title: Ideal Cardiovascular Health, Cardiovascular Remodeling, and Heart Failure in Blacks: The Jackson Heart Study.
abstract: BACKGROUND
  The lifetime risk of heart failure (HF) is higher in the black population than in other racial groups in the United States.
  
  
  RESULTS
  We measured the Life's Simple 7 ideal cardiovascular health metrics in 4195 blacks in the JHS (Jackson Heart Study; 2000-2004). We evaluated the association of Simple 7 metrics with incident HF and left ventricular structure and function by cardiac magnetic resonance (n=1188). Mean age at baseline was 54.4 years (65% women). Relative to 0 to 2 Simple 7 factors, blacks with 3 factors had 47% lower incident HF risk (hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.39-0.73;P<0.0001); and those with ≥4 factors had 61% lower HF risk (HR, 0.39; 95% CI, 0.24-0.64;P=0.0002). Higher blood pressure (HR, 2.32; 95% CI, 1.28-4.20;P=0.005), physical inactivity (HR, 1.65; 95% CI, 1.07-2.55;P=0.02), smoking (HR, 2.04; 95% CI, 1.43-2.91;P<0.0001), and impaired glucose control (HR, 1.76; 95% CI, 1.34-2.29;P<0.0001) were associated with incident HF. The age-/sex-adjusted population attributable risk for these Simple 7 metrics combined was 37.1%. Achievement of ideal blood pressure, ideal body mass index, ideal glucose control, and nonsmoking was associated with less likelihood of adverse cardiac remodeling by cardiac magnetic resonance.
  
  
  CONCLUSIONS
  Cardiovascular risk factors in midlife (specifically elevated blood pressure, physical inactivity, smoking, and poor glucose control) are associated with incident HF in blacks and represent targets for intensified HF prevention.
authors.affiliation: From the Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (A.S., R.K.); Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC (S.T.); Department of Medicine, University of Mississippi Medical Center, Jackson (A.C.); Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (J.C.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University, Nashville, TN (J.G.T.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (J.L.); Department of Medicine, University of Massachusetts Medical School, Worcester (J.E.F.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (S.D., R.V.S.); Department of Pediatrics, Children's Hospital Boston, MA (S.d.F.); Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (D.M.); Field Center, Jackson Heart Study, Jackson State University, MS (S.M.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, MA (K.L.T.); and Department of Medicine, Cardiovascular Medicine Division, University of Michigan, Ann Arbor (V.L.M.).
authors.forename: Aferdita
authors.initials: A
authors.lastname: Spahillari
authors.affiliation: From the Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (A.S., R.K.); Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC (S.T.); Department of Medicine, University of Mississippi Medical Center, Jackson (A.C.); Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (J.C.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University, Nashville, TN (J.G.T.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (J.L.); Department of Medicine, University of Massachusetts Medical School, Worcester (J.E.F.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (S.D., R.V.S.); Department of Pediatrics, Children's Hospital Boston, MA (S.d.F.); Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (D.M.); Field Center, Jackson Heart Study, Jackson State University, MS (S.M.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, MA (K.L.T.); and Department of Medicine, Cardiovascular Medicine Division, University of Michigan, Ann Arbor (V.L.M.).
authors.forename: Sameera
authors.initials: S
authors.lastname: Talegawkar
authors.affiliation: From the Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (A.S., R.K.); Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC (S.T.); Department of Medicine, University of Mississippi Medical Center, Jackson (A.C.); Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (J.C.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University, Nashville, TN (J.G.T.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (J.L.); Department of Medicine, University of Massachusetts Medical School, Worcester (J.E.F.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (S.D., R.V.S.); Department of Pediatrics, Children's Hospital Boston, MA (S.d.F.); Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (D.M.); Field Center, Jackson Heart Study, Jackson State University, MS (S.M.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, MA (K.L.T.); and Department of Medicine, Cardiovascular Medicine Division, University of Michigan, Ann Arbor (V.L.M.).
authors.forename: Adolfo
authors.initials: A
authors.lastname: Correa
authors.affiliation: From the Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (A.S., R.K.); Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC (S.T.); Department of Medicine, University of Mississippi Medical Center, Jackson (A.C.); Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (J.C.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University, Nashville, TN (J.G.T.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (J.L.); Department of Medicine, University of Massachusetts Medical School, Worcester (J.E.F.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (S.D., R.V.S.); Department of Pediatrics, Children's Hospital Boston, MA (S.d.F.); Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (D.M.); Field Center, Jackson Heart Study, Jackson State University, MS (S.M.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, MA (K.L.T.); and Department of Medicine, Cardiovascular Medicine Division, University of Michigan, Ann Arbor (V.L.M.).
