Life's Simple Research Articles

Current trends on the application of artificial intelligence in medical sciences.

Artificial Intelligence (AI) is expanding with colossal applications in various sectors. In the healthcare sector, it is booming to make life simpler with utmost accuracy by predicting, diagnosing and up to care with the help of Machine Learning (ML) and Deep Learning (DL) applications. Modern computer algorithms have attained accuracy levels comparable to those of human specialists in medical sciences, although computers often do jobs more quickly than people do. It is also expected that there will not be a mandate for humans to be present for the jobs that machines can do, and it is gaining the highest peak because of good trained artificial models in the medical field. ML enhances the therapeutic process and improves health by encouraging more patient participation. ML may get more accurate patient data when used with the Internet of Medical Things (IoMT) and automate message notifications that prompt patients to respond at certain times. The motivation behind this article is to make a comprehensive review of the on-going implementation of ML in medical science, what challenges it is facing now, and how it can be simplified for future researchers to contribute better to medical sciences while applying it to the practitioners' jobs easier. In this review, we have extensively mined the data and brought up systematised applications of AI in healthcare, what challenges have been faced by the experts, and what ethical responsibilities are liable to them while taking the data. We also tabulated which algorithms will be helpful for what kind of data and disease conditions will be useful for future researchers and developers. This article will provide a better insight into AI and ML for the beginner to the advanced developer and researcher to understand the concepts from the basics.

Association between socioeconomic status and arteriosclerotic cardiovascular disease risk and cause-specific and all-cause mortality: Data from the 2005-2018 National Health and Nutrition Examination Survey.

Morbidity and mortality of arteriosclerotic cardiovascular disease (ASCVD) varied according to socioeconomic status (SES), and evidence on the association between SES and ASCVD risk, and cause-specific and all-cause mortality was nevertheless lacking in large-scale or population-based studies. A multicycle cross-sectional design and mortality linkage study was conducted using data from Continuous National Health and Nutrition Examination Survey (NHANES) in the United States, including public use linked mortality follow-up files through December 31, 2019. Poverty income ratio (PIR) served as a SES index. A series of weighted Logistic regressions and Cox proportional hazards regressions were used to investigate the association between the SES and the risk of ASCVD and mortality, respectively. The study sample was comprised of 30,040 participants aged 20-85 years old during the 2005-2018 period. Weighted Logistic regression models consistently indicated significant relationship between people experiencing poverty and increased risk of ASCVD, and linear trend tests were all statistically significant (all P for trend < 0.001). Additionally, weighted Cox regression analysis consistently demonstrated that the hazards of cause-specific and all-cause mortality increased, with the decrease of each additional income level, and trend analyses indicated similar results (all P for trend < 0.001). Our study confirmed that the SES was strongly linked to living with ASCVD, and cause-specific and all-cause mortality, 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, sex, marital status, education, and depression severity.

Ideal cardiovascular health, biomarkers, and coronary artery disease in persons with HIV.

To investigate relationships between Life's Simple 7 (LS7), an assessment of cardiovascular health (CVH), and coronary plaque among people with HIV (PWH). Cross-sectional. Coronary computed tomography angiography, immune/inflammatory biomarkers, and characterization of LS7 were collected among a subset of ART-treated PWH enrolled in REPRIEVE, a primary prevention trial. Analyses adjusted for cardiovascular disease risk (ASCVD score). Median age of the 735 participants was 51(±6) years, 16% female, and median (Q1-Q3) CVD risk was 4.5% (2.6-6.9). Forty percent had poor (≤2 ideal components), 51% had intermediate (three or four ideal components), and only 9% had ideal CVH (≥5). Coronary plaque was present in 357 (49%); 167 (23%) had one or more vulnerable plaque features, 293 (40%) had noncalcified plaque, and 242 (35%) had a coronary artery calcium score >0. All three phenotypes were increasingly more prevalent with poorer CVH and these relationships remained after adjusting for ASCVD risk. Poor CVH was associated with higher high-sensitivity C-reactive protein, oxidized low-density cholesterol, and interleukin-6. The relationship of LS7 to plaque remained after adjusting for these biomarkers. Among PWH, poor CVH as measured by LS7 was associated with coronary plaque presence, vulnerable features, and calcification. LS7 was also associated with selected biomarkers; adjustment for these and ASCVD score reduced but did not eliminate LS7's association with plaque, suggesting the possibility of additional protective mechanisms against atherogenesis and plaque remodeling. Clinical use of LS7 and further exploration of its relationships with coronary artery disease may enhance efforts to reduce cardiovascular morbidity and mortality in PWH. NCT02344290.

