Life's Simple 7 at Midlife and Risk of Recurrent Cardiovascular Disease and Mortality after Stroke: The ARIC study

Yvonne Commodore-Mensah; Yejin Mok; Rebecca F. Gottesman; Anna Kucharska-Newton; Kunihiro Matsushita; Priya Palta; Wayne D. Rosamond; Fred Stephen Sarfo; Josef Coresh; Silvia Koton

doi:10.1016/j.jstrokecerebrovasdis.2022.106486

Life's Simple 7 at Midlife and Risk of Recurrent Cardiovascular Disease and Mortality after Stroke: The ARIC study

Yvonne Commodore-Mensah, Yejin Mok, Rebecca F. Gottesman, Anna Kucharska-Newton, Kunihiro Matsushita, Priya Palta, Wayne D. Rosamond, Fred Stephen Sarfo, Josef Coresh, Silvia Koton

Research output: Contribution to journal › Article › peer-review

7 Scopus citations

Abstract

Background: Stroke is a leading cause of morbidity and mortality among adults in the U.S. Ideal levels of the Life's Simple 7 (LS7) are associated with lower cardiovascular disease (CVD) and all-cause mortality. However, the association of LS7 with CVD, recurrent stroke, and all-cause mortality after incident stroke is unknown. Methods: We used data from the ARIC study, a cohort of 13,508 adults from four US communities, 45–64 years old at baseline (1987–1989). Cardiovascular hospitalizations and mortality were ascertained in follow-up through December 31^st, 2017. We defined cardiovascular health (CVH) based on AHA definitions for LS7 (range 0-14) and categorized CVH into four levels: LS7 0-3, 4-6, 7-9, and ≥10 (ideal LS7), according to prior studies. Outcomes included incident stroke, CVD, recurrent stroke, all-cause mortality, and a composite outcome including all the above. Adjusted hazard ratios (95% CI) were estimated with Cox proportional hazards regression models. Results: Median (25%-75%) follow-up for incident stroke was 28 (18.6-29.2) years. Participants with incident stroke were 55.7 (SD 5.6) years-old at baseline, 53% were women and 35% Black. Individuals with LS7 score ≥10 had 65% lower risk (HR: 0.35; 95% CI: 0.29-0.41) of incident stroke than those with LS7 4-6 (reference group). Of 1,218 participants with incident stroke, 41.2% (n=502) had composite CVD and 68.3% (n=832) died during a median (25%-75%) follow-up of 4.0 (0.76-9.95) years. Adjusted HR (95% CI) for stroke survivors with LS7≥10 at baseline were 0.74 (0.58-0.94) for the composite outcome, 0.38(0.17-0.85) for myocardial infarction, 0.60 (0.40-0.90) for heart failure, 0.63 (0.48-0.84) for all-cause mortality, and 0.65 (0.39-1.08) for recurrent stroke. Conclusions: Good and excellent midlife cardiovascular health are associated with lower risks of incident stroke and CVD after stroke. Clinicians should stress the importance of a healthy lifestyle for primary and secondary CVD prevention.

Original language	English
Article number	106486
Journal	Journal of Stroke and Cerebrovascular Diseases
Volume	31
Issue number	7
DOIs	https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106486
State	Published - Jul 2022

Bibliographical note

Publisher Copyright:
© 2022 Elsevier Inc.

Funding

The ARIC Study has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under Contract Nos.HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700004I, and HHSN268201700005I. Support was received from the National Institute of Health (5KL2TR001077-05 to YCM).

Funders	Funder number
National Institutes of Health (NIH)
U.S. Department of Health and Human Services	HHSN268201700003I, HHSN268201700004I, HHSN268201700005I, HHSN268201700002I
U.S. Department of Health and Human Services
National Heart, Lung, and Blood Institute (NHLBI)
National Center for Advancing Translational Sciences (NCATS)	UL1TR003098
National Center for Advancing Translational Sciences (NCATS)

Keywords

Cardiovascular disease
Lifestyle
Recurrent event
Risk factor
Stroke

ASJC Scopus subject areas

Surgery
Rehabilitation
Clinical Neurology
Cardiology and Cardiovascular Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.jstrokecerebrovasdis.2022.106486

Cite this

Commodore-Mensah, Y., Mok, Y., Gottesman, R. F., Kucharska-Newton, A., Matsushita, K., Palta, P., Rosamond, W. D., Sarfo, F. S., Coresh, J., & Koton, S. (2022). Life's Simple 7 at Midlife and Risk of Recurrent Cardiovascular Disease and Mortality after Stroke: The ARIC study. Journal of Stroke and Cerebrovascular Diseases, 31(7), Article 106486. https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106486

