Advertisement
Research Article| Volume 31, ISSUE 7, 106486, July 2022

Download started.

Ok

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

Published:April 23, 2022DOI:https://doi.org/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
Previous ArticleDiabetes is an Independent Growth Factor of Ischemic Stroke During Reperfusion Phase Leading to Poor Clinical Outcome
Next ArticleDo Adults with Stroke have Altered Interhemispheric Inhibition? A Systematic Review with Meta-Analysis

      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

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Stroke and Cerebrovascular Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Register: Create an account
      Institutional Access: Sign in to ScienceDirect

      References

        • Virani SS
        • Alonso A
        • Benjamin EJ
        • et al.
        Heart disease and stroke statistics-2020 update: a report from the American Heart Association.
        Circulation. 2020; 141: e139-e596
        https://doi.org/10.1161/CIR.0000000000000757
        View in Article
        • Ovbiagele B
        • Goldstein LB
        • Higashida RT
        • et al.
        Forecasting the future of stroke in the United States: a policy statement from the American Heart Association and American Stroke Association.
        Stroke. 2013; 44: 2361-2375
        https://doi.org/10.1161/STR.0b013e31829734f2
        View in Article

      3. Feigin VL, Roth GA, Naghavi M, et al. Global burden of stroke and risk factors in 188 countries, during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet Neurol. 2016;15(9):913-924.: S1474-4422(16)30073-4 [pii].

        View in Article

      4. Huffman MD, Capewell S, Ning H, Shay CM, Ford ES, Lloyd-Jones DM. Cardiovascular health behavior and health factor changes (1988-2008) and projections to 2020: results from the National Health and Nutrition Examination Surveys. Circulation. 2012;125(21):2595-2602.oi: https://doi.org/10.1161/CIRCULATIONAHA.111.070722.

        View in Article

      5. Benjamin EJ, Virani SS, Callaway CW, et al. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation. 2018;137(12):e67-e492. https://doi.org/10.1161/CIR.0000000000000558.

        View in Article

      6. Lloyd-Jones DM, Hong Y, Labarthe D, et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association's strategic Impact Goal through 2020 and beyond. Circulation. 2010;121(4):586-613.oi: https://doi.org/10.1161/CIRCULATIONAHA.109.192703.

        View in Article
        • Bambs C
        • Kip KE
        • Dinga A
        • Mulukutla SR
        • Aiyer AN
        • Reis SE
        Low prevalence of “ideal cardiovascular health” in a community-based population: the heart strategies concentrating on risk evaluation (Heart SCORE) study.
        Circulation. 2011; 123: 850-857
        https://doi.org/10.1161/CIRCULATIONAHA.110.980151
        View in Article
        • Folsom AR
        • Yatsuya H
        • Nettleton JA
        • et al.
        Community prevalence of ideal cardiovascular health, by the American Heart Association definition, and relationship with cardiovascular disease incidence.
        J Am Coll Cardiol. 2011; 57: 1690-1696
        https://doi.org/10.1016/j.jacc.2010.11.041
        View in Article
        • Ford ES
        • Greenlund KJ
        • Hong Y
        Ideal cardiovascular health and mortality from all causes and diseases of the circulatory system among adults in the United States.
        Circulation. 2012; 125: 987-995
        https://doi.org/10.1161/CIRCULATIONAHA.111.049122
        View in Article
        • Yang Q
        • Cogswell ME
        • Flanders WD
        • et al.
        Trends in cardiovascular health metrics and associations with all-cause and CVD mortality among US adults.
        JAMA. 2012; 307: 1273-1283https://doi.org/10.1001/jama.2012.339
        View in Article

      11. Mok Y, Sang Y, Ballew SH, et al. American Heart Association's Life's Simple 7 at Middle Age and Prognosis After Myocardial Infarction in Later Life. J Am Heart Assoc. 2018;7(4):e007658 [pii]. https://doi.org/10.1161/JAHA.117.007658

        View in Article
      12. The Atherosclerosis Risk in Communities (ARIC) Study: Design and Objectives. The ARIC Investigators.
        Am J Epidemiol. 1989; 129: 687-702
        View in Article
        • Folsom AR
        • Yatsuya H
        • Nettleton JA
        • et al.
        Community prevalence of ideal cardiovascular health, by the American Heart Association definition, and relationship with cardiovascular disease incidence.
        J Am Coll Cardiol. 2011; 57: 1690-1696
        https://doi.org/10.1016/j.jacc.2010.11.041
        View in Article

      14. Ogunmoroti O, Oni E, Michos ED, et al. Life's Simple 7 and Incident Heart Failure: The Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc. 2017;6(6):e005180 [pii]. https://doi.org/10.1161/JAHA.116.005180.

