Heart Association Life's Simple Research Articles

Life satisfaction and ideal cardiovascular health score: A cross-sectional study from ELSA-Brasil.

To investigate whether higher levels of life satisfaction are associated with a higher ideal cardiovascular health (CVH) score in middle-aged and older populations in the Brazilian context. Cross-sectional analysis of 12,936 participants of the Brazilian Longitudinal Study of Adult Health, Visit 2 (2012-2014), aged 38-79 years. The response variables were the global, lifestyle, and biological ideal CVH scores, as defined by the American Heart Association Life's Simple 7. The scores were categorized as low, intermediate, and optimal. Life satisfaction was measured by the Satisfaction with the Life Scale. Multinomial logistic regression was used to estimate the magnitude with adjustment for potential confounding factors. Low scores were the categories of reference for the analyses. Only 10.5% of the participants had an optimal (≥5) global ideal CVH score. After total adjustment, 1 SD increment in the life satisfaction score was associated with an odds ratio (OR) of 1.05 (95% confidence interval [CI: 1.01-1.09]) and 1.15 (95% CI [1.07-1.23]) for intermediate and optimal global ideal CVH scores, respectively. Regarding the lifestyle ideal CVH score, the increment of 1 SD in the life satisfaction scale determined an OR of 1.11 (95% CI [1.06-1.15]) and 1.22 (95% CI [1.14-1.31]) for intermediate and optimal lifestyle ideal CVH score, respectively. Life satisfaction was not associated with the biological ideal CVH score. The results suggested that the higher the life satisfaction, the higher the CVH. The findings add to the knowledge of assets to promote CVH. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The association between metabolic syndrome and insulin resistance with risk of cardiovascular events in different states of cardiovascular health status.

The aim was to examine the joint effect of metabolic syndrome (MetS) and insulin resistance (IR) with ideal cardiovascular health (iCVH) status on incident cardiovascular diseases (CVDs). The study included 6,240 Iranian adults ≥30 years, free of prior cardiovascular disease. Ideal cardiovascular health was determined based on American Heart Association's Life Simple 7. Metabolic syndrome was defined according to the Joint Interim Statement Criteria, and insulin resistance was defined as HOMA-IR ≥1.85 in women and ≥2.17 in men. Multivariable Cox proportional hazard ratios (HRs) were applied to examine the impact of metabolic syndrome, and insulin resistance at various levels of iCVH status. During the median follow-up of 14.0 years, 909 cases of cardiovascular disease occurred. Metabolic syndrome and insulin resistance were significantly associated with incident cardiovascular disease events. In the poor and intermediate status, metabolic syndrome increased cardiovascular disease events with HRs of 1.83 and 1.57, respectively; the corresponding values for insulin resistance in the mentioned categories were 1.91 and 1.25, respectively (P values < 0.05). In the intermediate and poor iCVH status, hypertriglyceridemia was linked to a 40% and 35% higher risk of cardiovascular disease, the corresponding values for low HDL-C was 20% and 60%, respectively (P values < 0.05). Although adding metabolic syndrome, its dyslipidemia and insulin resistance to iCVH status in both poor and intermediate status significantly improve the prediction of cardiovascular disease using net reclassification improvement (P values < 0.05), the value of C-index did not change. Metabolic syndrome and the dyslipidemia component had a negligible but significant improvement in the prediction of cardiovascular disease among individuals with non-optimal iCVH status.

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.

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.

The Association Between Cardiovascular Health with Internet and Mobile Technology Use Among Jackson Heart Study Participants.