@article{9bac8ecd883a416d9f1a131d3beb6e19,

title = "Life's Simple 7 at Midlife and Risk of Recurrent Cardiovascular Disease and Mortality after Stroke: The ARIC study",

abstract = "Background: Stroke is a leading cause of morbidity and mortality among adults in the U.S. Ideal levels of the Life's Simple 7 (LS7) are associated with lower cardiovascular disease (CVD) and all-cause mortality. However, the association of LS7 with CVD, recurrent stroke, and all-cause mortality after incident stroke is unknown. Methods: We used data from the ARIC study, a cohort of 13,508 adults from four US communities, 45–64 years old at baseline (1987–1989). Cardiovascular hospitalizations and mortality were ascertained in follow-up through December 31st, 2017. We defined cardiovascular health (CVH) based on AHA definitions for LS7 (range 0-14) and categorized CVH into four levels: LS7 0-3, 4-6, 7-9, and ≥10 (ideal LS7), according to prior studies. Outcomes included incident stroke, CVD, recurrent stroke, all-cause mortality, and a composite outcome including all the above. Adjusted hazard ratios (95\% CI) were estimated with Cox proportional hazards regression models. Results: Median (25\%-75\%) follow-up for incident stroke was 28 (18.6-29.2) years. Participants with incident stroke were 55.7 (SD 5.6) years-old at baseline, 53\% were women and 35\% Black. Individuals with LS7 score ≥10 had 65\% lower risk (HR: 0.35; 95\% CI: 0.29-0.41) of incident stroke than those with LS7 4-6 (reference group). Of 1,218 participants with incident stroke, 41.2\% (n=502) had composite CVD and 68.3\% (n=832) died during a median (25\%-75\%) follow-up of 4.0 (0.76-9.95) years. Adjusted HR (95\% CI) for stroke survivors with LS7≥10 at baseline were 0.74 (0.58-0.94) for the composite outcome, 0.38(0.17-0.85) for myocardial infarction, 0.60 (0.40-0.90) for heart failure, 0.63 (0.48-0.84) for all-cause mortality, and 0.65 (0.39-1.08) for recurrent stroke. Conclusions: Good and excellent midlife cardiovascular health are associated with lower risks of incident stroke and CVD after stroke. Clinicians should stress the importance of a healthy lifestyle for primary and secondary CVD prevention.",

keywords = "Cardiovascular disease, Lifestyle, Recurrent event, Risk factor, Stroke",

author = "Yvonne Commodore-Mensah and Yejin Mok and Gottesman, \{Rebecca F.\} and Anna Kucharska-Newton and Kunihiro Matsushita and Priya Palta and Rosamond, \{Wayne D.\} and Sarfo, \{Fred Stephen\} and Josef Coresh and Silvia Koton",

note = "Publisher Copyright: {\textcopyright} 2022 Elsevier Inc.",

year = "2022",

month = jul,

doi = "10.1016/j.jstrokecerebrovasdis.2022.106486",

language = "English",

volume = "31",

number = "7",

}

Commodore-Mensah, Y, Mok, Y, Gottesman, RF, Kucharska-Newton, A, Matsushita, K, Palta, P, Rosamond, WD, Sarfo, FS, Coresh, J & Koton, S 2022, 'Life's Simple 7 at Midlife and Risk of Recurrent Cardiovascular Disease and Mortality after Stroke: The ARIC study', Journal of Stroke and Cerebrovascular Diseases, vol. 31, no. 7, 106486. https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106486

TY - JOUR

T1 - Life's Simple 7 at Midlife and Risk of Recurrent Cardiovascular Disease and Mortality after Stroke

T2 - The ARIC study

AU - Commodore-Mensah, Yvonne

AU - Mok, Yejin

AU - Gottesman, Rebecca F.

AU - Kucharska-Newton, Anna

AU - Matsushita, Kunihiro

AU - Palta, Priya

AU - Rosamond, Wayne D.