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.

Abstract 15307: Change in Cardiovascular Health, Cardiovascular Disease, and Mortality in Patients With Diabetes

Aim: To describe patterns of change in cardiovascular health (CVH) measured by the Life’s Simple 7 (LS7) over 6 years in participants with diabetes, and assess the association of these patterns of change with subsequent CVD and all-cause mortality. Methods: We conducted a long-term prospective cohort analysis (median follow-up 19 years) using the ARIC study, a community-based, biracial cohort with participants aged 45-64 years at baseline in 1987-1989. Seven markers of LS7 were collected at baseline and 6 years later: smoking, body mass index, physical activity, diet, total cholesterol, blood glucose, and blood pressure. At both time points, participants were classified as low, moderate, and favorable CVH, corresponding to presenting 0-2, 3-4, and 5-7 metrics at ideal levels. Results: The majority (62.2%) of participants with diabetes at baseline had a stable low CVH at both visits, whereas 12.1% had stable moderate and 0.4% stable favorable, 14.9% improved, and 10.5% worsened. Compared to those with stable low LS7, CVD and mortality risk was lower for those who showed improvement 6 years later, or started moderate and remained so, or even who deteriorated to low CVH. This was driven by favorable changes in blood pressure, cholesterol, physical activity and smoking. Compared to participants free of diabetes with a stable favorable CVH trajectory, participants with diabetes had a higher CVD and mortality risk regardless of their CVH trajectory. However, those with a favorable LS7 trajectory displayed the same excess risk as participants without diabetes with constantly low CVH. Conclusions: Among individuals with diabetes, maintaining or reaching ideal levels of LS7 metrics can help reduce the excess CVD incidence and mortality. A favorable CVH trajectory in people with diabetes carried approximately the same excess CVD and mortality risk than an unfavorable CVH trajectory in people free of diabetes.

Abstract 15533: The Association Between Life’s Simple 7 and Arterial Stiffness in Black and White Women

Background: Black women have a higher prevalence of nonideal cardiovascular health (CVH) related risk factors across most components of the American Heart Association’s Life’s Simple 7 (LS7) than White women. Due to a higher burden of CVH-related risk factors, research suggests that Black women have accelerated and higher arterial stiffness than White women. However, the association between LS7 CVH and arterial stiffness among Black and White women is unknown. Objective: To examine the association between LS7 and arterial stiffness and investigate whether race modifies this association. Methods: We examined 1,640 adult women (n=1165 White, n=475 Black) from the Morehouse-Emory Center for Health Equity and Predictive Health Institute cohorts. Carotid-femoral pulse wave velocity (cfPWV), a marker of arterial stiffness, was assessed by applanation tonometry (SphygmoCor®). LS7 summary score (range 2-13) of 2-4 indicate ‘poor’, 5-9 ‘intermediate’, and 10-13 ‘ideal’ CVH. Cross-sectional analysis between the LS7 CVH 3-level categorical variable, cfPWV, and effect modification by race were examined. Multivariable linear regression models were conducted to examine the association between LS7 CVH and cfPWV, adjusting for model 1:(race, age); model 2:(model 1+ education, income). Results: Mean age 51±10.2 years. Compared to ‘ideal’ CVH, ‘poor’ ( β =1.08 m/s; 95% CI, 0.44, 1.71) and ‘intermediate’ ( β = 0.32 m/s; 95% CI, 0.20, 0.45) CVH groups had higher mean cfPWV in the minimal and fully adjusted models. Interaction of LS7 CVH and race on cfPWV was significant (p=.03) with Black women having higher mean cfPWV for each CVH group compared to White women. In race-stratified models, Black women with ‘poor’ ( β =1.56 m/s; 95% CI, 0.79, 2.32) and ‘intermediate’ ( β =0.46 m/s; 95% CI, 0.23, 0.68) CVH had higher cfPWV after minimal and full adjustment. Conclusions: Better CVH was associated with lower arterial stiffness. Compared to White women, Black women had greater arterial stiffness that was most pronounced for ‘poor’ and ‘intermediate’ CVH. Given that arterial stiffness is a prognostic measure, further study of health behaviors and psychosocial factors that contribute to higher arterial stiffness in Black women is warranted.

