Interrelationships Between American Heart Association's Life's Simple 7, ECG Silent Myocardial Infarction, and Cardiovascular Mortality

Abstract

Background We examined the interrelationships among cardiovascular health (CVH), assessed by the American Heart Association's Life's Simple 7 (LS7) health metrics, silent myocardial infarction (SMI), and cardiovascular disease (CVD) mortality. Methods and Results This analysis included 6766 participants without a history of coronary heart disease from the Third Report of the National Health and Nutrition Examination Survey. Poor, intermediate, and ideal CVH were defined as an LS7 score of 0 to 4, 5 to 9, and 10 to 14, respectively. SMI was defined as ECG evidence of myocardial infarction without a clinical diagnosis of myocardial infarction. Cox proportional hazard analysis was used to examine the association of baseline CVH with CVD death stratified by SMI status on follow‐up. In multivariable logistic regression models, ideal CVH was associated with 69% lower odds of SMI compared with poor CVH. During a median follow‐up of 14 years, 907 CVD deaths occurred. In patients without SMI, intermediate CVH (hazard ratio, 1.41; 95% CI, 1.14–1.74) and poor CVH (hazard ratio, 2.77; 95% CI, 2.10–3.66) were associated with increased risk of CVD mortality, compared with ideal CVH. However, in the presence of SMI, the magnitude of these associations almost doubled (hazard ratio, 2.17 [95% CI, 1.42–3.32] for intermediate CVH and hazard ratio, 6.28 [95% CI, 3.02–13.07] for poor CVH). SMI predicted a significant increased risk of CVD mortality in the intermediate and poor CVH subgroups but a nonsignificant increased risk in the ideal CVH subgroup. Conclusions Ideal CVH is associated with a lower risk of SMI, and concomitant presence of SMI and poor CVH is associated with a worse prognosis. These novel findings underscore the potential role of maintaining ideal CVH in preventing future CVD outcomes.

Life’s simple 7 and all-cause mortality. A population-based prospective cohort study in middle-aged and older adults of Amerindian ancestry living in rural Ecuador

“…As previously noted, several studies have addressed the utility of the Life’s Simple 7 scale for predicting adverse vascular outcomes and mortality across different races/ethnic groups and populations ( Ahmad et al, 2019 , Ahmed et al, 2020 , Del Brutto et al, 2013a , Dong et al, 2012 , Folsom et al, 2011 , Han et al, 2019 , Lin et al, 2015 , Patterson et al, 2016 , Zhang et al, 2020 ). In the multi-ethnic Northern Manhattan Study, the HR for all-cause mortality was not significantly lower for individuals with five or more ideal CVH metrics when compared to that of those with two ideal metrics (0.59 [95% C.I.…”

“…Several longitudinal studies have also addressed the influence of Life’s Simple 7 on mortality ( Ahmad et al, 2019 , Dong et al, 2012 , Han et al, 2019 , Lin et al, 2015 ). However, information on the value of this scale in predicting mortality among people living in remote or rural communities is limited.…”

Incident cardiovascular disease by clustering of favourable risk factors in type 1 diabetes: the EURODIAB Prospective Complications Study

“…Although there are few publications on type 1 diabetes that explore clustering, it has been demonstrated that the clustering of favourable AHA health metrics is associated with lower CVD and cardiovascular mortality in general populations [ 8 – 10 ]. In the National Health and Nutrition Examination Survey (NHANES III), participants with ideal cardiovascular health had a 69% lower risk of developing a silent myocardial infarction, as detected by ECG (OR [95% CI] 0.31 [0.12, 0.75]) [ 10 ]. Similarly, the Australian Health Survey found an inverse association between a higher number of ideal metrics and a lower risk of prevalent ischaemic heart disease.…”

“…Ideal values of each of these cardiovascular health metrics were specified, based on the literature and the recommendations of previous committees. A score is assigned based on the number of ideal cardiovascular health metrics, and studies in general populations have shown that higher scores are associated with lower risks of CVD [ 8 – 10 ].…”

Primary prevention of myocardial infarction: aspirin is not as useful as it seems

“…They are often unaware of their illness and do not limit their activities. With SMI, the incidence of heart failure was significantly increased (20,22), and the effects of high-risk factors, such as smoking, reduced physical activity, high body mass index, poor dietary habits, hypertension, hyperlipidaemia and hyperglycaemia, on cardiovascular disease were almost doubled (23). If clinically manifested acute myocardial infarction patients were found to have prior SMI by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) images, they would have a more than 3-fold risk of mortality and major adverse cardiovascular events (21).…”