title: The American Heart Association Life's Simple 7 and incident cognitive impairment: The REasons for Geographic And Racial Differences in Stroke (REGARDS) study.
abstract: BACKGROUND
  Life's Simple 7 is a new metric based on modifiable health behaviors and factors that the American Heart Association uses to promote improvements to cardiovascular health (CVH). We hypothesized that better Life's Simple 7 scores are associated with lower incidence of cognitive impairment.
  
  
  RESULTS
  For this prospective cohort study, we included REasons for Geographic And Racial Differences in Stroke (REGARDS) participants aged 45+ who had normal global cognitive status at baseline and no history of stroke (N=17 761). We calculated baseline Life's Simple 7 score (range, 0 to 14) based on smoking, diet, physical activity, body mass index, blood pressure, total cholesterol, and fasting glucose. We identified incident cognitive impairment using a 3-test measure of verbal learning, memory, and fluency obtained a mean of 4 years after baseline. Relative to the lowest tertile of Life's Simple 7 score (0 to 6 points), odds ratios of incident cognitive impairment were 0.65 (0.52, 0.81) in the middle tertile (7 to 8 points) and 0.63 (0.51, 0.79) in the highest tertile (9 to 14 points). The association was similar in blacks and whites, as well as outside and within the Southeastern stroke belt region of the United States.
  
  
  CONCLUSIONS
  Compared with low CVH, intermediate and high CVH were both associated with substantially lower incidence of cognitive impairment. We did not observe a dose-response pattern; people with intermediate and high levels of CVH had similar incidence of cognitive impairment. This suggests that even when high CVH is not achieved, intermediate levels of CVH are preferable to low CVH.
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL (E.L.T., V.J.H.) Department of Health Science, Brigham Young University, Provo, UT (E.L.T.).
authors.forename: Evan L
authors.initials: EL
authors.lastname: Thacker
authors.affiliation: Department of Medicine, University of Vermont College of Medicine , Burlington, VT (S.R.G., M.C.).
authors.forename: Sarah R
authors.initials: SR
authors.lastname: Gillett
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, AL (V.G.W.).
authors.forename: Virginia G
authors.initials: VG
authors.lastname: Wadley
authors.affiliation: Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN (F.W.U.).
authors.forename: Frederick W
authors.initials: FW
authors.lastname: Unverzagt
authors.affiliation: Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL (S.E.J., L.A.M.C.).
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Judd
authors.affiliation: Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL (S.E.J., L.A.M.C.).
authors.forename: Leslie A
authors.initials: LA
authors.lastname: McClure
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL (E.L.T., V.J.H.).
authors.forename: Virginia J
authors.initials: VJ
authors.lastname: Howard
authors.affiliation: Department of Medicine, University of Vermont College of Medicine , Burlington, VT (S.R.G., M.C.).
authors.forename: Mary
authors.initials: M
authors.lastname: Cushman
mesh_terms: D000368:Aged; D000572:American Heart Association; D003072:Cognition Disorders / Q000453:epidemiology / Q000517:prevention & control*; D060825:Cognitive Dysfunction / Q000453:epidemiology / Q000517:prevention & control; D003704:Dementia / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D044469:Racial Groups / Q000706:statistics & numerical data; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012959:Socioeconomic Factors; D020521:Stroke / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
keywords: cardiovascular disease prevention; cardiovascular disease risk factors; cognitive impairment; cognitive tests; lifestyle