authors.forename: J Jeffrey
authors.initials: JJ
authors.lastname: Carr
authors.affiliation: From the Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (A.S., R.K.); Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC (S.T.); Department of Medicine, University of Mississippi Medical Center, Jackson (A.C.); Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (J.C.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University, Nashville, TN (J.G.T.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (J.L.); Department of Medicine, University of Massachusetts Medical School, Worcester (J.E.F.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (S.D., R.V.S.); Department of Pediatrics, Children's Hospital Boston, MA (S.d.F.); Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (D.M.); Field Center, Jackson Heart Study, Jackson State University, MS (S.M.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, MA (K.L.T.); and Department of Medicine, Cardiovascular Medicine Division, University of Michigan, Ann Arbor (V.L.M.).
authors.forename: James G
authors.initials: JG
authors.lastname: Terry
authors.affiliation: From the Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (A.S., R.K.); Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC (S.T.); Department of Medicine, University of Mississippi Medical Center, Jackson (A.C.); Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (J.C.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University, Nashville, TN (J.G.T.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (J.L.); Department of Medicine, University of Massachusetts Medical School, Worcester (J.E.F.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (S.D., R.V.S.); Department of Pediatrics, Children's Hospital Boston, MA (S.d.F.); Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (D.M.); Field Center, Jackson Heart Study, Jackson State University, MS (S.M.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, MA (K.L.T.); and Department of Medicine, Cardiovascular Medicine Division, University of Michigan, Ann Arbor (V.L.M.).
authors.forename: João
authors.initials: J
authors.lastname: Lima
authors.affiliation: From the Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (A.S., R.K.); Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC (S.T.); Department of Medicine, University of Mississippi Medical Center, Jackson (A.C.); Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (J.C.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University, Nashville, TN (J.G.T.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (J.L.); Department of Medicine, University of Massachusetts Medical School, Worcester (J.E.F.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (S.D., R.V.S.); Department of Pediatrics, Children's Hospital Boston, MA (S.d.F.); Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (D.M.); Field Center, Jackson Heart Study, Jackson State University, MS (S.M.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, MA (K.L.T.); and Department of Medicine, Cardiovascular Medicine Division, University of Michigan, Ann Arbor (V.L.M.).
authors.forename: Jane E
authors.initials: JE
authors.lastname: Freedman
authors.affiliation: From the Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (A.S., R.K.); Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC (S.T.); Department of Medicine, University of Mississippi Medical Center, Jackson (A.C.); Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (J.C.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University, Nashville, TN (J.G.T.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (J.L.); Department of Medicine, University of Massachusetts Medical School, Worcester (J.E.F.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (S.D., R.V.S.); Department of Pediatrics, Children's Hospital Boston, MA (S.d.F.); Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (D.M.); Field Center, Jackson Heart Study, Jackson State University, MS (S.M.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, MA (K.L.T.); and Department of Medicine, Cardiovascular Medicine Division, University of Michigan, Ann Arbor (V.L.M.).
authors.forename: Saumya
authors.initials: S
authors.lastname: Das
authors.affiliation: From the Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (A.S., R.K.); Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC (S.T.); Department of Medicine, University of Mississippi Medical Center, Jackson (A.C.); Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (J.C.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University, Nashville, TN (J.G.T.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (J.L.); Department of Medicine, University of Massachusetts Medical School, Worcester (J.E.F.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (S.D., R.V.S.); Department of Pediatrics, Children's Hospital Boston, MA (S.d.F.); Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (D.M.); Field Center, Jackson Heart Study, Jackson State University, MS (S.M.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, MA (K.L.T.); and Department of Medicine, Cardiovascular Medicine Division, University of Michigan, Ann Arbor (V.L.M.).
authors.forename: Robb
authors.initials: R
authors.lastname: Kociol
authors.affiliation: From the Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (A.S., R.K.); Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC (S.T.); Department of Medicine, University of Mississippi Medical Center, Jackson (A.C.); Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (J.C.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University, Nashville, TN (J.G.T.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (J.L.); Department of Medicine, University of Massachusetts Medical School, Worcester (J.E.F.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (S.D., R.V.S.); Department of Pediatrics, Children's Hospital Boston, MA (S.d.F.); Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (D.M.); Field Center, Jackson Heart Study, Jackson State University, MS (S.M.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, MA (K.L.T.); and Department of Medicine, Cardiovascular Medicine Division, University of Michigan, Ann Arbor (V.L.M.).