AU - Sarfo, Fred Stephen

AU - Coresh, Josef

AU - Koton, Silvia

PY - 2022/7

Y1 - 2022/7

N2 - Background: Stroke is a leading cause of morbidity and mortality among adults in the U.S. Ideal levels of the Life's Simple 7 (LS7) are associated with lower cardiovascular disease (CVD) and all-cause mortality. However, the association of LS7 with CVD, recurrent stroke, and all-cause mortality after incident stroke is unknown. Methods: We used data from the ARIC study, a cohort of 13,508 adults from four US communities, 45–64 years old at baseline (1987–1989). Cardiovascular hospitalizations and mortality were ascertained in follow-up through December 31st, 2017. We defined cardiovascular health (CVH) based on AHA definitions for LS7 (range 0-14) and categorized CVH into four levels: LS7 0-3, 4-6, 7-9, and ≥10 (ideal LS7), according to prior studies. Outcomes included incident stroke, CVD, recurrent stroke, all-cause mortality, and a composite outcome including all the above. Adjusted hazard ratios (95% CI) were estimated with Cox proportional hazards regression models. Results: Median (25%-75%) follow-up for incident stroke was 28 (18.6-29.2) years. Participants with incident stroke were 55.7 (SD 5.6) years-old at baseline, 53% were women and 35% Black. Individuals with LS7 score ≥10 had 65% lower risk (HR: 0.35; 95% CI: 0.29-0.41) of incident stroke than those with LS7 4-6 (reference group). Of 1,218 participants with incident stroke, 41.2% (n=502) had composite CVD and 68.3% (n=832) died during a median (25%-75%) follow-up of 4.0 (0.76-9.95) years. Adjusted HR (95% CI) for stroke survivors with LS7≥10 at baseline were 0.74 (0.58-0.94) for the composite outcome, 0.38(0.17-0.85) for myocardial infarction, 0.60 (0.40-0.90) for heart failure, 0.63 (0.48-0.84) for all-cause mortality, and 0.65 (0.39-1.08) for recurrent stroke. Conclusions: Good and excellent midlife cardiovascular health are associated with lower risks of incident stroke and CVD after stroke. Clinicians should stress the importance of a healthy lifestyle for primary and secondary CVD prevention.

AB - Background: Stroke is a leading cause of morbidity and mortality among adults in the U.S. Ideal levels of the Life's Simple 7 (LS7) are associated with lower cardiovascular disease (CVD) and all-cause mortality. However, the association of LS7 with CVD, recurrent stroke, and all-cause mortality after incident stroke is unknown. Methods: We used data from the ARIC study, a cohort of 13,508 adults from four US communities, 45–64 years old at baseline (1987–1989). Cardiovascular hospitalizations and mortality were ascertained in follow-up through December 31st, 2017. We defined cardiovascular health (CVH) based on AHA definitions for LS7 (range 0-14) and categorized CVH into four levels: LS7 0-3, 4-6, 7-9, and ≥10 (ideal LS7), according to prior studies. Outcomes included incident stroke, CVD, recurrent stroke, all-cause mortality, and a composite outcome including all the above. Adjusted hazard ratios (95% CI) were estimated with Cox proportional hazards regression models. Results: Median (25%-75%) follow-up for incident stroke was 28 (18.6-29.2) years. Participants with incident stroke were 55.7 (SD 5.6) years-old at baseline, 53% were women and 35% Black. Individuals with LS7 score ≥10 had 65% lower risk (HR: 0.35; 95% CI: 0.29-0.41) of incident stroke than those with LS7 4-6 (reference group). Of 1,218 participants with incident stroke, 41.2% (n=502) had composite CVD and 68.3% (n=832) died during a median (25%-75%) follow-up of 4.0 (0.76-9.95) years. Adjusted HR (95% CI) for stroke survivors with LS7≥10 at baseline were 0.74 (0.58-0.94) for the composite outcome, 0.38(0.17-0.85) for myocardial infarction, 0.60 (0.40-0.90) for heart failure, 0.63 (0.48-0.84) for all-cause mortality, and 0.65 (0.39-1.08) for recurrent stroke. Conclusions: Good and excellent midlife cardiovascular health are associated with lower risks of incident stroke and CVD after stroke. Clinicians should stress the importance of a healthy lifestyle for primary and secondary CVD prevention.

KW - Cardiovascular disease

KW - Lifestyle

KW - Recurrent event

KW - Risk factor

KW - Stroke

UR - http://www.scopus.com/inward/record.url?scp=85129318601&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85129318601&partnerID=8YFLogxK

U2 - 10.1016/j.jstrokecerebrovasdis.2022.106486

DO - 10.1016/j.jstrokecerebrovasdis.2022.106486

M3 - Article

C2 - 35468496

AN - SCOPUS:85129318601

SN - 1052-3057

VL - 31

JO - Journal of Stroke and Cerebrovascular Diseases

JF - Journal of Stroke and Cerebrovascular Diseases

IS - 7

M1 - 106486

ER -

Life's Simple 7 at Midlife and Risk of Recurrent Cardiovascular Disease and Mortality after Stroke: The ARIC study

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this