Background: Although studies have examined if the internet and mobile technology (IMT) can support cardiovascular health (CVH) self-management and health information-seeking efforts, limited studies have targeted African American communities. This study analyzes a possible association between CVH and IMT use and if socioeconomic status is linked to this relationship among older, African Americans in the Jackson Heart Study (JHS). Methods: This analysis uses JHS data from three time points: Examination 1 (2000-2004), Examination 3 (2009-2013), and the Digital Connectedness Survey (2017-2019). Participants completed measures of CVH (the American Heart Association's Life Simple 7 [LS7]), IMT use, and demographic characteristics via telephone interview. Both multivariable logistic and linear regression analyses were conducted to analyze the relationship between the LS7 composite and component scores (representing CVH) and IMT use. Results: Fifty eight percent of participants were 60 or older; 64% were women. Overall, 2,255 (88%) of participants were IMT users. Generally, no association was found when analyzing LS7 composite scores and IMT use except for the association between LS7 composite scores and use of other smart devices (p = 0.01). However, having ideal blood pressure, body mass index, and cholesterol had positive associations with using technology to track health (p = 0.003, p = 0.004, p = 0.052, respectively), and having ideal physical activity was positively associated with using smart devices (p = 0.012). Conclusions: No association was found between LS7 composite scores and IMT use. However, there were associations between individual LS7 metrics, IMT use, and IMT use characteristics. More research should be done to continue assessing the feasibility of using IMT for CVH self-management among older African Americans.

Abstract 13203: Cardiovascular Health in Cardiac Rehabilitation: Applying the American Heart Association Life's Simple 7 in a Center-Based Cohort

Introduction: Cardiac rehabilitation (CR) is a comprehensive secondary cardiovascular disease (CVD) program which integrates structured lifestyle interventions to reduce morbidity and mortality. The Life’s Simple 7 (LS7) is an objective measure of cardiovascular health (CVH) which incorporates health-promoting behaviors and clinical factors however, it has not been rigorously evaluated in the CR setting. Methods: Retrospective cohort study of 937 patients who attended center-based CR at Mayo Clinic from Jan 2018 -Sept 2020. Patient characteristics and LS7 component metrics at baseline (pre-CR) and completion (post-CR) were collected: 3 clinical factors (blood pressure [BP], cholesterol, and hemoglobin A1c [HbA1c]), and 4 health behaviors (smoking, body mass index [BMI], physical activity [PA] and diet). LS7 score was computed as a composite of each LS7 component by assigning 2-points for ideal, 1-point for intermediate, or 0-points for poor CVH ranging from 0-14 points. LS7 score was further categorized as poor 0-6, intermediate 7-8 and ideal 9 -14. Results: Patients were 64±13 years old, 34% were female, and attended a mean of 11±12 CR sessions, Table 1. At baseline, the LS7 components with the highest proportion within the poor category were HbA1c (201/495, 41%) and BMI (465/936, 50%), Table 2. From pre to post-CR, there was a reduction in proportion of patients classified within the poor category for each LS7 component except HbA1c ( Figure 1 ), and the proportion of patients with LS7 scores in the ideal range increased from 6.4% to 19% (P&lt;0.001). There was a statistically significant improvement in LS7 score from 5.5±1.8 to 6.7± 2.4 (+Δ1.6±2.4, P&lt;.0001), Table 2 . Conclusions: Patients attending CR demonstrated an improvement in LS7 score and almost all LS7 components suggesting an overall positive impact of CR on CVH. Further research is needed to better understand the impact of the individual LS7 components on CV outcomes in diverse populations participating in CR.

Religiosity/Spirituality and Cardiovascular Health: The American Heart Association Life's Simple 7 in African Americans of the Jackson Heart Study.

BackgroundReligiosity/spirituality is a major coping mechanism for African Americans, but no prior studies have analyzed its association with the American Heart Association Life's Simple 7 (LS7) indicators in this group.Methods and ResultsThis cross‐sectional study using Jackson Heart Study (JHS) data examined relationships between religiosity (religious attendance, private prayer, religious coping) and spirituality (theistic, nontheistic, total) with LS7 individual components (eg, physical activity, diet, smoking, blood pressure) and composite score among African Americans. Multivariable logistic regression assessed the odds of achieving intermediate/ideal (versus poor) LS7 levels adjusted for sociodemographic, behavioral, and biomedical factors. Among the 2967 participants (mean [SD] age=54.0 [12.3] years; 65.7% women), higher religious attendance was associated with increased likelihood (reported as odds ratio [95% CI]) of achieving intermediate/ideal levels of physical activity (1.16 [1.06–1.26]), diet (1.10 [1.01–1.20]), smoking (1.50 [1.34–1.68]), blood pressure (1.12 [1.01–1.24]), and LS7 composite score (1.15 [1.06–1.26]). Private prayer was associated with increased odds of achieving intermediate/ideal levels for diet (1.12 [1.03–1.22]) and smoking (1.24 [1.12–1.39]). Religious coping was associated with increased odds of achieving intermediate/ideal levels of physical activity (1.18 [1.08–1.28]), diet (1.10 [1.01–1.20]), smoking (1.32 [1.18–1.48]), and LS7 composite score (1.14 [1.04–1.24]). Total spirituality was associated with increased odds of achieving intermediate/ideal levels of physical activity (1.11 [1.02–1.21]) and smoking (1.36 [1.21–1.53]).ConclusionsHigher levels of religiosity/spirituality were associated with intermediate/ideal cardiovascular health across multiple LS7 indicators. Reinforcement of religiosity/spirituality in lifestyle interventions may decrease overall cardiovascular disease risk among African Americans.

