American Heart Association's Life Research Articles

The menopausal transition period and cardiovascular risk.

The menopausal transition period spans, on average, 2-8 years before the final menstrual period and is associated with an increase in clinical and subclinical cardiovascular risk. In this Review, we discuss the metabolic and cardiovascular changes that occur during the menopausal transition period and the role of ovarian ageing, chronological ageing and other ageing-related risk factors in mediating these changes. Disentangling the relative contributions of chronological and reproductive ageing to cardiovascular risk is challenging, but data from longitudinal studies in women transitioning from premenopause to post-menopause have provided valuable insights. We also discuss evidence on how cardiovascular risk is altered by premature or early menopause, surgical menopause, and vasomotor and other menopausal symptoms. Whether targeted interventions can slow the progression of atherosclerosis and subclinical disease during the menopausal transition, thus delaying or preventing the onset of cardiovascular events, remains to be determined. Furthermore, we consider the recommended strategies for cardiovascular risk reduction in women undergoing menopausal transition using the framework of the American Heart Association's Life's Essential 8 key measures for improving and maintaining cardiovascular health, and discuss the cardiovascular risks and benefits of menopausal hormone therapy. Finally, we also discuss novel therapies that might benefit this population in reducing cardiovascular risk.

Association of a Healthy Lifestyle, Life's Essential 8 Scores With Incident Macrovascular and Microvascular Disease Among Individuals With Type 2 Diabetes.

Background The association of a healthy lifestyle with the prognosis of type 2 diabetes remains uncertain. We aimed to evaluate the associations of a healthy lifestyle and a higher American Heart Association's Life's Essential 8 score with incident macrovascular and microvascular diseases in type 2 diabetes. Methods and Results A total of 13 543 participants with baseline type 2 diabetes and free of macrovascular and microvascular diseases from the UK Biobank were included. A healthy lifestyle was determined based on body mass index, smoking, alcohol consumption, physical activity, sleep duration, and diet. Life's Essential 8 scores were generated from 8 metrics according to the American Heart Association's cardiovascular health advisory, ranging from 0 to 100. During a median follow-up of 12.1 years, 3279 (24.2%) incident macrovascular diseases and 2557 (18.9%) microvascular diseases were documented. Compared with those with a poor lifestyle, participants with an ideal lifestyle had significantly lower risks of incident macrovascular disease (hazard ratio [HR], 0.46 [95% CI, 0.36-0.59]) and microvascular disease (HR, 0.60 [95% CI, 0.47-0.77]). Significantly lower risks of macrovascular disease (HR, 0.20 [95% CI, 0.05-0.79]) and microvascular disease (HR, 0.24 [95% CI, 0.06-0.98]) were also found in the high cardiovascular health group (Life's Essential 8 scores: 80-100), compared to the low cardiovascular health group (scores: 0-49). Adhering to an ideal lifestyle may prevent 37.0% of macrovascular disease and 24.7% of microvascular disease, and attaining a high cardiovascular health may prevent 71.9% of macrovascular disease and 67.5% of microvascular disease. Conclusions A healthy lifestyle and a higher Life's Essential 8 score were associated with lower risks of macrovascular and microvascular diseases among participants with type 2 diabetes.

Cardiovascular health among persons with HIV without existing atherosclerotic cardiovascular disease.

We sought to characterize atherosclerotic cardiovascular disease (ASCVD) risk and metrics of cardiovascular health in persons with HIV (PWH) eligible for primary prevention of ASCVD. A cross-sectional study of PWH 40 years and older without documented ASCVD who received care at three HIV clinics in San Francisco from 2019 to 2022. We used ICD-10 codes and electronic health record data to assess ASCVD risk and cardiovascular health, as defined by the American Heart Association's Life's Essential 8 (LE8) metrics for nicotine exposure, BMI, lipids, glucose, and blood pressure (BP). Among 2567 PWH eligible for primary prevention of ASCVD, the median age was 55 years, 14% were women, and 95% were on antiretroviral therapy. Seventy-seven percent had undergone complete assessment of ASCVD risk factors, and 50% of these patients had intermediate-high ASCVD risk (≥7.5%). Of those with hypertension, 39% were prescribed an antihypertensive. Among those eligible, 43% were prescribed a statin. The mean LE8 cardiovascular health score [0--100 (best health)] was 55.1 for nicotine exposure, 71.3 for BMI, 70.4 for lipids, 81.2 for blood glucose, 56.0 for BP, with an average score of 66.2 across the five metrics. Patients with Medicare insurance, black patients, and those with sleep apnea and chronic kidney disease had on average lower cardiovascular health scores; patients with undetectable viral loads had higher cardiovascular health scores. We highlight opportunities for improving primary prevention of ASCVD among PWH, especially in the areas of guideline-based therapy, nicotine exposure, and BP control.