Abstract 9442: Increasing Patient Activation Among Black American Men in a Community-Based Lifestyle Intervention Pilot: Black Impact

Introduction: Life’s simple 7 (LS7) is a seven-metric framework from which cardiovascular health can be measured. Black Americans have the lowest attainment of LS7 among all communities. This may be in part related to patient activation or “having the capability and the willingness to take on the role of managing one’s own health and health care”. Patients with lower patient activation scores on the Patient Activation Measure tool (PAM) are more likely to develop and suffer from chronic diseases like hypertension and stroke. Black Americans report lower patient activation as compared to Non-Hispanic Whites, and lower medication adherence. Here, we discuss changes in patient activation during a 24-week community-based, lifestyle intervention focused on improving cardiovascular health in Black American men. Methods: We recruited 74 Black men with less than 4 of 7 LS7 metrics in the “ideal” range to participate in Black Impact, a community-based lifestyle intervention adapted from the AHA’s Check, Change, Control Program and Diabetes Prevention Program. Participants met weekly in groups of 8-25 for 24 weeks, completing group-based physical activities and health education sessions. Biometric screenings and self-report surveys (including the PAM 10-item questionnaire) were administered at baseline, 12, and 24 weeks. Changes in PAM scores at 12 and 24 weeks were calculated using a linear mixed-effects model with random intercepts. Results: The mean baseline PAM score of participants, when adjusted for age, education, and income, was 64.68 (95% CI: 60.51, 68.85). At week 12, the PAM score increased by an average of 4.36 (95% CI: 1.09, 7.63; p = 0.01). At week 24, the increase from baseline was 8.22 (95% CI: 5.06, 11.38; p &lt; 0.001). Increases in PAM were non-significantly associated with increases in LS7 over the 24 weeks (p= 0.346) Conclusions: In Black Impact, PAM scores increased substantially at 12 and 24 weeks. The 8-point PAM increase at 24 weeks is equivalent to a 16% reduction in the likelihood of hospitalizations and a 16% increase in medication adherence. These findings suggest community-based lifestyle interventions focused on increasing cardiovascular health may be a key strategy in advancing equity in patient activation.

Abstract 10549: American Heart Association's Life's Simple 7 and Major Bleeding in Atrial Fibrillation: A Multicenter Cohort Study

Background: Stroke prevention with oral anticoagulation (OAC) is a mainstay therapy in atrial fibrillation (AF) but is associated with increased bleeding. Identifying health determinants that contribute to this risk is essential to minimizing these adverse events and evaluating the risk benefit of OAC in an individual patient. This study examines the association between the seven cardiovascular risk factors (blood pressure, cholesterol, smoking status, physical activity, glucose, BMI, and diet) from the American Heart Association’s (AHA) Life’s Simple 7 (LS7) and major bleeding in older individuals with AF on OAC. Methods: In this multicenter prospective cohort study, we enrolled 1064 patients who were 65 years old and above, had non-valvular AF, and on OAC and followed them for 2 years. Based on AHA’s LS7 criteria, each risk factor was graded on a 3-point scale: 0 points (poor), 1 point (intermediate), and 2 points (ideal). Patients were separated into poor (0-6 pts), intermediate (7-9 pts), or ideal (10-14 pts) cohorts based on their aggregate score. Cox models were used to assess the relationship between the aggregate cohort scores and major bleeding as well as each individual cardiovascular risk factor score and major bleeding. Results: Our 1064 patients were separated into poor (n=242), intermediate (n=581) and ideal (n=241) cardiovascular health cohorts. There was a total of 95 major bleeding events, 8.93% of patients who had a major bleed, and a crude rate of 4.68 major bleeding events per 100 person-years. Compared to the ideal group, patients in the poor (HR, 2.29; 95% CI, 1.13 to 4.65) and intermediate groups (HR, 2.17; 95% CI, 1.14 to 4.14) were more likely to have a major bleeding event. Additionally, patients with poor smoking status (HR, 2.78; 95% CI, 1.29 to 5.98) or physical activity (HR, 1.66; 95% CI, 1.07 to 2.59) were significantly more likely to have a major bleeding event than those in the intermediate and ideal categories. Conclusions: In older adults with AF on OAC, poor cardiovascular health, smoking, and poor physical activity are all associated with a higher risk of major bleeding. Further investigation is needed to determine if smoking cessation and physical activity can lead to clinically meaningful reduction in bleeding events.