authors.forename: Sarah
authors.initials: S
authors.lastname: de Ferranti
authors.affiliation: From the Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (A.S., R.K.); Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC (S.T.); Department of Medicine, University of Mississippi Medical Center, Jackson (A.C.); Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (J.C.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University, Nashville, TN (J.G.T.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (J.L.); Department of Medicine, University of Massachusetts Medical School, Worcester (J.E.F.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (S.D., R.V.S.); Department of Pediatrics, Children's Hospital Boston, MA (S.d.F.); Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (D.M.); Field Center, Jackson Heart Study, Jackson State University, MS (S.M.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, MA (K.L.T.); and Department of Medicine, Cardiovascular Medicine Division, University of Michigan, Ann Arbor (V.L.M.).
authors.forename: Donya
authors.initials: D
authors.lastname: Mohebali
authors.affiliation: From the Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (A.S., R.K.); Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC (S.T.); Department of Medicine, University of Mississippi Medical Center, Jackson (A.C.); Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (J.C.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University, Nashville, TN (J.G.T.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (J.L.); Department of Medicine, University of Massachusetts Medical School, Worcester (J.E.F.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (S.D., R.V.S.); Department of Pediatrics, Children's Hospital Boston, MA (S.d.F.); Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (D.M.); Field Center, Jackson Heart Study, Jackson State University, MS (S.M.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, MA (K.L.T.); and Department of Medicine, Cardiovascular Medicine Division, University of Michigan, Ann Arbor (V.L.M.).
authors.forename: Stanford
authors.initials: S
authors.lastname: Mwasongwe
authors.affiliation: From the Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (A.S., R.K.); Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC (S.T.); Department of Medicine, University of Mississippi Medical Center, Jackson (A.C.); Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (J.C.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University, Nashville, TN (J.G.T.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (J.L.); Department of Medicine, University of Massachusetts Medical School, Worcester (J.E.F.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (S.D., R.V.S.); Department of Pediatrics, Children's Hospital Boston, MA (S.d.F.); Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (D.M.); Field Center, Jackson Heart Study, Jackson State University, MS (S.M.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, MA (K.L.T.); and Department of Medicine, Cardiovascular Medicine Division, University of Michigan, Ann Arbor (V.L.M.).
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Tucker
authors.affiliation: From the Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (A.S., R.K.); Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC (S.T.); Department of Medicine, University of Mississippi Medical Center, Jackson (A.C.); Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (J.C.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University, Nashville, TN (J.G.T.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (J.L.); Department of Medicine, University of Massachusetts Medical School, Worcester (J.E.F.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (S.D., R.V.S.); Department of Pediatrics, Children's Hospital Boston, MA (S.d.F.); Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (D.M.); Field Center, Jackson Heart Study, Jackson State University, MS (S.M.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, MA (K.L.T.); and Department of Medicine, Cardiovascular Medicine Division, University of Michigan, Ann Arbor (V.L.M.). rvshah@partners.org vlmurthy@med.umich.edu.
authors.forename: Venkatesh L
authors.initials: VL
authors.lastname: Murthy
authors.affiliation: From the Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (A.S., R.K.); Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC (S.T.); Department of Medicine, University of Mississippi Medical Center, Jackson (A.C.); Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (J.C.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University, Nashville, TN (J.G.T.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (J.L.); Department of Medicine, University of Massachusetts Medical School, Worcester (J.E.F.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (S.D., R.V.S.); Department of Pediatrics, Children's Hospital Boston, MA (S.d.F.); Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (D.M.); Field Center, Jackson Heart Study, Jackson State University, MS (S.M.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, MA (K.L.T.); and Department of Medicine, Cardiovascular Medicine Division, University of Michigan, Ann Arbor (V.L.M.). rvshah@partners.org vlmurthy@med.umich.edu.
authors.forename: Ravi V
authors.initials: RV
authors.lastname: Shah
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000097:blood / Q000208:ethnology; D015444:Exercise; D005260:Female; D054624:Health Status Disparities; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000208:ethnology* / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D006973:Hypertension / Q000208:ethnology / Q000503:physiopathology; D015994:Incidence; D053208:Kaplan-Meier Estimate; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D008922:Mississippi / Q000453:epidemiology; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D057185:Sedentary Behavior / Q000208:ethnology; D012907:Smoking / Q000009:adverse effects / Q000208:ethnology; D016540:Smoking Cessation; D000074606:Smoking Prevention; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
chemical_list: D001786:Blood Glucose
keywords: blood pressure; body mass index; heart failure; hypertension; risk factors