Estimation of life's essential 8 score with incomplete data of individual metrics.

The American Heart Association's Life's Essential 8 (LE8) is an updated construct of cardiovascular health (CVH), including blood pressure, lipids, glucose, body mass index, nicotine exposure, diet, physical activity, and sleep health. It is challenging to simultaneously measure all eight metrics at multiple time points in most research and clinical settings, hindering the use of LE8 to assess individuals' overall CVH trajectories over time. We obtained data from 5,588 participants in the Nurses' Health Studies (NHS, NHSII) and Health Professionaĺs Follow-up Study (HPFS), and 27,194 participants in the 2005-2016 National Health and Nutrition Examination Survey (NHANES) with all eight metrics available. Individuals' overall cardiovascular health (CVH) was determined by LE8 score (0-100). CVH-related factors that are routinely collected in many settings (i.e., demographics, BMI, smoking, hypertension, hypercholesterolemia, and diabetes) were included as predictors in the base models of LE8 score, and subsequent models further included less frequently measured factors (i.e., physical activity, diet, blood pressure, and sleep health). Gradient boosting decision trees were trained with hyper-parameters tuned by cross-validations. The base models trained using NHS, NHSII, and HPFS had validated root mean squared errors (RMSEs) of 8.06 (internal) and 16.72 (external). Models with additional predictors further improved performance. Consistent results were observed in models trained using NHANES. The predicted CVH scores can generate consistent effect estimates in associational studies as the observed CVH scores. CVH-related factors routinely measured in many settings can be used to accurately estimate individuals' overall CVH when LE8 metrics are incomplete.

Family Meals and Cardiometabolic Risk Factors in Young Children.

Family meals represent a novel strategy for improving cardiovascular health in youth. The purpose of this paper is to describe the association between family meals, dietary patterns, and weight status in youth. According to the American Heart Association's Life's Essential 8, poor diet quality and overweight/obesity status are key contributors to suboptimal cardiovascular health. Current literature highlights a positive correlation between the number of family meals and healthier eating patterns, including greater consumption of fruits and vegetables, and a reduced risk of obesity in youth. However, to date, the role of family meals in improving cardiovascular health in youth has been largely observational and prospective studies are needed to assess causality. Family meals may be an effective strategy for improved dietary patterns and weight status in youth.

Psychosocial Stressors as a Determinant of Maternal Cardiovascular Health During Pregnancy

Maternal psychosocial stress may be a risk factor for poor cardiovascular health (CVH) during pregnancy. We aimed to identify classes of psychosocial stressors in pregnant women and to evaluate their cross-sectional association with CVH. We performed a secondary analysis of women from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b) cohort (2010 to 2013). Latent class analysis was used to identify distinct classes of exposure to psychosocial stressors based on psychological (stress, anxiety, resilience, depression) and sociocultural indicators (social support, economic stress, discrimination). Optimal and suboptimal CVH was defined based on the presence of 0 to 1 and ≥2 risk factors (hypertension, diabetes mellitus, smoking, obesity, inadequate physical activity), respectively based on the American Heart Association Life's Essential 8. We used logistic regression to evaluate the association between psychosocial classes and CVH. We included 8,491 women and identified 5 classes reflective of gradations of psychosocial stress. In unadjusted models, women in the most disadvantaged psychosocial stressor class were approximately 3 times more likely to have suboptimal CVH than those in the most advantaged class (odds ratio 2.98, 95% confidence interval: 2.54 to 3.51). Adjusting for demographics minimally attenuated the risk (adjusted odds ratio 2.09, 95% confidence interval: 1.76 to 2.48). We observed variation across psychosocial stressor landscapes in women in the nuMoM2b cohort. Women in the most disadvantaged psychosocial class had a greater risk of suboptimal CVH which was only partially explained by differences in demographic characteristics. In conclusion, our findings highlight the association of maternal psychosocial stressors with CVH during pregnancy.

