Life's Simple 7 and Peripheral Artery Disease: The Multi-Ethnic Study of Atherosclerosis

Am J Prev Med. 2019 Feb;56(2):262-270. doi: 10.1016/j.amepre.2018.09.021. Epub 2018 Dec 13.


Introduction: In 2010, the American Heart Association initiated Life's Simple 7 with the goal of significantly improving cardiovascular health by the year 2020. The association of Life's Simple 7 with risk of peripheral artery disease has not been thoroughly explored.

Methods: Racially diverse individuals from the Multi-Ethnic Study of Atherosclerosis (2000-2012) were followed for incident peripheral artery disease (ankle brachial index ≤0.90) and decline in ankle brachial index (≥0.15) over approximately 10 years of follow-up. Cox and logistic regression were used to assess associations of individual Life's Simple 7 components (score 0-2) and overall Life's Simple 7 score (score 0-14) with incident peripheral artery disease and ankle brachial index decline, respectively, adjusted for age, sex, race/ethnicity, education, and income. Analyses were performed in 2016-2018.

Results: Of 5,529 participants, 251 (4.5%) developed incident peripheral artery disease; 419 (9.8%) of 4,267 participants experienced a decline in ankle brachial index. Each point higher for the overall Life's Simple 7 score was associated with a 17% lower rate of incident peripheral artery disease (hazard ratio=0.83, 95% CI=0.78, 0.88, p<0.001). Additionally, each point higher in overall Life's Simple 7 was associated with a 0.94-fold lower odds of decline in ankle brachial index (OR=0.94, 95% CI=0.87, 0.97, p=0.003). Four components (smoking, physical activity, glucose, and blood pressure) were associated with incident peripheral artery disease and two (smoking and glucose) with decline in ankle brachial index.

Conclusions: Better cardiovascular health as measured by Life's Simple 7 is associated with lower incidence of peripheral artery disease and less decline in ankle brachial index. Use of the Life's Simple 7 to target modifiable health behaviors may aid in decreasing the population burden of peripheral artery disease-related morbidity and mortality.

Publication types

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

MeSH terms

  • Aged
  • American Heart Association / organization & administration
  • Ankle Brachial Index
  • Cost of Illness*
  • Ethnic Groups / statistics & numerical data*
  • Female
  • Follow-Up Studies
  • Health Promotion / methods*
  • Health Promotion / organization & administration
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Peripheral Arterial Disease / diagnosis
  • Peripheral Arterial Disease / epidemiology*
  • Peripheral Arterial Disease / prevention & control
  • Prospective Studies
  • Risk Factors
  • Risk Reduction Behavior*
  • United States / epidemiology