Polygenic Risk, Midlife Life's Simple 7, and Lifetime Risk of Stroke.

BackgroundRecent genetic discoveries in stroke have unleashed the potential of using genetic information for risk prediction and health interventions aimed at disease prevention. We sought to estimate the lifetime risk of stroke (LTRS) by levels of genetic risk and to investigate whether optimal cardiovascular health can offset the negative impact of high genetic risk on lifetime risk of stroke.Methods and ResultsStudy participants were 11 568 middle‐aged adults (56% women, 23% Black adults), who were free of stroke at baseline and were followed up for a median of 28 years. The remaining LTRS was estimated according to levels of genetic risk based on a validated stroke polygenic risk score, and to levels of cardiovascular health based on the American Heart Association Life's Simple 7 recommendations. At age 45, individuals with high, intermediate, and low polygenic risk score had a remaining LTRS of 23.2% (95% CI, 20.8%–25.5%), 13.8% (95% CI, 11.7%–15.8%), and 9.6% (95% CI, 7.3%–11.8%), respectively. Those with both a high genetic risk and an inadequate Life's Simple 7 experienced the highest LTRS: 24.8% (95% CI, 22.0%–27.6%). Across all polygenic risk score categories, those with an optimal Life's Simple 7 had a ≈30% to 43% lower LTRS than those with an inadequate Life's Simple 7. This corresponded to almost 6 additional years lived free of stroke.ConclusionsThe LTRS varies by levels of polygenic risk and cardiovascular health. Maintaining an optimal cardiovascular health can partially offset a high genetic risk, emphasizing the importance of modifiable risk factors and illustrating the potential of personalizing genetic risk information to motivate lifestyle changes for stroke prevention.

Relationship of American Heart Association's Life Simple 7, Ectopic Fat, and Insulin Resistance in 5 Racial/Ethnic Groups.

The inverse association between ideal cardiovascular health (CVH) as measured by the American Heart Association's Life Simple 7 (LS7) and cardiovascular disease (CVD) incidence is well documented. However, research exploring the association between CVH and specific risk factors for cardiometabolic disease is sparse in diverse cohorts. This study included 7717 participants from the Mediators of Atherosclerosis in South Asians Living in America and the Multi-Ethnic Study of Atherosclerosis cohorts. We assigned each LS7 component a 0, 1, and 2 and summed these scores to derive an overall CVH score. Visceral, subcutaneous, and intermuscular fat area, pericardial fat volume, and hepatic fat attenuation were measured using noncontrast computed tomography. Multivariable linear regression was used to examine associations between CVH categories and each log-transformed ectopic fat depot, as well as the homeostatic assessment for insulin resistance (HOMA-IR). In adjusted analysis, compared to those with ideal CVH, participants with poor CVH demonstrated 63.4% (95% CI, 54.3-73.0) higher visceral fat area, 84.0% (95% CI, 76.5-92.1) higher pericardial fat volume, 61.6% (95% CI, 50.7-73.2) higher subcutaneous fat area, and 40.6% (95% CI, 30.2-52.0) higher intermuscular fat area, and 15.1% (95% CI, 13.1-17.2) higher hepatic fat (all Ps < 0.001). Also, poor CVH was associated with 148.2% (95% CI, 131.1-166.7) higher HOMA-IR. We also found significant heterogeneity in the strengths of association by race/ethnicity for each ectopic fat depot. Poor and intermediate CVH, as defined by LS7 metrics, were associated with significantly higher measures of ectopic fat and insulin resistance among individuals from 5 racial/ethnic groups.

