Journal of the American Heart AssociationJun 29, 2017

Life's Simple 7 and New Cases of Heart Failure in a Diverse Population Study

Circadian Biology Weekly Brief ↗PubMed ↗DOI ↗

Updated Mar 27, 2026

Abstract

During a median follow-up of 12.2 years, 262 (4%) participants developed heart failure.

The incidence of heart failure decreased significantly as the number of ideal Life's Simple 7 metrics increased.
Participants with 0 to 1 ideal metrics had an incidence of 5.9 heart failure cases per 1000 person-years, compared to 0.6 per 1000 person-years for those with 6 to 7 ideal metrics.
Hazard ratios for heart failure were 0.57 for average LS7 scores (9-10 points) and 0.31 for optimal scores (11-14 points) compared to inadequate scores (0-8 points).
This pattern was consistent across four racial/ethnic groups: white, Chinese American, black, and Hispanic.

Simplified

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.

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Life's Simple 7 and New Cases of Heart Failure in a Diverse Population Study

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