title: "Life's Simple 7" and Long-Term Mortality After Stroke.
abstract: BACKGROUND
  The American Heart Association developed criteria dubbed "Life's Simple 7" defining ideal cardiovascular health: not smoking, regular physical activity, healthy diet, maintaining normal weight, and controlling cholesterol, blood pressure, and blood glucose levels. The impact of achieving these metrics on survival after stroke is unknown. We aimed to determine cardiovascular health scores among stroke survivors in the United States and to assess the link between cardiovascular health score and all-cause mortality after stroke.
  
  
  RESULTS
  We assessed cardiovascular health metrics among a nationally representative sample of US adults with stroke (n=420) who participated in the National Health and Nutrition Examination Surveys in 1988-1994 (with mortality assessment through 2006). We determined cumulative all-cause mortality by cardiovascular health score under the Cox proportional hazards model after adjusting for sociodemographic characteristics and comorbidities. No stroke survivors met all 7 ideal health metrics. Over a median duration of 98 months (range, 53-159), there was an inverse dose-dependent relationship between number of ideal lifestyle metrics met and 10-year adjusted mortality: 0 to 1: 57%; 2: 48%; 3: 43%; 4: 36%; and ≥5: 30%. Those who met ≥4 health metrics had lower all-cause mortality than those who met 0 to 1 (hazard ratio, 0.51; 95% confidence interval, 0.28-0.92). After adjusting for sociodemographics, higher health score was associated with lower all-cause mortality (trend P-value, 0.022).
  
  
  CONCLUSIONS
  Achieving a greater number of ideal cardiovascular health metrics is associated with lower long-term risk of dying after stroke. Specifically targeting "Life's Simple 7" goals might have a profound impact, extending survival after stroke.
authors.affiliation: Department of Neurology, University of Southern California, Los Angeles, CA (M.P.L., A.T.) Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA (M.P.L., A.T.).
authors.forename: Michelle P
authors.initials: MP
authors.lastname: Lin
authors.affiliation: Department of Neurology, Medical University of South Carolina, Charleston, SC (B.O.).
authors.forename: Bruce
authors.initials: B
authors.lastname: Ovbiagele
authors.affiliation: Department of Biomathematics, University of California at Los Angeles, CA (D.M.).
authors.forename: Daniela
authors.initials: D
authors.lastname: Markovic
authors.affiliation: Department of Neurology, University of Southern California, Los Angeles, CA (M.P.L., A.T.) Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA (M.P.L., A.T.).
authors.forename: Amytis
authors.initials: A
authors.lastname: Towfighi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D001835:Body Weight; D002423:Cause of Death; D016009:Chi-Square Distribution; D003920:Diabetes Mellitus / Q000097:blood / Q000401:mortality / Q000628:therapy; D004032:Diet / Q000009:adverse effects / Q000401:mortality; D050171:Dyslipidemias / Q000097:blood / Q000401:mortality / Q000628:therapy; D005260:Female; D006040:Goals; D015438:Health Behavior; D006801:Humans; D006973:Hypertension / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D008055:Lipids / Q000097:blood; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009749:Nutrition Surveys; D009765:Obesity / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control; D016017:Odds Ratio; D011379:Prognosis; D016016:Proportional Hazards Models; D065840:Protective Factors; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012907:Smoking / Q000009:adverse effects / Q000401:mortality; D016540:Smoking Cessation; D000074606:Smoking Prevention; D020521:Stroke / Q000097:blood / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D008055:Lipids
keywords: American Heart Association; Life's Simple 7; Stroke; all‐cause mortality; ideal cardiovascular health metrics