American heart association's Life's Simple 7 at middle age and prognosis after myocardial infarction in later life

Yejin Mok, Yingying Sang, Shoshana H. Ballew, Casey M. Rebholz, Wayne D. Rosamond, Gerardo Heiss, Aaron R. Folsom, Josef Coresh, Kunihiro Matsushita

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35 Scopus citations


Background--The American Heart Association recommends focusing on 7 health factors (Life's Simple 7) for primordial prevention of cardiovascular health. However, whether greater adherence to Life's Simple 7 in midlife improves prognosis after myocardial infarction (MI) in later life is unknown. Methods and Results--In 1277 participants who developed MI during the ARIC (Atherosclerosis Risk in Communities) Study follow-up, a 14-point score of Life's Simple 7 was constructed according to the status (2 points for ideal, 1 point for intermediate, and 0 points for poor) of each of 7 factors (smoking, adiposity, physical activity, diet, total cholesterol, blood pressure, and fasting glucose) at baseline (1987-1989). Hazard ratios for composite and individual adverse outcomes of all-cause mortality, cardiovascular mortality, recurrent MI, heart failure, and stroke were calculated according to Life's Simple 7 score. During a median follow-up of 3.3 years, 918 participants (72%) had subsequent adverse outcomes after MI. Life's Simple 7 score at middle age was inversely associated with adverse outcomes after MI (adjusted hazard ratios of composite outcome, 0.57 [95% confidence interval, 0.39-0.84] if score is ≥10, 0.78 [95% confidence interval, 0.57-1.07] if score is 7-9, and 0.82 [95% confidence interval, 0.60-1.11] if score is 4-6 versus ≤3). The association was largely independent of access to care and MI severity. Individual factors related to better prognosis after MI were ideal nonsmoking, body mass index, blood pressure, and fasting glucose. Conclusions--Optimal Life's Simple 7 at middle age was associated with better prognosis after MI in later life. Our findings suggest a secondary prevention benefit of having better cardiovascular health status in midlife.

Original languageEnglish (US)
Article numbere007658
JournalJournal of the American Heart Association
Issue number4
StatePublished - Feb 1 2018

Bibliographical note

Funding Information:
The ARIC (Atherosclerosis Risk in Communities) Study has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under contracts (HHSN268201700001I, HHSN268201700003I, HHSN268201700005I, HHSN268201700004I, and HHSN2682017000021). Dr. Rebholz is supported by National Institute of Diabetes and Digestive and Kidney Diseases grant K01 DK107782.

Publisher Copyright:
© 2018 The Authors.


  • Cardiovascular disease risk factors
  • Life's Simple 7
  • Myocardial infarction
  • Secondary prevention


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