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

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Article number106486
JournalJournal of Stroke and Cerebrovascular Diseases
Volume31
Issue number7
DOIs
StatePublished - Jul 2022

Funding

FundersFunder number
National Institutes of Health
U.S. Department of Health and Human ServicesHHSN268201700003I, HHSN268201700004I, HHSN268201700005I, HHSN268201700002I
National Heart, Lung, and Blood Institute
National Center for Advancing Translational SciencesUL1TR003098

    Keywords

    • Cardiovascular disease
    • Lifestyle
    • Recurrent event
    • Risk factor
    • Stroke

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