Life's Simple 7 and Incident Heart Failure: The Multi-Ethnic Study of Atherosclerosis

J Am Heart Assoc. 2017 Jun 27;6(6):e005180. doi: 10.1161/JAHA.116.005180.


Background: The American Heart Association introduced the Life's Simple 7 (LS7) metrics to assess and promote cardiovascular health. We sought to examine the association between the LS7 metrics and incident heart failure (HF) in a multiethnic cohort.

Methods and results: We analyzed data from 6506 participants of the Multi-Ethnic Study of Atherosclerosis free of cardiovascular disease at baseline. The LS7 metrics (smoking, physical activity, body mass index, diet, blood pressure, total cholesterol, and blood glucose) were graded on a scale of 0 to 2, with 2 indicating "ideal" status, 1 "intermediate" status, and 0 "poor" status. Points were summed, thus the LS7 score ranged from 0 to 14. Cox proportional hazard ratios and incidence rates of HF per 1000 person-years were calculated. During a median follow-up of 12.2 years, 262 (4%) participants developed HF. Incidence of HF decreased as the number of ideal LS7 metrics increased; 5.9 per 1000 person-years for participants with 0 to 1 ideal metrics and 0.6 per 1000 person-years for those with 6 to 7 ideal metrics. Compared with inadequate scores (0-8 points), hazard ratios for HF were 0.57 (0.43-0.76) and 0.31 (0.19-0.49) for average (9-10 points) and optimal (11-14 points) scores, respectively. A similar pattern was observed when the results were stratified by 4 racial/ethnic groups: white, Chinese American, black, and Hispanic.

Conclusions: A lower risk of HF with more favorable LS7 status regardless of race/ethnicity suggests that efforts to achieve ideal cardiovascular health may reduce the burden of HF, a major source of morbidity and mortality.

Keywords: Life's Simple 7; cardiovascular disease prevention; epidemiology; heart failure; ideal cardiovascular health metrics; risk factor.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Biomarkers / blood
  • Blood Glucose / analysis
  • Blood Pressure
  • Body Mass Index
  • Cholesterol / blood
  • Diet, Healthy / ethnology
  • Exercise
  • Female
  • Healthy Lifestyle*
  • Heart Failure / diagnosis
  • Heart Failure / ethnology*
  • Heart Failure / prevention & control
  • Humans
  • Incidence
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Prognosis
  • Protective Factors
  • Risk Factors
  • Risk Reduction Behavior*
  • Smoking Cessation / ethnology
  • Time Factors
  • United States / epidemiology


  • Biomarkers
  • Blood Glucose
  • Cholesterol