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LIFE’S SIMPLE 7 – YOUR PATIENT’S CARDIOVASCULAR HEALTH

Statistics

Between 20-45% of American’s are currently at risk of suffering heart failure sometime in their life (Lin, Ovbiagele, Markovic & Towfighi, 2015). One out of every four American’s currently in middle age will develop heart failure by the age of 85 (Lin et al., 2015). Prevention is a critical component of reducing these statistics and reaching out to patients with evidence based tools before they develop cardiovascular issues has been proven as an effective strategy (Lin et al., 2015).

Evidence

In 2010, the American Heart Association (AHA) published a set of health metrics, entitled “Life’s Simple 7,” which highlight seven evidence-based areas physicians should encourage their patients to focus on in order to obtain and maintain optimal levels of cardiovascular function (Lin et al., 2015). The clinical trials that tested the efficacy and relevance of the AHA’s Simple 7 (physical activity, cholesterol, blood pressure, glucose levels, body mass, diet and smoking) revealed a positive correlation between optimal use of their lifestyle management guideline and a reduced risk of heart failure and an overall improvement of cardiac function and structure, particularly for those who begin using the guide as early as middle age (Lin et al., 2015).

The USC ADRC Recognizes How Cardiovascular Health is Related to Memory Loss

We now know how important heart health is for brain health. There is a new saying we find useful when speaking with patients: “What’s bad for the heart is also bad for the brain.” Cardiovascular health conditions that have been linked with heart disease — high blood pressure, high cholesterol, and diabetes — have also now been linked to memory problems.

SIMPLE 7 Measure:

How to Calculate the Simple 7 Score

All seven of the lifestyle categories should be measured using a scale of 0 to 14, scoring 2 points for ideal, 1 point for intermediate and 0 points for poor quality. These calculations are then added and the total score will identify 3 ranks of lifestyle health, 10-14 being optimal, 5-9 being average, and 0-4 being inadequate. Research has revealed that the overall lifetime risk for heart failure among adults aged from 45-64 is only 14.4% if they fall into the optimal category, 26.8% for average, and an alarming 48.6% for those in the inadequate category (Folsom, 2015).

SIMPLE 7 Lifestyle Measure

SIMPLE 7 Lifestyle Tool
Area Definition (Score: 2 points = Ideal; 1 point = Intermediate; 0 points = poor quality) Score
STAYING ACTIVE – physical exercise and activities strengthen your body, mind and reduce your risk for cardiovascular issues. Find exercises and activities you enjoy and can engage with at least 12 times per month and consult with your primary care physician if you are just starting.
EATING HEALTHY – the quality and quantity of the nutrients you put into your body will affect how your body moves, repairs, rests and functions in the long term. Consult with a nutritionist or your primary care physician to optimize your diet and reduce your lifetime risk of cardiovascular issues.
WATCHING YOUR BMI – rather than worrying about weight, have your Body Mass Index (BMI) calculated. The measurements of the BMI will closely approximate the body’s percentage of fat. Ideally, your BMI should below 25 in order to significantly reduce the likelihood of cardiac health issues. If your BMI is 25-29, you are at an average risk for cardiovascular disease and heart failure, and if it is 30 or higher, your risk is elevated into the highest category.
BLOOD PRESSURE – your blood pressure measures your vascular health by testing how hard your heart has to work to push blood through your veins and arteries; the higher the pressure, the greater the risk of damage being caused to your heart and veins (i.e. hypertension).
BLOOD CHOLESTEROL – there are 2 types of cholesterol: low-density lipoprote (LDL) and high-density lipoproteins. Lipoproteins are made of fat on the inside and protein on the outside. These packages are essential for your body to function properly. An unhealthy amount of LDL cholesterol, however, may clog your arteries.
BLOOD SUGAR – knowing your blood sugar is just as important as knowing your blood pressure and cholesterol. The American Diabetes Association states the approximately 86 million American’s are currently prediabetic, a condition that your physician can identify by testing your blood sugar levels. Prediabetes can be managed with diet and exercise to prevent it from becoming full blown diabetes, a condition that raises your risk for heart disease.
TOBACCO USE – smoking damages almost every organ in your body, and the chemicals in tobacco can harm the structure and function of your blood vessels and damage your heart.
Total Score

Journal Articles

“Life’s Simple 7” and Long-Term Mortality After Stroke

Michelle P. Lin, MD, MPH; Bruce Ovbiagele, MD, MSc, MAS; Daniela Markovic, MS; Amytis Towfighi, MD

Background

-—The American Heart Association developed criteria dubbed “Life’s Simple 7” defining ideal cardiovascular health: not smoking, regular physical activity, healthy diet, maintaining normal weight, and controlling cholesterol, blood pressure, and blood glucose levels. The impact of achieving these metrics on survival after stroke is unknown. We aimed to determine cardiovascular health scores among stroke survivors in the United States and to assess the link between cardiovascular health score and all-cause mortality after stroke.