Community-based, cluster-randomized pilot trial of a cardiovascular mHealth intervention: Rationale, design, and baseline findings of the FAITH! Trial

Compared to whites, African-Americans have lower prevalence of ideal cardiovascular health (CVH) based on the American Heart Association Life's Simple 7 (LS7). These CVH inequities have worsened during the COVID-19 pandemic. Ideal LS7 health-promoting behaviors and biological risk factors (eg, diet, blood pressure) are associated with improved CVH outcomes. The FAITH! (Fostering African-American Improvement in Total Health) App, a community-informed, mobile health (mHealth) intervention, previously demonstrated significant improvements in LS7 components among African-Americans, suggesting that mHealth interventions may be effective in improving CVH. This paper presents the FAITH! Trial design, baseline findings, and pandemic-related lessons learned. Utilizing a community-based participatory research approach, this study assessed the feasibility/preliminary efficacy of a refined FAITH! App for promoting LS7 among African-Americans in faith communities using a cluster, randomized controlled trial. Participants received the FAITH! App (immediate intervention) or were assigned to a delayed intervention comparator group. Baseline data were collected via electronic surveys and health assessments. Primary outcomes are change in LS7 score from baseline to 6-months post-intervention and app engagement/usability. Of 85 enrolled individuals, 76 completed baseline surveys/health assessments, for a participation rate of 89% (N=34 randomized to the immediate intervention, N=42 to delayed intervention). At baseline, participants were predominantly female (54/76, 71%), employed (56/76, 78%) and of high cardiometabolic risk (72/76, 95% with hypertension and/or overweight/obesity) with mean LS7 scores in the poor range (6.8, SD=1.9). The FAITH! Trial recruitment was feasible, and its results may inform the use of mHealth tools to increase ideal CVH among African-Americans.

Abstract 9139: Two Decade Trends in Cardiovascular Health Among Adults With Cardiovascular Disease in the United States Using a Revised American Heart Association Life's Simple 7 Framework

Introduction: The American Heart Association Life’s Simple 7 (LS7) framework is used to promote cardiovascular health. Trends in cardiovascular health of US adults with a history of cardiovascular disease (CVD) are not well characterized. Hypothesis: To assess trends in LS7 factors in US adults with CVD. Methods: In 4,233 adults with a self-reported history of CVD (i.e., myocardial infarction, stroke, angina, and heart failure) from the National Health and Nutrition Examination Survey (NHANES) 1999-2018, we constructed a revised 14-point LS7 score. The revision included Healthy Eating Index-2015 for scoring diet, non-HDL-cholesterol for cholesterol, hemoglobin A1c and self-reported diabetes for blood glucose, blood pressure cutoffs that reflect current guidelines for adults with CVD, and removal of medication use in scoring cardiovascular health (Figure). We used multivariable linear regression to examine trends in cardiovascular health, accounting for weights and the complex survey design. Results: After adjusting for age, sex, and race/ethnicity, the mean revised LS7 score in US adults with CVD remained low from 5.72 in 1999-2002 to 5.80 in 2015-2018 (p-for-trend=0.084) (Figure). Improvements were noted in cholesterol control (7.0% achieving ideal in 1999-2002 to 28.9% in 2015-2018, p-for-trend &lt;0.001) and smoking cessation (32.8% ideal in 1999-2002 to 37.9% in 2015-2018, p-for-trend=0.037). There were declines in blood glucose and weight control (65.6% and 24.2% ideal in 1999-2002 to 52.6% and 14.7% in 2015-2018, p-for-trends &lt;0.001). Proportions achieving ideal remained low and unchanged for diet and physical activity (1.4% and 2.8% in 1999-2002 to 0.7% and 3.9% in 2015-2018, p-for-trend=0.61 and 0.41). Conclusions: Over the last two decades in US adults with CVD, among LS7 factors, cholesterol and smoking improved, while glucose and weight worsened, with an overall concerning trend of persistently suboptimal cardiovascular health.

