Life's Simple 7 and incidence of diabetes among American Indians: the Strong Heart Family Study

Diabetes Care. 2014 Aug;37(8):2240-5. doi: 10.2337/dc13-2267. Epub 2014 May 7.


Objective: The American Heart Association's recommendations for optimal health, summarized in Life's Simple 7, have been associated with reduced risk of cardiovascular disease (CVD)-related end points, but no studies have examined the association of these goals with incident type 2 diabetes, which is associated with high risk for CVD. The purpose of this analysis was to examine the associations of Life's Simple 7 goals with incident diabetes among American Indians, a population at high risk of cardiometabolic diseases.

Research design and methods: Strong Heart Family Study participants without diabetes (n = 1,639) at baseline and who participated in a follow-up examination were included in the analysis. Risk scores ranging from 0 to 7 were created using physical activity, diet, BMI, smoking, blood pressure, fasting glucose, and cholesterol metrics in accordance with Life's Simple 7 goals. Diabetes was defined using 2003 American Diabetes Association criteria, including use of insulin or oral antidiabetes medication or a follow-up fasting plasma glucose level ≥126 mg/dL. Generalized estimating equations were used to examine the association of risk scores with incident diabetes.

Results: During a mean 5-year follow-up (range 4-8 years), we identified 210 cases of incident type 2 diabetes. Compared with participants who achieved 0-1 goals, those who achieved 2-3 or 4+ goals had lower odds of diabetes, with odds ratios = 0.40 (95% CI 0.29-0.56) and 0.11 (95% CI 0.05-0.21), respectively.

Conclusions: The adoption of as few as two or three Life's Simple 7 goals is associated with a lower risk of diabetes.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • American Heart Association
  • Cardiovascular Diseases / ethnology
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / prevention & control*
  • Diabetes Mellitus, Type 2 / ethnology*
  • Female
  • Health Behavior / ethnology*
  • Humans
  • Incidence
  • Indians, North American / statistics & numerical data*
  • Life Style
  • Male
  • Middle Aged
  • Patient Care Planning / standards
  • Patient Compliance / ethnology
  • Patient Compliance / statistics & numerical data
  • Risk Factors
  • Risk Reduction Behavior*
  • United States / epidemiology
  • Young Adult