Methods and Results

-—We assessed cardiovascular health metrics among a nationally representative sample of US adults with stroke (n=420) who participated in the National Health and Nutrition Examination Surveys in 1988–1994 (with mortality assessment through 2006). We determined cumulative all-cause mortality by cardiovascular health score under the Cox proportional hazards model after adjusting for sociodemographic characteristics and comorbidities. No stroke survivors met all 7 ideal health metrics. Over a median duration of 98 months (range, 53–159), there was an inverse dose-dependent relationship between number of ideal lifestyle metrics met and 10-year adjusted mortality: 0 to 1: 57%; 2: 48%; 3: 43%; 4: 36%; and ≥5: 30%. Those who met ≥4 health metrics had lower all-cause mortality than those who met 0 to 1 (hazard ratio, 0.51; 95% confidence interval, 0.28–0.92). After adjusting for sociodemographics, higher health score was associated with lower all-cause mortality (trend P-value, 0.022).

Conclusions

-—Achieving a greater number of ideal cardiovascular health metrics is associated with lower long-term risk of dying after stroke. Specifically targeting “Life’s Simple 7” goals might have a profound impact, extending survival after stroke.

Journal/Issue:

J Am Heart Assoc. 2015;4:e001470 doi: 10.1161/JAHA.114.001470

From the Department of Neurology, University of Southern California, Los Angeles, CA (M.P.L., A.T.); Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA (M.P.L., A.T.); Department of Neurology, Medical University of South Carolina, Charleston, SC (B.O.); Department of Biomathematics, University of California at Los Angeles, CA (D.M.).

Link to Full Article: http://jaha.ahajournals.org/content/4/11/e001470

Key Words:

all-cause mortality • American Heart Association • ideal cardiovascular health metrics • Life’s Simple 7 • Stroke

RESEARCH PAPER

Impact of a healthy lifestyle on all-cause and cardiovascular mortality after stroke in the USA
Amytis Towfighi,1,2 Daniela Markovic,3 Bruce Ovbiagele4
ABSTRACT

Background Little is known about the effects of a healthy lifestyle on mortality after stroke. This study assessed whether five healthy lifestyle factors had independent and dose dependent associations with all- cause and cardiovascular mortality after stroke.

Methods

In a nationally representative sample of the US population (n 15 299) with previous stroke (n 649) followed from survey participation (1988e1994) through to mortality assessment (2000), the relationship between five factors (eating $5 servings of fruits/ vegetables per day, exercising >12 times/month, having a body mass index of 18.5e29.9 mg/kg2, moderate alcohol use [1 drink/day for women and 2 drinks/day for men] and not smoking) and all-cause and cardiovascular mortality was assessed.

Results

Mean age was 67.0 years (SE 1.1 years) and 53% were women. After adjusting for covariates, abstaining from smoking (HR 0.57, CI 0.34 to 0.98) and exercising regularly (HR 0.66, CI 0.44 to 0.99) were associated with lower all-cause mortality but no individual factors had independent associations with cardiovascular mortality. All-cause mortality decreased with higher numbers of healthy behaviours (1e3 factors vs none: HR 0.12, CI 0.03 to 0.47; 4e5 factors vs none: HR 0.04, CI 0.01 to 0.20; 4e5 factors vs 1e3 factors: HR 0.38, CI 0.22 to 0.66; trend p 0.04). Similar effects were observed for cardiovascular mortality (4e5 factors vs none: HR 0.08, CI 0.01 to 0.66; 1e3 factors vs none: HR 0.15, CI 0.02 to 1.15; 4e5 factors vs 1e3 factors: HR 0.53, CI 0.28 to 0.98; trend p 0.18).

Conclusions

Regular exercise and abstinence from smoking were independently associated with lower
all-cause mortality after stroke. Combinations of healthy lifestyle factors were associated with lower all-cause and cardiovascular mortality in a dose dependent
fashion.

Journal/Issue

J Neurol Neurosurg Psychiatry 2012;83:146-151 doi:10.1136/jnnp-2011-300743

1 Division of Stroke and Critical Care, Department of Neurology, University of Southern California, Los Angeles, California, USA
2 Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, California, USA
3 Department of Biomathematics, University of California at Los Angeles, Los Angeles, California, USA
4 Stroke Center and Department of Neurosciences, University of California at San Diego, San Diego, California, USA

Link to Full Article:

http://jnnp.bmj.com/content/83/2/146.f