The link between blood pressure and Alzheimer's disease

Brain function and blood pressure are deeply connected. Despite being only a fortieth of our bodyweight, the brain receives nearly a fifth of our cardiac output. Such a large percentage is unique to humans, possibly because of the increasing metabolic needs of the brain during evolution. 1 Seymour RS Bosiocic V Snelling EP Correction to 'Fossil skulls reveal that blood flow rate to the brain increased faster than brain volume during human evolution’. R Soc Open Sci. 2017; 4: 170846 Crossref PubMed Scopus (5) Google Scholar Finely tuned physiological systems also maintain cerebral blood flow across a vast range of blood pressures to ensure blood delivery. It should not be surprising, therefore, that circulatory disorders strongly affect brain function, particularly hypertension. Prevalence of hypertension increases with age, as do stroke and Alzheimer's disease, and a study done in the USA showed that it is common to see both vascular and Alzheimer's disease pathologies present in brains of older individuals (median age 80 years) in the community. 2 Schneider JA Arvanitakis Z Bang W Bennett DA Mixed brain pathologies account for most dementia cases in community-dwelling older persons. Neurology. 2007; 69: 2197-2204 Crossref PubMed Scopus (1180) Google Scholar Moreover, validated Alzheimer's disease risk profiles include blood pressure along with other vascular risk factors, such as body-mass index and serum cholesterol concentrations. Life's Simple 7, a measure of healthy vascular lifestyle, is inversely associated with incident mild cognitive impairment, dementia, and preserved brain structure. 3 Thacker EL Gillett SR Wadley VG et al. The American Heart Association Life's Simple 7 and incident cognitive impairment: The REasons for Geographic And Racial Differences in Stroke (REGARDS) study. J Am Heart Assoc. 2014; 3: e000635 Crossref PubMed Scopus (90) Google Scholar Finally, the Systolic Blood Pressure Intervention Trial (SPRINT) MIND study 4 Williamson JD Pajewski NM et al. SPRINT MIND Investigators for the SPRINT Research GroupEffect of intensive vs standard blood pressure control on probable dementia: a randomized clinical trial. JAMA. 2019; 321: 553-561 Crossref PubMed Scopus (493) Google Scholar conclusively showed that intensive treatment of hypertension was associated with a significant reduction in incident cognitive impairment. In that study, nearly 10 000 individuals were randomly assigned to standard (systolic blood pressure goal <140 mm Hg) or intensive (systolic blood pressure goal <120 mm Hg) blood pressure management. There was no substantial increase in side-effects with intensive treatment, even among older individuals (aged 75 years or older). Taken together, there is strong evidence that aggressive blood pressure management can mitigate dementia for at-risk older adults. Safety and efficacy of losartan for the reduction of brain atrophy in clinically diagnosed Alzheimer's disease (the RADAR trial): a double-blind, randomised, placebo-controlled, phase 2 trial12 months of treatment with losartan was well tolerated but was not effective in reducing the rate of brain atrophy in individuals with clinically diagnosed mild-to-moderate Alzheimer's disease. Further research is needed to assess the potential therapeutic benefit from earlier treatment in patients with milder cognitive impairment or from longer treatment periods. Full-Text PDF Open Access

Association Between Early Trauma and Ideal Cardiovascular Health Among Black Americans: Results From the Morehouse-Emory Cardiovascular (MECA) Center for Health Equity.

Early trauma (general, emotional, physical, and sexual abuse before age 18 years) has been associated with both cardiovascular disease risk and lifestyle-related risk factors for cardiovascular disease, including smoking, obesity, and physical inactivity. Despite higher prevalence, the association between early trauma and cardiovascular health (CVH) has been understudied in Black Americans, especially those from low-income backgrounds, who may be doubly vulnerable. Therefore, we investigated the association between early trauma and CVH, particularly among low-income Black Americans. We recruited 457 Black adults (age 53±10, 38% male) without known cardiovascular disease from the Atlanta, GA, metropolitan area using personalized, community-based recruitment methods. The Early Trauma Inventory was administered to assess overall early traumatic life experiences which include physical, sexual, emotional abuse, and general trauma. Our primary outcome was the American Heart Association Life's Simple 7, which is a set of 7 CVH metrics, including 4 lifestyle-related factors (smoking, body mass index, physical activity, and diet) and three physiologically measured health factors (blood pressure, total blood cholesterol, and blood glucose). We used linear regression models adjusting for age, sex, socioeconomic status, and depression to test the association between early trauma and CVH and tested the early trauma by household income (<$50 000) interaction. Higher levels of early trauma were associated with lower Life's Simple 7 scores (β, -0.05 [95% CI, -0.09 to -0.01], P=0.02, per 1 unit increase in the Early Trauma Inventory score) among lower, but not higher, income Black participants (P value for interaction=0.04). Subtypes of early trauma linked to Life's Simple 7 were general trauma, emotional abuse, and sexual abuse. Exploratory analyses demonstrated that early trauma was only associated with the body mass index and smoking components of Life's Simple 7. Early trauma, including general trauma, emotional abuse, and sexual abuse, may be associated with worse CVH among low-, but not higher-income Black adults.