Abstract 10677: A Systems Biology Approach Demonstrating the Association Between Mir 122-5p and Glutamine Metabolism With Cardiovascular Health in Black Adults: Results From the Morehouse-Emory Cardiovascular (meca) Center for Health Equity

Intro: Integrative analysis of extracellular microRNA (miRNA) and metabolomics is a novel approach to identifying molecular pathways underlying cardiovascular health (CVH). Levels of miRNAs are linked to cardiovascular disease (CVD), while cardiometabolic risk factors are known to alter activity of select metabolic pathways. We identified miRNAs and metabolites underlying CVH in a cohort of Black adults through an integrative analysis of extracellular miRNA levels, metabolite concentrations and clinical factors associated with CVH. Methods: The MECA cohort consisted of 371 Black adults (age 53+10, 38.5% male) without known CVD. CVH was determined by Life’s Simple 7 (LS7) score, calculated from blood pressure, fasting glucose, cholesterol, BMI, exercise, diet, and smoking. Metabolite concentrations in plasma was assessed by high-resolution metabolomics profiling, and expression of miRs-122-5p, -150-5p, and -30c-5p was assessed by RT-qPCR. Metabolome wide association study (MWAS) identified metabolites associated with LS7. Association of miRNA levels with CVH clinical domains was assessed using Spearman correlation. Integrative analysis of select miRNAs, metabolites, and CVH clinical domains was performed using the program xMWAS. Results: Expression of 30 metabolites was associated with improved CVH (FDR&lt;0.2) where glutamine was higher (p=0.005), and glutamate was lower (p&lt;0.001). Integrative analysis showed association between miR-122-5p, glutamine and fasting glucose. miR-122-5p expression independently correlated with fasting glucose (p=0.03) and glutamine/glutamate is known to be associated with glucose metabolism. In silico and in vitro analyses revealed glutamine synthetase as a potential target of miR-122-5p (Fig). Conclusions: We demonstrate novel associations between glutamine, miR-122-5p and fasting glucose in CVH, suggesting that select metabolites and miRNAs are markers of CVH and maybe potential therapeutic targets.

Abstract 12058: The Impact of Cardiovascular Health Intervention on Plasma Metabolomic Profiles

Introduction: Previously, we used plasma metabolomics profiling to identify metabolites underlying cardiovascular health (CVH) in participants of the Morehouse-Emory Cardiovascular (MECA) Center for Health Equity Study. Herein, we explored whether a health intervention could alter plasma concentrations of metabolites associated with CVH in MECA participants with poor CVH. Methods: 71 Black adults without known cardiovascular disease and with poor CVH, defined as AHA Life’s Simple 7 (LS7) score &lt;8, were given a technology-enabled behavioral intervention platform (Health360x) for 6 months with or without access to a health coach. Metabolites were assessed pre- and post-intervention by untargeted high-resolution metabolomics profiling. Metabolome wide association study (MWAS) was conducted to identify differentially expressed metabolites and Mummichog was used to identify metabolic pathways that were differentially enriched after the intervention. Annotations were performed by matching to an in-house library of confirmed metabolites. Paired t-test and Wilcoxon signed-rank test were used to compare clinical metrics. Results: Mean age was 55 + 9.0 years, 69% female. Total LS7 scores improved from 6.2 ( + 1.49) to 6.5 ( + 1.74) with the intervention. While total and subcomponent LS7 scores and clinical metrics (BMI, blood pressure, glucose and cholesterol levels) trended toward improvement, the changes were not statistically significant. MWAS identified 18 metabolites that were significantly changed after intervention, including glutamine and glutamate. Pathway analysis demonstrated 30 metabolic pathways that were significantly changed with intervention, including glutamate, aspartate, asparagine, arginine and proline metabolism. Conclusions: Six-months of lifestyle intervention altered activity of 30 metabolic pathways without significant alterations in the clinical metrics. These metabolites and pathways appear to be indicators of a healthier lifestyle in the Black population, potentially supporting their use as markers of CVH and possible therapeutic targets.

