title: Life's Simple 7 and incidence of diabetes among American Indians: the Strong Heart Family Study.
abstract: OBJECTIVE
  The American Heart Association's recommendations for optimal health, summarized in Life's Simple 7, have been associated with reduced risk of cardiovascular disease (CVD)-related end points, but no studies have examined the association of these goals with incident type 2 diabetes, which is associated with high risk for CVD. The purpose of this analysis was to examine the associations of Life's Simple 7 goals with incident diabetes among American Indians, a population at high risk of cardiometabolic diseases.
  
  
  METHODS
  Strong Heart Family Study participants without diabetes (n = 1,639) at baseline and who participated in a follow-up examination were included in the analysis. Risk scores ranging from 0 to 7 were created using physical activity, diet, BMI, smoking, blood pressure, fasting glucose, and cholesterol metrics in accordance with Life's Simple 7 goals. Diabetes was defined using 2003 American Diabetes Association criteria, including use of insulin or oral antidiabetes medication or a follow-up fasting plasma glucose level ≥126 mg/dL. Generalized estimating equations were used to examine the association of risk scores with incident diabetes.
  
  
  RESULTS
  During a mean 5-year follow-up (range 4-8 years), we identified 210 cases of incident type 2 diabetes. Compared with participants who achieved 0-1 goals, those who achieved 2-3 or 4+ goals had lower odds of diabetes, with odds ratios = 0.40 (95% CI 0.29-0.56) and 0.11 (95% CI 0.05-0.21), respectively.
  
  
  CONCLUSIONS
  The adoption of as few as two or three Life's Simple 7 goals is associated with a lower risk of diabetes.
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, WACardiovascular Health Research Unit, University of Washington, Seattle, WA amfretts@u.washington.edu.
authors.forename: Amanda M
authors.initials: AM
authors.lastname: Fretts
authors.affiliation: MedStar Health Research Institute, Washington, DCGeorgetown and Howard Universities Center for Clinical and Translational Research, Washington, DC.
authors.forename: Barbara V
authors.initials: BV
authors.lastname: Howard
authors.affiliation: Cardiovascular Health Research Unit, University of Washington, Seattle, WADepartment of Biostatistics, University of Washington, Seattle, WA.
authors.forename: Barbara
authors.initials: B
authors.lastname: McKnight
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, WA.
authors.forename: Glen E
authors.initials: GE
authors.lastname: Duncan
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, WA.
authors.forename: Shirley A A
authors.initials: SA
authors.lastname: Beresford
authors.affiliation: MedStar Health Research Institute, Washington, DC.
authors.forename: Mihriye
authors.initials: M
authors.lastname: Mete
authors.affiliation: Center for American Indian Health Research, University of Oklahoma, Oklahoma City, OK.
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, WACardiovascular Health Research Unit, University of Washington, Seattle, WADepartment of Medicine, University of Washington, Seattle, WA.
authors.forename: David S
authors.initials: DS
authors.lastname: Siscovick
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000572:American Heart Association; D002318:Cardiovascular Diseases / Q000208:ethnology / Q000209:etiology / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology*; D005260:Female; D015438:Health Behavior / Q000208:ethnology*; D006801:Humans; D015994:Incidence; D007198:Indians, North American / Q000706:statistics & numerical data*; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning / Q000592:standards; D010349:Patient Compliance / Q000208:ethnology / Q000706:statistics & numerical data; D012307:Risk Factors; D040242:Risk Reduction Behavior; D014481:United States / Q000453:epidemiology; D055815:Young Adult