Physical Activity Over the Lifecourse and Cardiovascular Disease.

Despite improvements in cardiovascular care in recent decades, cardiovascular disease (CVD) remains a leading cause of death worldwide. At its core, CVD is a largely preventable disease with diligent risk factor management and early detection. As highlighted in the American Heart Association's Life's Essential 8, physical activity plays a central role in CVD prevention at an individual and population level. Despite pervasive knowledge of the numerous cardiovascular and noncardiovascular health benefits of physical activity, physical activity has steadily decreased over time and unfavorable changes in physical activity occur throughout people's lives. Here, we use a lifecourse framework to examine the evidence reporting on the association of physical activity with CVD. From in utero to older adults, we review and discuss the evidence detailing how physical activity may prevent incident CVD and mitigate CVD-related morbidity and death across all life stages.

Assessing Life's Essential 8 and Adverse Childhood Experiences in Grandparent-Grandchild Co-residing Dyads.

We assessed a subset of behavioral indicators from the American Heart Association Life's Essential 8 cardiovascular health (CVH) construct-diet, physical activity, sleep, and nicotine exposure-and quantified associations in scores between members of 12 grandparent-grandchild dyads (grandparents, 52-70 years old; children, 7-12 years old). We also assessed the number of adverse childhood experiences from the dyads. Using the Life's Essential 8 scoring algorithm (0-100, with 100 as optimal), we calculated averages and used Spearman's ρ correlation to quantify associations. Mean score was 67.5 (±12.4) for grandparents and 63.0 (±11.2) for grandchildren. Mean scores for the dyad members were significantly correlated ( r = 0.66, P < .05). The mean numbers of adverse childhood experiences were 7.0 and 5.8 for the grandparents and grandchildren, respectively. The results indicate that CVH in these dyads was suboptimal and interrelated. Adverse childhood experiences in this analysis surpass levels reported as high risk for poor CVH. Our findings suggest that dyadic-based interventions to improve CVH are warranted.

Vasomotor and other menopause symptoms and the prevalence of ideal cardiovascular health metrics among premenopausal stage women.

We examined the association between menopause symptoms and the prevalence of ideal cardiovascular health (CVH) metrics among premenopausal women. This cross-sectional study comprised 4,611 premenopausal women aged 42 to 52 years. Data for CVH metrics were collected during health screening examinations. Menopause symptoms were measured using the Korean version of the Menopause-Specific Quality of Life questionnaire. For vasomotor, psychosocial, physical, and sexual symptoms, participants were divided into absent or symptomatic groups, further divided into tertiles (range, 0-7; 7 being the most bothersome). Ideal CVH metrics were defined according to the American Heart Association Life Simple 7 metrics, except dietary component. Cardiovascular health metrics were scored from 0 (unhealthy) to 6 (healthy) and classified as poor (0-2), intermediate (3-4), and ideal (5-6). Multinomial logistic regression models were used to estimate the prevalence ratios for intermediate and poor CVH metrics using ideal CVH as the reference. The overall and 4 menopause-specific quality of life domain scores were significantly associated with poorer CVH metrics scores in a dose-response manner (P < 0.05). After adjusting for age, parity, education level, anti-Mullerian hormone levels, and alcohol intake, women with the most bothersome degree for vasomotor, psychosocial, physical, and sexual symptoms had significantly higher prevalence of poor CVH metrics, with corresponding prevalence ratios (95% confidence interval) of 2.90 (1.95-4.31), 2.07 (1.36-3.15), 3.01 (1.19-7.65), and 1.66 (1.15-2.39), respectively, compared with those without each vasomotor, psychosocial, physical, and sexual symptom. Premenopausal stage women with either vasomotor or nonvasomotor menopausal symptoms have significantly higher prevalence of poor CVH metrics, compared with those without any menopausal symptoms.