Abstract 9596: An Investigation of Differences in Ideal Cardiovascular Health Between Sexual Minority and Heterosexual Adults: Findings From the National Health and Nutrition Examination Survey (2007-2016)

Introduction: There is growing evidence that sexual minority (e.g., lesbian, gay, bisexual) adults are at higher risk of cardiovascular disease (CVD) than heterosexual adults. Research on the cardiovascular health (CVH) of sexual minority adults has primarily examined differences in the prevalence of individual CVH metrics rather than comprehensive measures. Therefore, we investigated sexual identity differences in ideal CVH among adults (ages 18-59) in the United States using the American Heart Association’s (AHA) Life’s Simple 7; a composite measure of ideal CVH. Methods: We analyzed cross-sectional data from the National Health and Nutrition Examination Survey (2007-2016). Questionnaire, dietary, and physical examination data were used to assess the seven metrics included in the Life's Simple 7 measure. Participants received a score of 0 (poor), 1 (intermediate), or 2 (ideal) for each CVH metric and scores were summed to calculate ideal CVH scores (continuous; range 0-14). We ran sex-stratified regression models adjusted for demographic characteristics and survey year to examine sexual identity differences in ideal CVH scores and ideal CVH (i.e., odds of meeting ideal criteria for ≥5 CVH metrics). Results: The sample included 12,832 participants with a mean age of 39.2 (±11.95) of which 5.7% were sexual minority. Compared to heterosexual women, bisexual women had lower ideal CVH scores ( B = -0.65, 95% CI = -1.02, -0.27) and they were also less likely to meet criteria for ideal CVH (AOR = 0.66, 95% CI = 0.47-0.93). Gay men had higher ideal CVH scores than heterosexual men ( B = 0.61 95% CI = 0.01, 1.21). Gay (AOR = 2.05, 95% CI = 1.16-3.62) and bisexual (AOR = 2.15, 95% CI = 1.16-3.99) men were more likely than heterosexual men to meet criteria for ideal CVH. Conclusions: This is the first representative study to investigate sexual identity differences in ideal CVH. Bisexual women were at higher risk of CVD than heterosexual women, which was attributed to higher odds of current tobacco use and obesity. Gay and bisexual men were at lower risk of CVD than heterosexual men. Future longitudinal research is needed to examine factors that might contribute to CVH disparities among bisexual women. Clinical interventions to reduce CVD risk among bisexual women are needed.

Social support, psychosocial risks, and cardiovascular health: Using harmonized data from the Jackson Heart Study, Mediators of Atherosclerosis in South Asians Living in America Study, and Multi-Ethnic Study of Atherosclerosis

PurposeSocial support may have benefits on cardiovascular health (CVH). CVH is evaluated using seven important metrics (Life's Simple 7; LS7) established by the American Heart Association (e.g., smoking, diet). However, evidence from longitudinal studies is limited and inconsistent. The objective of this study is to examine the longitudinal relationship between social support and CVH, and assess whether psychosocial risks (e.g., anger and stress) modify the relationship in a racially/ethnically diverse population. MethodsParticipants from three harmonized cohort studies – Jackson Heart Study, Mediators of Atherosclerosis in South Asians Living in America, and Multi-Ethnic Study of Atherosclerosis – were included. Repeated-measures modified Poisson regression models were used to examine the overall relationship between social support (in tertiles) and CVH (LS7 metric), and to assess for effect modification by psychosocial risk. ResultsAmong 7724 participants, those with high (versus low) social support had an adjusted prevalence ratio (aPR) and 95% confidence interval (CI) for ideal or intermediate (versus poor) CVH of 0.99 (0.96–1.03). For medium (versus low) social support, the aPR (95% CI) was 1.01 (0.98–1.05). There was evidence for modification by employment and anger. Those with medium (versus low) social support had an aPR (95% CI) of 1.04 (0.99–1.10) among unemployed or low anger participants. Corresponding results for employed or high anger participants were 0.99 (0.94–1.03) and 0.97 (0.91–1.03), respectively. ConclusionOverall, we observed no strong evidence for an association between social support and CVH. However, some psychosocial risks may be modifiers. Prospective studies are needed to assess the social support-CVH relationship by psychosocial risks in racially/ethnically diverse populations.

OR20-5 The Association between Life's Simple 7 Score and Three Biomarkers of Cardiovascular Disease: Aldosterone, CRP, and IL-6

