Life's Simple 7 Steps to Avoid Heart Failure

Study Questions:

What is the impact of American Heart Association's Life's Simple 7 guidelines on lifetime risk of heart failure and preservation of cardiac structure and function in old age?


The investigators studied the population-based Atherosclerosis Risk in Communities Study cohort of 13,462 adults ages 45-64 years in 1987-1989. From the 1987-1989 risk factor measurements, they created a Life's Simple 7 score (range 0-14, giving 2 points for ideal, 1 point for intermediate, and 0 points for poor components). The authors identified 2,218 incident heart failure events using surveillance of hospital discharge and death codes through 2011. In addition, in 4,855 participants free of clinical cardiovascular disease in 2011-2013, the authors performed echocardiography from which they quantified left ventricular hypertrophy and diastolic dysfunction.


One in four participants (25.5%) developed heart failure through age 85 years. Yet, this lifetime heart failure risk was 14.4% for those with a middle-age Life's Simple 7 score of 10-14 (optimal), 26.8% for a score of 5-9 (average), and 48.6% for a score of 0-4 (inadequate). Among those with no clinical cardiovascular event, the prevalence of left ventricular hypertrophy in late life was approximately 40% as common, and diastolic dysfunction was approximately 60% as common, among those with an optimal middle-age Life's Simple 7 score, compared with an inadequate score.


The authors concluded that greater achievement of American Heart Association's Life's Simple 7 in middle age is associated with a lower lifetime occurrence of heart failure and greater preservation of cardiac structure and function in late life.


There is evidence that greater achievement of Life's Simple 7 is associated not only with lower incidence of heart failure, but also with lower rates of coronary heart disease, stroke, cognitive impairment, diabetes, chronic kidney disease, and cancer. This study further highlights the importance of lifestyle changes to reduce the public health burden of heart failure, cardiovascular disease, and potentially, other chronic diseases. Physicians and other health professionals need to strongly encourage the public to optimize lifestyle-related risk factors early in life.

Clinical Topics: Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Acute Heart Failure, Echocardiography/Ultrasound

Keywords: Chronic Disease, Echocardiography, Heart Failure, Hypertrophy, Left Ventricular, Life Style, Primary Prevention, Risk Factors, Ventricular Dysfunction

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