Cost and time estimates for integrating a cardiovascular health application for cancer survivors in the electronic health record: Case studies from the NCORP network.

e13557 Background: Clinical decision support (CDS) tools may support the delivery of guideline concordant cancer care yet must be integrated into EHR platforms and optimized for clinical workflow. Implementation outcomes are not well-documented in the literature for deployment of CDS tools in community oncology practices. Here we provide best practices for teams looking to implement CDS tools in diverse cancer care settings. Methods: The Automated Heart-Health Assessment (AH-HA-WF-1804CD) study is a clinic-randomized trial coordinated by the Wake Forest NCI Community Oncology Research Program (NCORP) Research Base to support cardiovascular health assessment among cancer survivors. The AH-HA team developed and guided the implementation of the AH-HA tool, an EHR-based CDS visualization of the American Heart Association's Life's Simple 7 modifiable risk factors supplemented with cancer treatment information. Four NCORP clinics were randomized to the intervention arm and implemented the tool within their EHR leveraging Fast Healthcare Interoperable Resources (FHIR) standards and best practice advisories (BPAs). Information technology (IT) team authorization was required prior to randomization. We provided an implementation checklist to each clinic alongside virtual support from experts in implementing CDS for research and operational purposes. We describe our successful CDS tool implementation strategy and report the timeline for implementation at each clinic. Results: Although all clinics utilized the same EHR platform (Epic), clinics differed in terms of their time to approval, implementation, and tool activation, ranging in a total from 4 to 15 months. Although we provided step-by-step guidance for CDS deployment, each site required at least one technical assistance consultation. The estimated cost at each implementation site to deploy the tool, given a range of 40 to 80 hours at $150/hour, was $6,000 to $12,000 US dollars. Conclusions: Strengths of the implementation process included extensive documentation and clear communication of the steps for implementation. Clinics desired flexibility to adapt BPAs to their workflows. Site-level differences may pose challenges for interpretation of study implementation outcomes, including patient-level reach measures. Studies testing the impact of similar CDS tools should plan for clinic-level adaption and consider variability in timelines and assistance needed within the overall study timeline and budget. Clinical trial information: NCT03935282 .

POLYGENIC RISK SCORES AND THEIR PHENOTYPIC ADJUSTMENT: NOVEL BIOMARKERS IN CARDIOVASCULAR DISEASE PREVENTION

Objective: This study aimed to develop a novel genetic tool, the Polygenic Risk Score (PRS), to non-invasively and routinely estimate predisposition to cardiovascular diseases (CVDs), comprising coronary artery disease, dilated cardiomyopathy, hypertrophic cardiomyopathy, atrial fibrillation, ischemic stroke, and heart failure. The study also aimed to improve risk estimation by incorporating chronological age, physiological characteristics, and behavioral parameters to calculate an adjusted PRS. Design and method: Three algorithms were designed to i) search literature databases for GWAS on CVD predisposition, ii) derive Single Nucleotide Polymorphisms (SNPs) by assessing p-values, beta coefficients, odds ratios, and linkage disequilibrium metrics, and then iii) calculate the PRS for each CVD. Manual scientific evaluation was also employed. Thus, a novel genetic panel (termed iDNA Cardio Health) was developed to assess polygenic risk for the six above mentioned CVDs, following buccal swab sampling. Finally, we employed the American Heart Association's (AHA) Life's Simple 7 (LS7) lifestyle and phenotypic characteristics scoring system to assess current cardiovascular health status and then use this information, as well as chronological age, to dynamically calculate an adjusted PRS. Results: After testing the iDNA Cardio Health on a Greek population sample, we were capable to examine CVD risk stratification. Additionally, we could identify individuals with high polygenic risk, who could significantly benefit from lifestyle and/or clinical modifications. Furthermore, employing the LS7 categorization, we were capable to fine-tune risk prediction based on the adjusted PRS. Conclusions: It is evident that current clinical tools for CVD risk estimation may underestimate the risk, while the PRS can be employed to optimally reclassify individuals with marginal intermediate risk to a high-risk category. Our novel methodology, which at its core encompasses polygenic risk, can be combined with LS7 traditional clinical risk prediction metrics and chronological age to revolutionize CVD prevention though screening, monitoring, and clinical management, thus enabling the implementation of PRS and adjusted PRS in clinical care to empower personalized medicine.