The effect of the lone parent household on cardiovascular health (National Health and Nutrition Examination Survey, 2015–2016)

Study objectiveSingle parenthood is associated with adverse health outcomes. How cardiovascular risk differs by parenthood status has had limited study. We hypothesized that single parents would have worse cardiovascular risk profiles compared to those in partnered-parent households. DesignWe compared associations of parenthood status and the American Heart Association's Life Simple 7 (LS7), an established metric measuring modifiable components of cardiovascular health (smoking status, body mass index, physical activity, diet, cholesterol, glycohemoglobin, and blood pressure) in multivariable-adjusted models. ParticipantsWe selected adults (age ≥ 25) from the National Health and Nutrition Examination Survey (NHANES) 2015–16 cycle. We defined single parenthood as reporting a child <18 years residing in the home and marital status other than married or living with partner. Main outcome measuresLS7, continuous (range 0–14) and categorized as poor (0–4), intermediate (5–9), or ideal (10–14). ResultsIn total, 2180 NHANES participants identified as parents and 1782 (82%) had complete LS7 scores. Of these, 462 identified as single parents, of whom 356 (74.9%) were women. Single parents were more likely to smoke, have poor physical activity, and have high blood pressure (p < 0.01) than partnered parents. Single parents had 1.3-fold greater likelihood of poor cardiovascular health compared with partnered parents, adjusting for age, sex, race/ethnicity, health insurance, healthcare access, poverty index, educational attainment and number of children (95% confidence interval [CI] 1.01–1.71). ConclusionsWe identified an association between single parenthood and adverse cardiovascular health. Our results demonstrate the importance of considering household composition in risk assessment and cardiovascular disease prevention.

Barriers and Facilitators to Adhering to the American Heart Association's Life's Simple 7 for African American Women Living in Public Housing.

African American (AA) women living in public housing have some of the highest risk factors for cardiovascular disease (CVD). Limited information exists on this population's perceived barriers and facilitators to achieving optimal heart health and adhering to practices known to lower risk factors for CVD. Six 1.5-hour long focus groups among 32 AA women living in public housing (mean age = 49.9±10.3) were conducted, audiotaped, and transcribed. Participants' quotes were analyzed using the American Heart Association Life's Simple 7 as a guideline for optimal heart health. Focus groups revealed stress and finances as primary barriers, and family/friends/social support as primary facilitators. Participants also mentioned a lack of community involvement and limited government assistance focused on making healthy foods affordable. The information gained from this study can help future programs more adequately assist this underserved group in pursuing heart healthy behaviors and lowering their disproportionately high CVD risk.

Community-engaged and community-based participatory research to promote American Heart Association Life's Simple 7 among African American adults: A systematic review.

BackgroundCardiovascular disease (CVD) is the leading cause of death in the United States and African Americans (AA) have a disproportionately greater burden of CVD as compared to Whites. The American Heart Association (AHA) Life’s Simple 7 (LS7) framework outlines goals for attaining ideal cardiovascular health. Yet, there is a lack of evidence summarizing best practices to maximize LS7 attainment. The objective of the present study was to systematically review the extant peer-reviewed literature on community-engaged and community-based participatory research (CBPR) aimed at improving one or more LS7 metrics among AA.MethodsPubMed, CINAHL, and Embase databases were searched. We included articles that reported quantitative results for one or more of the following LS7 metrics: physical activity, diet, cholesterol, blood pressure, body mass index, smoking, and glycemia. We included analyses with a greater than 50% AA study population focused on adults (≥18 years of age).ResultsOf the 1008 unique studies identified, 54 met inclusion criteria; 27 of which were randomized controlled trials. 50% of studies assessed more than one LS7 metric but only two studies evaluated all seven of the LS7 metrics. No studies had a high proportion of AA males. 40 studies improved at least one LS7 metric at the study end-point. Formative research was used in many studies to guide intervention design. Studies were of varying quality, but overall rated “fair” using a modified approach to the National Institute of Health quality assessment tool.ConclusionThere is insufficient data to recommend a specific community-engaged or CBPR intervention to improve attainment of LS7 metrics among AA. Future studies using rigorous methodology with increased gender diversity and utilizing the AHA LS7 framework are required to establish a validated program to improve LS7 in AAs.