Abstract Background To promote ideal cardiovascular health, the American Heart Association recommends adhering to Life's Simple 7 (LS7)—achieving healthy targets for BMI, physical activity, dietary intake, blood pressure, fasting plasma glucose, and cholesterol, along with smoking abstinence. Retrospective data analyses have shown associations between poorer achievement of LS7 (lower score) and the development of hypertension and cardiovascular disease (CVD). However, less is known about the associations between LS7 and specific biomarkers linked to cardiovascular health. Hypothesis We hypothesized that achievement of LS7 (higher score) would be associated with lower levels of aldosterone and inflammatory markers implicated in CVD in individuals with controlled dietary sodium intake. Methodology The analysis included 379 normotensive and hypertensive individuals (age 18-66 years) from the HyperPATH (International Hypertensive Pathotype) consortium, who were maintained on at least 200 mEq of NaCl daily for one week and had a urinary salt balance of &amp;gt;150 mEq/24 hours at the time of sample collection. We calculated a 14-point summative LS7 score according to participants’ baseline data. Based on the range of LS7 score in this population, we classified participants as 'inadequate' (3-6), 'average' (7-10), and 'optimal' (11-14). We then performed regression analyses (adjusted for age, sex, race, and serum creatinine) between the LS7 score groups (inadequate, average, or optimal) and biochemical measures, including levels of aldosterone, C-reactive protein (CRP), and interleukin 6 (IL-6). Results When comparing across all three LS7 score groups, a higher LS7 score group was associated with lower aldosterone levels both in the serum (p=0.005, -0.97 [-1.63, -0.30]) and urine (p=0.003, -2.34 [-4.07, -0.825]). Additionally, a higher LS7 score group was associated with lower renin (p=0.008, -0.13 [-0.22, -0.03]) and a blunted increase in aldosterone with angiotensin-II infusion (p=0.019, -1.66 [-3.04, -0.27]). Serum potassium and serum cortisol were not associated with the LS7 scores. Being in the 'optimal' LS7 score group was associated with lower serum levels of CRP (p=0.001, -0.1 [-0.15, -0.04]) and IL-6 (p=0.026, -0.84 [-1.59, -0.10]). Notably, among the individual LS7 components, achieving target blood pressure and exercise goals most significantly impacted the associations between LS7 score and aldosterone levels. Conclusions Achieving an optimal American Heart Association's LS7 score was associated with a lower activity of the renin-angiotensin-aldosterone system and lower levels of the inflammatory markers CRP and IL-6, which may help to explain previous reports of better cardiovascular outcomes in individuals with a higher LS7 score. These findings offer a possible link between ideal cardiovascular health targets and biomarkers known to play a central role in the development of CVD. Presentation: Monday, June 13, 2022 12:00 p.m. - 12:15 p.m.

Early Midlife Cardiovascular Health Influences Future HDL Metrics in Women: The SWAN HDL Study.

Background Utility of high-density lipoprotein cholesterol (HDL-C) in assessing the antiatherogenic properties of HDL may be limited in midlife women. Novel metrics of HDL function, lipid contents, and subclasses may better reflect the atheroprotective capacities of HDL, supporting the need to evaluate how cardiovascular health affects these metrics in women. We assessed the relationship of early midlife Life's Simple 7 (LS7) score and its health behavior components with future HDL function (HDL-cholesterol efflux capacity), HDL-phospholipid, HDL-triglyceride, HDL particles (HDL-P) and size, and the relationship between LS7 score and changes in HDL metrics over time. Methods and Results We analyzed 529 women (baseline age: 46.4 [2.6] years, 57% White) from the SWAN HDL (Study of Women's Health Across the Nation HDL) study who had baseline LS7 followed by future repeated HDL metrics. Multivariable linear mixed models were used. Higher LS7 score was associated with favorable future HDL profile (higher HDL-phospholipid, total HDL-P and large HDL-P, lower HDL-triglyceride, and larger overall HDL size). Ideal body mass index was associated with higher HDL-cholesterol efflux capacity, HDL-phospholipid, and large HDL-P, lower HDL-triglyceride and small HDL-P, and larger overall HDL size. Ideal physical activity was associated with higher HDL-phospholipid, and total, large, and medium HDL-P. Ideal smoking was associated with less HDL-triglycerides. Diet was not related to HDL metrics. Higher LS7 score and ideal body mass index were associated with slower progression of HDL size over time. Conclusions Novel HDL metrics may better reflect the clinical utility of HDL. Improving lifestyle at midlife, particularly maintaining ideal body mass index, is associated with better future HDL phenotype.

