Journal of the American Heart AssociationMar 13, 2019

Links Between Heart Health Habits, Undetected Heart Attacks, and Heart-Related Deaths

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Updated Mar 31, 2026

Abstract

Ideal cardiovascular health (CVH) is associated with 69% lower odds of silent myocardial infarction (SMI) compared with poor CVH.

Poor and intermediate CVH are linked to increased risk of cardiovascular disease (CVD) mortality.
In patients without silent myocardial infarction (SMI), intermediate CVH is associated with a 41% increased risk of CVD death compared to ideal CVH, while poor CVH shows a 177% increased risk.
The risk associated with poor and intermediate CVH nearly doubles in the presence of SMI.
For patients with SMI, the hazard ratios for CVD mortality are 2.17 for intermediate CVH and 6.28 for poor CVH.
SMI indicates a significant increased risk of CVD mortality in individuals with intermediate and poor CVH, but does not significantly increase risk in those with ideal CVH.

Simplified

Background We examined the interrelationships among cardiovascular health (CVH), assessed by the American Heart Association's Life's Simple 7 (LS7) health metrics, silent myocardial infarction (SMI), and cardiovascular disease (CVD) mortality. Methods and Results This analysis included 6766 participants without a history of coronary heart disease from the Third Report of the National Health and Nutrition Examination Survey. Poor, intermediate, and ideal CVH were defined as an LS7 score of 0 to 4, 5 to 9, and 10 to 14, respectively. SMI was defined as ECG evidence of myocardial infarction without a clinical diagnosis of myocardial infarction. Cox proportional hazard analysis was used to examine the association of baseline CVH with CVD death stratified by SMI status on follow-up. In multivariable logistic regression models, ideal CVH was associated with 69% lower odds of SMI compared with poor CVH. During a median follow-up of 14 years, 907 CVD deaths occurred. In patients without SMI, intermediate CVH (hazard ratio, 1.41; 95% CI, 1.14-1.74) and poor CVH (hazard ratio, 2.77; 95% CI, 2.10-3.66) were associated with increased risk of CVD mortality, compared with ideal CVH. However, in the presence of SMI, the magnitude of these associations almost doubled (hazard ratio, 2.17 [95% CI, 1.42-3.32] for intermediate CVH and hazard ratio, 6.28 [95% CI, 3.02-13.07] for poor CVH). SMI predicted a significant increased risk of CVD mortality in the intermediate and poor CVH subgroups but a nonsignificant increased risk in the ideal CVH subgroup. Conclusions Ideal CVH is associated with a lower risk of SMI, and concomitant presence of SMI and poor CVH is associated with a worse prognosis. These novel findings underscore the potential role of maintaining ideal CVH in preventing future CVD outcomes.

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Links Between Heart Health Habits, Undetected Heart Attacks, and Heart-Related Deaths

Abstract

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