Association between hysterectomy status and stroke risk and cause-specific and all-cause mortality: evidence from the 2005-2018 National Health and Nutrition Examination Survey.

Prior research on women who had hysterectomies has shown mixed results on whether or not hysterectomies increased the incidence of stroke and cause-specific or all-cause mortality. Using information from the Continuous National Health and Nutrition Examination Survey (NHANES) in the United States, including linked mortality follow-up files available for public access, a multicycle cross-sectional design mortality linkage study was performed. Conducted during the years 2005-2018, the study sample included 14,214 female participants ranging in age from 20 to 85 years. The relationship between the hysterectomy status and the risk of stroke and cause-specific and all-cause mortality was examined using a series of weighted logistic regressions and Cox proportional hazards regressions, respectively. The presence of a hysterectomy was consistently linked to an elevated risk of stroke using weighted logistic regression models. The hysterectomy status, however, consistently showed no effect on survival by adjusted weighted Cox regression analysis. Our study found a significant association between hysterectomy and stroke, even after adjusting for other factors that could impact risk, such as the American Heart Association (AHA)'s Life's Simple 7 cardiovascular health score and variables of age, ethnicity, marital status, income, education, and depression severity.

Life’s Simple 7 and the Risk of Dementia among Women (P2-5.030)

<h3>Objective:</h3> To determine if higher scores on the American Heart Association (AHA) Life’s Simple 7 in midlife are associated with a decreased risk of dementia among women. <h3>Background:</h3> A growing body of research underscores the need to examine midlife risk factors for dementia, as dementia pathology often begins decades before diagnosis. <h3>Design/Methods:</h3> The study population included women enrolled in the Women’s Health Study who had available risk factor information needed to calculate the AHA Life’s Simple 7 at baseline (1992–1994) and approximately ten years later (2004) and were fully covered by fee-for-service Medicare for all eligible person-months. Women received one point for each component of the AHA Life’s Simple 7 (smoking status, diet, physical activity, body mass index, diabetes, blood cholesterol, and blood pressure) for which they had ideal cardiovascular health. We used fee-for-service Medicare data (available from 2011 through 2018) and validated lists of ICD-9 and ICD-10 codes to identify dementia diagnoses. We used logistic regression to examine the association between the score, modeled as a continuous variable, and dementia diagnosis adjusted for age and socioeconomic status at baseline. <h3>Results:</h3> 13,720 women were eligible for these analyses and 1771 (12.9%) dementia cases were observed. The mean age (standard deviation (SD)) was 54.2 (6.6) years at baseline. The average AHA Life’s Simple 7 score at baseline was 4.3 (SD=1.3) and after ten years of follow-up was 4.2 (SD=1.3). Higher AHA Life’s Simple 7 score as measured at baseline (odds ratio per one unit change in score=0.94, 95% CI: 0.90–0.98) was associated with a decreased risk of dementia. This effect was similar for the AHA Life’s Simple 7 score as measured after ten years of follow-up (OR=0.95, 95% CI: 0.91–1.00). <h3>Conclusions:</h3> Better cardiovascular health in midlife was associated with a decreased risk of dementia in late life among women. <b>Disclosure:</b> Dr. Rist has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association. The institution of Dr. Rist has received research support from National Institutes of Health. The institution of Dr. Rist has received research support from Biogen, Inc. The institution of Dr. Rist has received research support from Brigham and Women’s Hospital. Melinda Power, PhD has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. I-Min Lee has nothing to disclose. Julie E. Buring has nothing to disclose.