Does ageing make life simpler? The dynamics, covariates, and implications of complexity of time-use patterns in late adulthood

Ageing affects individuals’ daily behaviours. Functional and social limitations increase, while the pool of possible activities and individuals’ ability to switch between tasks decline. If older adults lose ability to perform certain activities and do not substitute them with others, the complexity of their daily time-use sequences will decline. Studies show that having less complex behaviours and being in less complex environments are associated with poorer cognitive performance, worse intellectual functioning, and lower wellbeing. This study looks at complexity of everyday time-use patterns of older adults, aged 65 and above. A pooled sample of 25,495 time-use diaries came from four nationally representative time-use surveys: German (2012/2013), Polish (2013/2014), Finnish (2009/2010), and British (2014/2015). Using multivariable linear regression we investigated how complexity was related to individuals’ age, gender, education and income, area of residence, household composition, and disability status. Complexity generally declined in later life but its mean levels and the steepness of this decline differed across countries. Controlling for age, complexity was significantly lower for men and lower-educated individuals, as well as for individuals with disabilities and those living in larger households. Most older adults want to live rich and engaged lives. Individuals having significantly less complex sequences may be at an increased risk of functional, cognitive or social decline, and lower overall wellbeing. Looking at sequence complexity may offer unique insight into older adults’ overall functioning in later life.

Redefining Cardiovascular Health to Include Sleep: Prospective Associations With Cardiovascular Disease in the MESA Sleep Study.

Background Although sufficient and healthy sleep is inversely associated with cardiovascular disease (CVD) and its risk factors, the American Heart Association's Life's Simple 7 (LS7), as a measure of cardiovascular health (CVH), did not include sleep. We evaluated an expanded measure of CVH that includes sleep as an eighth metric in relation to CVD risk. Methods and Results The analytic sample consisted of MESA (Multi-Ethnic Study of Atherosclerosis) Sleep Study participants who had complete data on sleep characteristics from overnight polysomnography, 7-day wrist actigraphy, validated questionnaires, and the outcome. We computed the LS7 score and 4 iterations of a new CVH score: score 1 included sleep duration, score 2 included sleep characteristics linked to CVD in the literature (sleep duration, insomnia, daytime sleepiness, and obstructive sleep apnea), scores 3 and 4 included sleep characteristics associated with CVD in MESA (score 3: sleep duration and efficiency, daytime sleepiness, and obstructive sleep apnea; score 4: score 3+sleep regularity). Multivariable-adjusted logistic and Cox proportional hazards models evaluated associations of the LS7 and CVH scores 1 to 4 with CVD prevalence and incidence. Among 1920 participants (mean age: 69±9 years; 54% female), there were 95 prevalent CVD events and 93 incident cases (mean follow-up, 4.4 years). Those in the highest versus lowest tertile of the LS7 score and CVH scores 1 to 4 had up to 80% lower odds of prevalent CVD. The LS7 score was not significantly associated with CVD incidence (hazard ratio, 0.62 [95% CI, 0.37-1.04]). Those in the highest versus lowest tertile of CVH score 1, which included sleep duration, and CVH score 4, which included multidimensional sleep health, had 43% and 47% lower incident CVD risk (hazard ratio, 0.57 [95% CI, 0.33-0.97]; and hazard ratio, 0.53 [95% CI, 0.32-0.89]), respectively. Conclusions CVH scores that include sleep health predicted CVD risk in older US adults. The incorporation of sleep as a CVH metric, akin to other health behaviors, may enhance CVD primordial and primary prevention efforts. Findings warrant confirmation in larger cohorts over longer follow-up.

Examining relationships between perceived neighborhood social cohesion and ideal cardiovascular health and whether psychosocial stressors modify observed relationships among JHS, MESA, and MASALA participants

BackgroundPsychosocial stressors increase the risks for cardiovascular disease across diverse populations. However, neighborhood level resilience resources may protect against poor cardiovascular health (CVH). This study used data from three CVH cohorts to examine longitudinally the associations of a resilience resource, perceived neighborhood social cohesion (hereafter referred to as neighborhood social cohesion), with the American Heart Association’s Life’s Simple 7 (LS7), and whether psychosocial stressors modify observed relationships.MethodsWe examined neighborhood social cohesion (measured in tertiles) and LS7 in the Jackson Heart Study, Multi-Ethnic Study of Atherosclerosis, and Mediators of Atherosclerosis in South Asians Living in America study. We used repeated-measures, modified Poisson regression models to estimate the relationship between neighborhood social cohesion and LS7 (primary analysis, n = 6,086) and four biological metrics (body mass index, blood pressure, cholesterol, blood glucose; secondary analysis, n = 7,291). We assessed effect measure modification by each psychosocial stressor (e.g., low educational attainment, discrimination).ResultsIn primary analyses, adjusted prevalence ratios (aPR) and 95% confidence intervals (CIs) for ideal/intermediate versus poor CVH among high or medium (versus low) neighborhood social cohesion were 1.01 (0.97–1.05) and 1.02 (0.98–1.06), respectively. The psychosocial stressors, low education and discrimination, functioned as effect modifiers. Secondary analyses showed similar findings. Also, in the secondary analyses, there was evidence for effect modification by income.ConclusionWe did not find much support for an association between neighborhood social cohesion and LS7, but did find evidence of effect modification. Some of the effect modification results operated in unexpected directions. Future studies should examine neighborhood social cohesion more comprehensively and assess for effect modification by psychosocial stressors.