Cardiovascular Risk and Resilience Among Black Adults: Rationale and Design of the MECA Study.

BackgroundCardiovascular disease incidence, prevalence, morbidity, and mortality have declined in the past several decades; however, disparities persist among subsets of the population. Notably, blacks have not experienced the same improvements on the whole as whites. Furthermore, frequent reports of relatively poorer health statistics among the black population have led to a broad assumption that black race reliably predicts relatively poorer health outcomes. However, substantial intraethnic and intraracial heterogeneity exists; moreover, individuals with similar risk factors and environmental exposures are often known to experience vastly different cardiovascular health outcomes. Thus, some individuals have good outcomes even in the presence of cardiovascular risk factors, a concept known as resilience.Methods and ResultsThe MECA (Morehouse‐Emory Center for Health Equity) Study was designed to investigate the multilevel exposures that contribute to “resilience” in the face of risk for poor cardiovascular health among blacks in the greater Atlanta, GA, metropolitan area. We used census tract data to determine “at‐risk” and “resilient” neighborhoods with high or low prevalence of cardiovascular morbidity and mortality, based on cardiovascular death, hospitalization, and emergency department visits for blacks. More than 1400 individuals from these census tracts assented to demographic, health, and psychosocial questionnaires administered through telephone surveys. Afterwards, ≈500 individuals were recruited to enroll in a clinical study, where risk biomarkers, such as oxidative stress, and inflammatory markers, endothelial progenitor cells, metabolomic and microRNA profiles, and subclinical vascular dysfunction were measured. In addition, comprehensive behavioral questionnaires were collected and ideal cardiovascular health metrics were assessed using the American Heart Association's Life Simple 7 measure. Last, 150 individuals with low Life Simple 7 were recruited and randomized to a behavioral mobile health (eHealth) plus health coach or eHealth only intervention and followed up for improvement.ConclusionsThe MECA Study is investigating socioenvironmental and individual behavioral measures that promote resilience to cardiovascular disease in blacks by assessing biological, functional, and molecular mechanisms.REGISTRATION URL: https://www.clini​caltr​ials.gov. Unique identifier: NCT03308812.

Optimism and cardiovascular health among African Americans in the Jackson Heart Study

Little research has examined associations of positive psychosocial factors with the American Heart Association Life's Simple 7™ (LS7) among African Americans. This study examined the associations between positive optimistic orientation and LS7 among African Americans. Using exam 1 data (2000–2004) from the Jackson Heart Study, we examined cross-sectional associations of optimism (in tertiles) with LS7 components [smoking, physical activity, diet, body mass index, blood pressure, cholesterol, glucose] and a composite LS7 score (classified as poor, intermediate, ideal) among 4734 African Americans free of cardiovascular disease. Multivariable prevalence regression was used to estimate prevalence ratios (PR, 95% confidence interval-CI) of intermediate and ideal (vs. poor) individual LS7 components and composite LS7 score by optimism levels, adjusting for demographics, socioeconomic status, and depressive symptoms. For LS7 components with low prevalence, we estimated odds ratios. A greater percentage of participants with high vs. low optimism were younger, female, high SES, and not depressed. After full covariate adjustment, the prevalence ratio of ideal (vs. poor) composite LS7 score was 1.24 for participants who reported high (vs. low) optimism (95% CI 1.09–1.42) at exam 1. Higher levels of optimism were also associated with greater prevalence of ideal (vs. poor) physical activity and smoking. Promoting positive optimistic orientation may be an important step toward increasing the likelihood of achieving optimal cardiovascular health among African Americans.