Life's simple 7 and its association with trajectories in depressive symptoms among urban middle-aged adults

BackgroundThe American Heart Association Life's Simple 7 (LS7) is a composite metric assessing cardiovascular health on a scale of 0–14 comprised of nutrition, physical activity, cigarette use, body mass index, blood pressure, cholesterol and glucose. MethodsUsing data from the Healthy Aging in Neighborhoods of Diversity across the Life Span study [n = 1465, Age at visit 1 (v1: 2004–2009): 30–66 y, 41.7 % male, 60.6 % African American], we investigated associations of trajectories in depressive symptoms (2004–2017) with Life's simple 7 scores after ∼8.6 years follow-up (2013–2017). Analyses used group-based zero-inflated Poisson trajectory (GBTM) models and multiple linear or ordinal logistic regression. GBTM analyses generated two classes of depressive symptoms trajectories (“low declining” and “high declining”), based on intercept and slope direction and significance. ResultsOverall, “high declining depressive symptoms” vs. the “low declining” group was associated with −0.67 ± 0.10 lower scores on LS7 total score (P < 0.001) in analyses adjusted for age, sex, race and the inverse mills ratio. This effect was markedly attenuated to −0.45 ± 0.10 score-points (P < 0.001) upon adjustment for socio-economic factors and to −0.27 ± 0.10 score-points (P < 0.010) in fully adjusted analyses, with a stronger association detected among women (β ± SE: −0.45 ± 0.14, P = 0.002). An association between elevated depressive symptoms over time (“high declining” vs “low declining”) and LS7 total score was detected among African American adults (β ± SE: −0.281 ± 0.131, p = 0.031, full model). Moreover, the “high declining” vs. “low declining” depressive symptoms group was associated with a lower score on LS7 physical activity (β ± SE: −0.494 ± 0.130, P < 0.001). ConclusionsPoorer cardiovascular health was linked to higher depressive symptoms over time.

Differences in Adherence to American Heart Association's Life's Essential 8, Diet Quality, and Weight Loss Strategies Between Those With and Without Recent Clinically Significant Weight Loss in a Nationally Representative Sample of US Adults.

Background The American Heart Association defines ideal cardiovascular health based on 8 risk factors (Life's Essential 8 [LE8]); a high LE8 score (range 0-100) reflects greater adherence to their recommendations. Weight status influences cardiovascular health, yet individuals may use detrimental diet and weight loss strategies to improve weight status. We assessed differences in LE8 adherence, diet quality, and weight loss strategies between those with and without a recent history of clinically significant weight loss (CSWL). Methods and Results Data from 2007 to 2016 National Health and Nutrition Examination Survey questionnaires, clinical measures, and 24-hour dietary recalls were assessed to determine LE8 adherence, diet quality (Healthy Eating Index), and weight loss strategies between adults with: (1) intentional CSWL ≥5%; and (2) non-CSWL <5%, weight maintenance, or weight gain over the past 12 months using ANCOVA and chi-square tests. Those with CSWL demonstrated higher scores for diet quality (P=0.014), physical activity (P<0.001), and blood lipids (P<0.001). Those without CSWL reported lower BMI (P<0.001). There were no differences in total LE8 cardiovascular health scores between those with and without CSWL. More individuals with CSWL reported weight loss strategies of exercising (P=0.016); those without CSWL reported skipping meals (P=0.002) and using prescription diet pills (P<0.001). Conclusions Greater adherence to the LE8 recommendations was observed among individuals with CSWL, although overall LE8 scores were low. Future research should address the implementation of evidence-based strategies that improve diet quality while promoting optimal cardiovascular health among those with intent to lose weight.

Association of group-level segregation with cardiovascular health in older adults: an analysis of data from the Korean Social Life, Health, and Aging Project.

The adverse health effects of individual-level social isolation (e.g., perceived loneliness) have been well documented in older adults. However, little is known about the impact of collective-level social isolation on health outcomes. We sought to examine the association of group-level segregation with cardiovascular health (CVH) in older adults. From the prospective Korean Social Life, Health, and Aging Project database, we identified 528 community-dwelling older adults who were aged ≥60 years or were married to those aged ≥60 years. Participants who belonged to smaller social groups separate from the major social group were defined as group-level-segregated. The CVH score was calculated as the number of ideal non-dietary CVH metrics (0-6), as modified from the American Heart Association's Life's Simple 7. Using ordinal logistic regression models, we assessed cross-sectional and longitudinal associations between group-level segregation and CVH. Of the 528 participants (mean age, 71.7 years; 60.0% women), 108 (20.5%) were segregated at baseline. In the cross-sectional analysis, group-level segregation was significantly associated with lower odds of having a higher CVH score at baseline after adjusting for sociodemographic factors and cognitive function (odds ratio [OR]=0.64; 95% confidence interval [CI], 0.43-0.95). Among 274 participants who completed an 8-year follow-up, group-level segregation at baseline was marginally associated with lower odds of having a higher CVH score at 8 years (OR=0.49; 95% CI, 0.24-1.02). Group-level segregation was associated with worse CVH. These findings imply that the social network structure of a community may influence its members' health status.