Art in the Electronic Age: Process of assimilation

The modern world could not exist without cell phones. This fundamental technology is commonly utilised on a daily basis. Using technology makes life simpler. It is currently impossible to conceive a world without technology. The electrical technology of a nation advances in tandem with its economy. E-waste is detrimental to both individuals and the environment. The assimilation of the modern way of life as a result of socio-cultural change affects the receipt of elements such as internal and external terms of assimilation, acculturation, and diffusion that are attained and conditioned by a complex source of globalisation.

Adherence to Life's simple 7 is associated with better carotid properties

Background and aimsCardiovascular health scores have emerged as a simple way to assess the risk to suffer from a cardiovascular disease. The American Heart Association's Life's Simple 7 constitutes of modifiable lifestyle factors to reduce cardiovascular risk. Its association with carotid properties is yet inconclusive. The aim of this study is to determine the association between the adherence to Life's Simple 7 and carotid properties in middle-aged to elderly Finns. MethodsA representative sample of Finnish men and women aged 55–74 years was included in the present study. Carotid intima-media thickness (cIMT), lumen diameter (cLD), and carotid distensibility were measured by transcutaneous ultrasound using state-of-the-art wall contour detection techniques. The Life's Simple 7 cardiovascular health score was calculated using seven categories (body mass index, cholesterol, systolic blood pressure, fasting plasma glucose, smoking status, physical activity, and diet). In accordance to the American Heart Association, for each category, an ideal score was given 2 points, intermediate scores 1 point, and poor scores 0 points. ResultsIn total, 1400 (49.4% male) subjects were included in the analyses. After adjusting for age and sex, we found that subjects with a an ideal cardiovascular health score had lower cLD than those with an intermediate score (−0.21 mm, 95% CI: 0.37 to −0.05 mm, p=0.005) and a poor score (−0.39 mm, 95% CI: 0.65 to −0.12 mm, p=0.001). Similarly, subjects with an ideal health score had higher carotid distensibility than those with an intermediate score (0.0032 1/kPa, 95% CI: 0.009–0.0055 1/kPa, p=0.002) and a poor score (0.0018 1/kPa, 95% CI: 0.0005–0.0032 1/kPa, p=0.004). We found no differences regarding cIMT. ConclusionsIn middle-aged to elderly Finns, higher adherence to the Life's Simple 7 is associated with lower cLD and higher distensibility, but not with cIMT. Adherence to healthy lifestyle habits is therefore associated with better carotid structure and carotid function in middle-aged to elderly Finns.

The Role of Social Support in Cardiovascular Clinical Trial Participation among Black Men: Black Impact.

Background: Attainment of the American Heart Association’s Life’s Simple 7 (LS7) metrics reduces cardiovascular disease (CVD) risk; yet, Black Americans have the lowest LS7 attainment among all communities, the highest rate of CVD mortality, and low clinical trial participation. Social support is positively correlated with chronic disease self-management. Here, we describe the role of social support in a single-arm pilot clinical trial of a community-based lifestyle intervention among Black American men. Methods: The 24-week intervention featured weekly team-based physical activity and LS7-themed education. Seventy-four Black men participated in the intervention; twenty agreed to participate in exit surveys via one of three semi-structured focus groups. Data were transcribed verbatim and analyzed using content analysis framed by House’s social support framework. Results: Participants reported support from both peers and health coaches. The sub-themes of social support among peers were: (1) acknowledgement, understanding, and validation, (2) inspiration, (3) sense of community, (4) fear of disappointing fellow participants, and (5) group synergy. The sub-themes of social support from the health coaches and study team staff included: (1) contemplation of current health status, (2) racial concordance of health coaches and study team staff, (3) investment of the research team, (4) incentives, (5) access to healthcare providers, and (6) the COVID-19 pandemic. Emotional support was the most frequently discussed theme. Conclusions: Social support, especially emotional support, from peers and health coaches was a driver of clinical trial participation among participants. The intervention created a positive social environment and decreased medical mistrust. This intervention may provide a framework by which to facilitate clinical trial participation among Black men.