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

Abstract

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.

Association of Socioeconomic Status With Ideal Cardiovascular Health in Black Men

“…Since the inception of Life’s Simple 7, numerous studies have shown an association between attainment of better levels of Life’s Simple 7 with lower risk of diabetes, heart disease, cancer, heart failure, and cognitive impairment across racial/ethnic groups. 12 , 13 , 14 , 15 …”

The role of aldosterone and ideal cardiovascular health in incident diabetes: The Jackson Heart Study

“…Higher attainment of ICH metrics has been associated with lower risk of incident diabetes among AAs in the Jackson Heart Study (JHS), Multi-Ethnic Study of Atherosclerosis and the REasons for Geographic and Racial Differences in Stroke (REGARDS) study [ 3 , [7] , [8] , [9] ]. Additionally, higher attainment of ICH was associated with lower aldosterone among AAs in the JHS [10] .…”

“…Each baseline metric was evaluated separately using poor, intermediate, and ideal categories [7] . Based on preclinical and clinical studies we hypothesized that BMI, dietary intake, smoking, physical activity and total cholesterol are upstream of aldosterone and impact levels of serum aldosterone, whereas BP and glucose are downstream of aldosterone [ 12 , 16 , 17 , 25 ]. Based on this we excluded BP and glucose from the score categorization, and thus included 5 components in the ICH score.…”

The role of aldosterone and ideal cardiovascular health in incident cardiovascular disease: The Jackson heart study

“…Each baseline metric was evaluated separately using poor, intermediate, and ideal categories [37] . Based on preclinical and clinical studies we hypothesized that BMI, dietary intake, smoking, physical activity and total cholesterol are upstream of aldosterone and impact levels of serum aldosterone, whereas BP and glucose are downstream of aldosterone [ 11 , 28 , 29 , 38 ]. We thus excluded BP and glucose from the score categorization, and included the remaining 5 components in the ICH score.…”

“…Furthermore, aldosterone has been shown to contribute to higher BP and blood glucose [9] . Additionally, aldosterone is influenced by ICH status, as higher ICH attainment is associated with lower levels of aldosterone among AAs [11] . Specifically, increased adiposity has been associated with increased aldosterone production directly through adipocytes [12] , [13] , [14] .…”