        View in Article

      15. Olson NC, Cushman M, Judd SE, et al. American Heart Association's Life's Simple 7 and risk of venous thromboembolism: the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. J Am Heart Assoc. 2015;4(3):e001494: https://doi.org/10.1161/JAHA.114.001494.

        View in Article

      16. White AD, Folsom AR, Chambless LE, et al. Community surveillance of coronary heartisease in the Atherosclerosis Risk in Communities (ARIC) Study: methods and initial two years' experience. J Clin Epidemiol. 1996;49(2):223-233.: 0895435695000410 [pii].

        View in Article
        • Rosamond WD
        • Folsom AR
        • Chambless LE
        • et al.
        Stroke Incidence and survival among middle-aged adults: 9-year follow-up of the Atherosclerosis Risk In Communities (ARIC) cohort.
        Stroke. 1999; 30: 736-743
        https://doi.org/10.1161/01.str.30.4.736
        View in Article
        • Koton S
        • Schneider AL
        • Rosamond WD
        • et al.
        Stroke incidence and mortality trends in US communities, 1987 to 2011.
        JAMA. 2014; 312: 259-268https://doi.org/10.1001/jama.2014.7692
        View in Article

      19. Loehr LR, Rosamond WD, Chang PP, Folsom AR, Chambless LE. Heart failure Incidence and survival (from the Atherosclerosis Risk in Communities study). Am J Cardiol. 2008;101(7):1016-1022: https://doi.org/10.1016/j.amjcard.2007.11.061.

        View in Article
        • Gonzalez HM
        • Tarraf W
        • Rodriguez CJ
        • et al.
        Cardiovascular health among diverse Hispanics/Latinos: Hispanic Community Health Study/Study of Latinos (HCHS/SOL) results.
        Am Heart J. 2016; 176: 134-144
        https://doi.org/10.1016/j.ahj.2016.02.008
        View in Article
        • Kulshreshtha A
        • Vaccarino V
        • Judd SE
        • et al.
        Life’s Simple 7 and risk of incident stroke: the Reasons for Geographic and Racial Differences in stroke study.
        Stroke. 2013; 44: 1909-1914
        https://doi.org/10.1161/STROKEAHA.111.000352
        View in Article

      22. Ommerborn MJ, Blackshear CT, Hickson DA, et al. Ideal Cardiovascular Health and Incident Cardiovascular Events: The Jackson Heart Study. Am J Prev Med. 2016;51(4):502-506. https://doi.org/10.1016/j.amepre.2016.07.003.

        View in Article

      23. Sacco RL, Kargman DE, Gu Q, Zamanillo MC. Race-ethnicity and determinants of intracranial atherosclerotic cerebral infarction. The Northern Manhattan Stroke Study. Stroke. 1995;26(1):14-20. https://doi.org/10.1161/01.str.26.1.14.

        View in Article
        • Sacco RL
        • Foulkes MA
        • Mohr JP
        • Wolf PA
        • Hier DB
        • Price TR
        Determinants of early recurrence of cerebral infarction. The Stroke Data Bank.
        Stroke. 1989; 20: 983-989
        https://doi.org/10.1161/01.str.20.8.983
        View in Article
        • Shou J
        • Zhou L
        • Zhu S
        • Zhang X
        Diabetes as an Independent Risk Factor for Stroke Recurrence in Stroke Patients: A Meta-analysis.
        J Stroke Cerebrovasc Dis. 2015; 24: 1961-1968
        https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.04.004
        View in Article

      26. Boulanger M, Bejot Y, Rothwell PM, Touze E. Long-Term Risk of Myocardial Infarction Compared to Recurrent Stroke After Transient Ischemic Attack and Ischemic Stroke: Systematic Review and Meta-Analysis. J Am Heart Assoc. 2018;7(2):e007267 [pii]. https://doi.org/10.1161/JAHA.117.007267.

        View in Article

      27. Deijle IA, Van Schaik SM, Van Wegen EE, Weinstein HC, Kwakkel G, Vanen Berg-Vos RM. Lifestyle Interventions to Prevent Cardiovascular Events After Stroke and Transient Ischemic Attack: Systematic Review and Meta-Analysis. Stroke. 2017;48(1):174-179: https://doi.org/10.1161/STROKEAHA.116.013794.

        View in Article

      28. Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(7):2160-2236: https://doi.org/10.1161/STR.0000000000000024.

        View in Article

      Article info

      Publication history

      Published online: April 23, 2022
      Accepted: March 27, 2022
      Received in revised form: March 6, 2022
      Received: November 26, 2021

      Identification

      DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106486

      Copyright

      © 2022 Elsevier Inc. All rights reserved.

      ScienceDirect

      Access this article on ScienceDirect
      We use cookies to help provide and enhance our service and tailor content. To update your cookie settings, please visit the for this site.
      Copyright © 2023 Elsevier Inc. except certain content provided by third parties. The content on this site is intended for healthcare professionals.


      RELX