title: American Heart Association's Life's Simple 7: Avoiding Heart Failure and Preserving Cardiac Structure and Function.
abstract: BACKGROUND
  Many people may underappreciate the role of lifestyle in avoiding heart failure. We estimated whether greater adherence in middle age to American Heart Association's Life's Simple 7 guidelines—on smoking, body mass, physical activity, diet, cholesterol, blood pressure, and glucose—is associated with lower lifetime risk of heart failure and greater preservation of cardiac structure and function in old age.
  
  
  METHODS
  We studied the population-based Atherosclerosis Risk in Communities Study cohort of 13,462 adults ages 45-64 years in 1987-1989. From the 1987-1989 risk factor measurements, we created a Life's Simple 7 score (range 0-14, giving 2 points for ideal, 1 point for intermediate, and 0 points for poor components). We identified 2218 incident heart failure events using surveillance of hospital discharge and death codes through 2011. In addition, in 4855 participants free of clinical cardiovascular disease in 2011-2013, we performed echocardiography from which we quantified left ventricular hypertrophy and diastolic dysfunction.
  
  
  RESULTS
  One in four participants (25.5%) developed heart failure through age 85 years. Yet, this lifetime heart failure risk was 14.4% for those with a middle-age Life's Simple 7 score of 10-14 (optimal), 26.8% for a score of 5-9 (average), and 48.6% for a score of 0-4 (inadequate). Among those with no clinical cardiovascular event, the prevalence of left ventricular hypertrophy in late life was approximately 40% as common, and diastolic dysfunction was approximately 60% as common, among those with an optimal middle-age Life's Simple 7 score, compared with an inadequate score.
  
  
  CONCLUSIONS
  Greater achievement of American Heart Association's Life's Simple 7 in middle age is associated with a lower lifetime occurrence of heart failure and greater preservation of cardiac structure and function.
authors.affiliation: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. Electronic address: folso001@umn.edu.
authors.forename: Aaron R
authors.initials: AR
authors.lastname: Folsom
authors.affiliation: Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Mass.
authors.forename: Amil M
authors.initials: AM
authors.lastname: Shah
authors.affiliation: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis.
authors.forename: Pamela L
authors.initials: PL
authors.lastname: Lutsey
authors.affiliation: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis.
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Roetker
authors.affiliation: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Alonso
authors.affiliation: Department of Epidemiology, University of North Carolina, Chapel Hill.
authors.forename: Christy L
authors.initials: CL
authors.lastname: Avery
authors.affiliation: Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minn.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Miedema
authors.affiliation: Cardiology Division, University of Minnesota Medical School, Minneapolis.
authors.forename: Suma
authors.initials: S
authors.lastname: Konety
authors.affiliation: Division of Cardiology, Department of Medicine, University of North Carolina, Chapel Hill.
authors.forename: Patricia P
authors.initials: PP
authors.lastname: Chang
authors.affiliation: Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Mass.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000572:American Heart Association; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000517:prevention & control; D002784:Cholesterol; D004032:Diet; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006321:Heart / Q000033:anatomy & histology / Q000502:physiology*; D006333:Heart Failure / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012307:Risk Factors; D000074606:Smoking Prevention; D014481:United States
chemical_list: D001786:Blood Glucose; D002784:Cholesterol
keywords: Heart failure; Prospective study; Risk factors