A Longitudinal Study of Acculturation in Context and Cardiovascular Health and Their Effects on Cognition Among Older Latino Adults.

Background We previously outlined the importance of considering acculturation within the context of older Latino adults'lived experience (ie, acculturation in context) to better capture contributors to cognitive aging. We now examine this conceptual framework as related to level of and change in cardiovascular health, and whether cardiovascular health modifies previously documented associations of acculturation in context with cognition. Methods and Results Acculturation in context data from 192 Latino participants without dementia at baseline (age ~70 years) were compiled into 3 separate composite scores: acculturation-related (nativity, language-, and social-based preferences), contextually related socioenvironmental (experiences of discrimination, social isolation, social networks), and familism-related (Latino-centric family ethos). A modified American Heart Association's Life's Simple 7 (mLS7; ie, smoking, physical activity, body mass index, blood pressure, total cholesterol, blood glucose) was used to measure cardiovascular health. Mixed effects regressions simultaneously tested the association of all 3 composite scores with total mLS7 adjusting for confounders. Separate models tested whether mLS7 modified associations of the 3 composite scores and cognition. The contextually related socioenvironmental composite score reflecting higher discrimination, higher social isolation, and smaller social networks (estimate=0.22, SE=0.10, P=0.02) and the familism score (estimate=0.16, SE=0.07, P=0.02) both significantly associated with change in total mLS7. The acculturation-related composite was not significantly associated with change in mLS7. No composite was significantly associated with level of mLS7. Total mLS7, however, significantly modified associations between the acculturation-related composite and change in working memory (estimate=-0.02, SE=0.01, P=0.043). Conclusions Acculturation within the context of older Latino adults' lived experience is important for maintaining cardiovascular health, relationships that also affect domain-specific cognitive decline.

Associations of Life's Simple 7 with cerebral white matter hyperintensities and microstructural integrity: UK Biobank cohort study.

The American Heart Association Life's Simple 7 (LS7) metric was used to define optimal cardiovascular and brain health, but the associations with macrostructural hyperintensities and microstructural white matter damage are unclear. The objective was to determine the association of LS7 ideal cardiovascular health factors with macrostructural and microstructural integrity. A total of 37,140 participants with available LS7 and imaging data from UK Biobank were included in this study. Linear associations were implemented to examine the associations of LS7 score and subscores with white matter hyperintensity load (WMH) (WMH volume normalized by total white matter volume and logit-transformed) and diffusion imaging indices (fractional anisotropy [FA], mean diffusivity, orientation dispersion index [OD], intracellular volume fraction, isotropic volume fraction [ISOVF]). In individuals (mean age 54.76 years; 19,697 females, 52.4%), higher LS7 score and subscores were strongly associated with lower WMH and microstructural white matter injury, including OD, ISOVF, FA. Both interaction analyses and stratified analyses of LS7 score and subscores with age and sex showed a strong association with microstructural damage markers, with remarkable age and sex differences. The association of OD was pronounced in females and populations younger than 50 years and FA, mean diffusivity and ISOVF were pronounced in males and populations older than 50 years. These findings suggest that healthier LS7 profiles are associated with better profiles of both macrostructural and microstructural markers of brain health, and indicate that ideal cardiovascular health is associated with improved brain health.