Multiparity is associated with poorer cardiovascular health among women from the Multi-Ethnic Study of Atherosclerosis

Multiparity is associated with a greater risk of incident cardiovascular disease. However, the relationship of parity with cardiovascular health, as measured by the American Heart Association Life's Simple 7 metrics, is uncertain. We aimed to examine the association between parity and ideal cardiovascular health among 3430 women, aged 45-84 years, free of clinical cardiovascular disease enrolled in the Multi-Ethnic Study of Atherosclerosis. The Multi-Ethnic Study of Atherosclerosis is a prospective cohort study that recruited middle-aged to older women and men from 6 centers in the United States between 2000 and 2002. The study population comprised 38% White, 28% Black, 23% Hispanic, and 11% Chinese American subjects. Parity (total number of live births) was self-reported and categorized as 0, 1-2, 3-4 and ≥5. The Life's Simple 7 metrics, defined according to American Heart Association criteria, include health behaviors (smoking, physical activity, body mass index, diet) and health factors (blood pressure, total cholesterol, and blood glucose). We categorized each metric into ideal (2 points), intermediate (1 point), and poor (0 points). A total cardiovascular health score of 0-8 was considered inadequate; 9-10, average; and 11-14, optimal. We used multinomial logistic regression to examine the cross-sectional association between parity and the cardiovascular health score, adjusted for sociodemographics, field site, hormone therapy, and menopause. The mean (standard deviation) age was 62 (10) years. The mean (standard deviation) cardiovascular health score was lower with higher parity (8.9 [2.3], 8.7 [2.3], 8.5 [2.2], and 7.8 [2.0] for 0, 1-2, 3-4, and ≥5 live births, respectively). In comparison to inadequate cardiovascular health scores, the adjusted odds of average cardiovascular health scores were significantly lower for all parity categories relative to nulliparity (prevalence odds ratios [OR] for parity of 1-2, 0.64 [95% confidence interval 0.49-0.83]; 3-4, 0.65 [0.49-0.86]; ≥5, 0.64 [0.45-0.91]). Women with ≥5 live births had a lower prevalence of optimal cardiovascular health scores (OR 0.50 [0.30-0.83]). In the fully adjusted models, the association between parity and each Life's Simple 7 metric was only statistically significant for body mass index. Women with ≥5 live births had lower prevalence of ideal body mass index (OR 0.52 [0.35-0.80]). In addition, the test for interaction showed that the association between parity and cardiovascular health was not modified by race/ethnicity (P= .81 for average cardiovascular health scores and P= .20 for optimal cardiovascular health scores). Multiparity was associated with poorer cardiovascular health, especially for women with ≥5 live births. More research is required to explore the mechanisms by which parity may worsen cardiovascular health.

Chewing capacity and ideal cardiovascular health in adulthood: A cross-sectional analysis of a population-based cohort study

To study the association between chewing capacity-a prerequisite for eating- and the level of cardiovascular health (CVH). This is a cross-sectional analysis conducted on 5430 study participants from the Paris Prospective Study 3 that were subjected to an oral examination by trained dentists at study recruitment between 2008 and 2012. Chewing capacity was determined by the number of functional tooth units (FTUs), and ≥ 5FTUs defined adequate chewing capacity. Subjects were categorized into poor, intermediate, or ideal CVH for the 4 behavioural (smoking status, body mass index, physical activity, diet) and the 3 biological (total cholesterol, fasting glycemia, and blood pressure) factors according to the American Heart Association Life's Simple 7. Multinomial logistic regression was used to explore the association between the number of FTUs (exposure) and ideal or intermediate vs. poor CVH (main outcome). 10.31% of the study participants had an ideal CVH and 7% presented an impaired chewing capacity (<5 FTUs). Subjects with at least 5 FTUs (OR=2.37; 95% CI: 1.37-4.12) were more likely to have an ideal global CVH, after adjustment for age, sex, marital status, education, deprivation, depressive status, and dental plaque. This association existed for the behavioural but not the biological CVH, with the strongest association being observed with the diet metric. This is the first study suggesting that adults with a preserved chewing capacity have an increased likelihood to be at an ideal behavioural CVH.