CVH scores was greater among people with a higher GRS for NAFLD.…”

Arteriosclerosis, Atherosclerosis, and Cardiovascular Health: Joint Relations to the Incidence of Cardiovascular Disease

“…In contrast, a good CVH can mitigate the longitudinal progression of both subclinical atherosclerosis and arteriosclerosis. 15,16,[40][41][42][43] A recent autopsy study of elderly Japanese 44 reported partial correlations of aortic PWV and coronary atherosclerotic burden of about 0.19, which is remarkably similar to the pair-wise partial correlation in our investigation. To our knowledge, no prior study has evaluated the prognostic significance of the conjoint presence of CAC, higher CFPWV, and poor CVH.…”