American Heart Association's Life's Simple 7: Lifestyle Recommendations, Polygenic Risk, and Lifetime Risk of Coronary Heart Disease

Natalie R. Hasbani, Symen Ligthart, Michael R. Brown, Adam S. Heath, Allison Bebo, Kellan E. Ashley, Eric Boerwinkle, Alanna C. Morrison, Aaron R. Folsom, David Aguilar, Paul S. De Vries

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Understanding the effect of lifestyle and genetic risk on the lifetime risk of coronary heart disease (CHD) is important to improving public health initiatives. Our objective was to quantify remaining lifetime risk and years free of CHD according to polygenic risk and the American Heart Association's Life's Simple 7 (LS7) guidelines in a population-based cohort study. Methods: Our analysis included data from participants of the ARIC (Atherosclerosis Risk in Communities) study: 8372 White and 2314 Black participants; 45 years of age and older; and free of CHD at baseline examination. A polygenic risk score (PRS) comprised more than 6 million genetic variants was categorized into low (<20th percentile), intermediate, and high (>80th percentile). An overall LS7 score was calculated at baseline and categorized into "poor," "intermediate," and "ideal" cardiovascular health. Lifetime risk and CHD-free years were computed according to polygenic risk and LS7 categories. Results: The overall remaining lifetime risk was 27%, ranging from 16.6% in individuals with an ideal LS7 score to 43.1% for individuals with a poor LS7 score. The association of PRS with lifetime risk differed according to ancestry. In White participants, remaining lifetime risk ranged from 19.8% to 39.3% according to increasing PRS categories. Individuals with a high PRS and poor LS7 had a remaining lifetime risk of 67.1% and 15.9 fewer CHD-free years than did those with intermediate polygenic risk and LS7 scores. In the high-PRS group, ideal LS7 was associated with 20.2 more CHD-free years compared with poor LS7. In Black participants, remaining lifetime risk ranged from 19.1% to 28.6% according to increasing PRS category. Similar lifetime risk estimates were observed for individuals of poor LS7 regardless of PRS category. In the high-PRS group, an ideal LS7 score was associated with only 4.5 more CHD-free years compared with a poor LS7 score. Conclusions: Ideal adherence to LS7 recommendations was associated with lower lifetime risk of CHD for all individuals, especially in those with high genetic susceptibility. In Black participants, adherence to LS7 guidelines contributed to lifetime risk of CHD more so than current PRSs. Improved PRSs are needed to properly evaluate genetic susceptibility for CHD in diverse populations.

Original languageEnglish (US)
Pages (from-to)808-818
Number of pages11
JournalCirculation
Volume145
Issue number11
DOIs
StatePublished - Mar 15 2022

Bibliographical note

Funding Information:
This study was supported by the National Heart, Lung, and Blood Institute (grant No. R01 HL146860). Paul S. de Vries and Allison Bebo were also supported by American Heart Association (grant no. 18CDA34110116). The ARIC (Atherosclerosis Risk in Communities) study has been funded in whole or part with federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services (contract Nos. HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700004I, HHSN268201700005I, HHSN268200625226C, R01HL087641, R01HL059367, and R01HL086694); and National Human Genome Research Institute (contract U01HG004402). Infrastructure was supported in part by grant No. UL1RR025005, a component of the National Institutes of Health and National Institutes of Health Roadmap for Medical Research.

Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.

Keywords

  • atherosclerosis
  • cohort studies
  • coronary disease
  • genetic predisposition to disease
  • lifestyle
  • public health
  • risk factors

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

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