Abstract 33: Using the AHA's Life Essential 8 Criteria to Assess Sleep Duration and Its Association With Social Determinants of Health in U.S. Children

Introduction: In 2010, the American Heart Association (AHA) began using 7 indicators to measure cardiovascular health, known collectively as Life’s Simple 7. In June 2022, the AHA added an 8 th indicator: sleep duration. Although earlier studies have examined whether/how the indicators in Life’s Simple 7 might be impacted by social determinants of health (SDoH), few epidemiological studies have examined how SDoH influence the 8 th indicator in U.S. children. Purpose: We used the AHA Life Essential 8 scoring criteria to assess sleep duration among U.S. children and whether certain SDoH were associated with sleep duration. Methods: We utilized data from the 2019-2020 National Survey of Children’s Health. For all children, we calculated the score for sleep duration (range 0 [lowest] to 100 [highest]). Based on the AHA scoring algorithm and the distribution of sleep duration, participants were divided into three mutually exclusive subgroups: (1) those who met age-appropriate optimal sleep duration; (2) those who had 1-&lt;2 hour below or ≥ 1 hour above optimal sleep duration; and (3) those who had ≥ 2 hours below optimal sleep duration. Multinomial logistic regressions were used to assess the association of sleep duration with 4 SDoH factors (adverse childhood experiences [ACEs], received preventive care during past 12 months, food insufficiency, and living in unsafe neighborhoods). We controlled for child’s sex, age, race/ethnicity, and household poverty level. Results: Among children aged 6 to 17 years (n=49,821), the mean sleep duration score was 77.1 (95% CI 76.4 to 77.7) and 65.5% of the children had age-appropriate optimal sleep scores. Three SDoH factors were associated with higher likelihood of suboptimal sleep duration. Adjusting for covariates, for each point increase in number of ACEs the likelihood of having suboptimal sleep duration was increased (relative risk ratios [RR]:1.05 [95% CI 1.02 to 1.09]; 1.21 [95% CI 1.15 to 1.27]). The likelihood of having suboptimal sleep duration was also increased for those who reported food insufficiency at home (RR:1.19 [95% CI 1.06 to 1.33]; 1.67 [95% CI 1.40 to 1.98]) as well as for those who reported living in an unsafe neighborhood (RR: 1.34 [95% CI 1.04 to 1.71]; 1.63 [95% CI 1.19 to 2.23]). Conclusions: Our findings show that using the AHA’s Life Essential 8 scoring criteria, one third of U.S. children do not meet optimal sleep duration standards. These findings highlight the need for greater attention to social and systemic influences on children's sleep health. It is critical for healthcare providers to recognize that suboptimal sleep duration is a risk factor for poor cardiovascular health, and that certain SDoH are associated with suboptimal sleep duration.

Abstract P638: Sex Differences in Cardiovascular Health Among Young Adults in Puerto Rico

Background: Emerging evidence supports significant variations in cardiovascular health (CVH), as defined by the American Heart Association (AHA) using “Life’s Simple 7” metrics, among Hispanics in the mainland US by sex and heritage group. Of these, Hispanic men and those of Puerto Rican background are less likely to meet favorable CVH criteria. Yet data on young men and women residing in Puerto Rico, an understudied population with a unique sociocultural context, are scarce. We assessed sex differences in CVH among young adults living in Puerto Rico. Measures: We used PR-OUTLOOK baseline data, collected between September 2020 and September 2022, for this analysis. Participants were between the ages of 18-29 years. CVH was measured using the AHA Life’s Essential 8 (LE8) score, a revised composite metric of physical activity, smoking, diet, sleep, body mass index (BMI), blood pressure, blood glucose, and non-HDL cholesterol. The total score ranges from 0-100, with higher scores indicating better CVH. For this analysis, the measure was modified to exclude diet given the lack of dietary data. Multivariable linear regression models were used to assess sex differences in the overall CVH score and its components. Analyses were adjusted for age, sex, marital status, and childhood material deprivation. Results: The sample included 964 adults - 619 women and 345 men. In adjusted analysis, women had a higher overall CVH score compared to men (β=2.77, 95% CI: 1.10, 4.44). Women also had higher scores for nicotine exposure (β=9.24, 95% CI: 5.18, 13.29), non-HDL cholesterol (β=4.31, 95% CI: 1.11, 7.51), and blood pressure (β=13.22, 95% CI: 10.39, 16.05) but lower for physical activity (β=-9.55, 95% CI: -15.18, -3.91). There were no significant sex differences in scores for sleep health, BMI, and blood glucose. Conclusion: There are sex differences in CVH among young adults in Puerto Rico, with women having overall better CVH. Interventions to improve nicotine exposure, non-HDL cholesterol, and blood pressure in men and participation in physical activity in women are needed to enhance and preserve overall CVH.