Abstract 17917: Is Small Change Significant? Association of Small Differences in Life's Simple 7 and Mortality: the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Cohort
Background. The AHA 2020 Goal includes improving cardiovascular health, defined using a metric consisting of 7 health factors, Life's Simple 7. A central concept of the goal is that small improvements in behavior / lifestyle factors at the population level will lead to large risk reductions over the life course. We developed a simple score to quantify Life's Simple 7 and evaluated the association of small differences in this score with all-cause mortality in REGARDS, a biracial national cohort.
Methods. We studied 17,820 REGARDS participants without vascular diseases; black and white men and women aged 45-98 from across the US, enrolled in 2003-7, when extensive risk factor data were measured in participants' homes. The 7 components of Life's Simple 7 (blood pressure, cholesterol, glucose, BMI, smoking, physical activity, diet) were each scored in AHA-defined categories of poor (1 point), intermediate (2 points) and ideal (3 points), and were summed to yield scores ranging from poor for all (7) to ideal for all (21). With 4.6 years follow up there were 2319 deaths.
Results. The score was normally distributed with mean (SD) of 13.5 (2.6). The age, sex and race-hazard ratio (HR) of death for a 1-unit increase in Simple 7 Score was 0.86 (95% CI 0.84, 0.87). There was no impact of further adjustment for income and education. Considering only the 4 behavior/lifestyle score components (BMI, smoking, physical activity, diet), the adjusted HR per 1 unit higher score was 0.79 (95% CI 0.77, 0.81).
Conclusions. A small incremental difference, corresponding to improvement of 1 category (poor to intermediate or intermediate to ideal) for 1 component of Life's Simple 7 Score was associated with substantial reduction in 4.6-year all cause mortality. The association was larger considering only the 4 behavioral/lifestyle components. Results suggest profound implications of achieving the 2020 Goal that 20% of people improve by 1 level of this metric.
- © 2011 by American Heart Association, Inc.