Life's Simple 7 and peripheral artery disease: The Multi-Ethnic Study of Atherosclerosis

Authors: UNKART, JONATHAN - University Of California; ALLISON, MATTHEW - University Of California; CRIQUI, MICHAEL - University Of California; MCDERMOTT, MARY - Northwestern University; WOOD, ALEXIS - Children'S Nutrition Research Center (CNRC); FOLSOM, AARON - University Of Minnesota; LLOYD-JONES, DONALD - Northwestern University; RASMUSSEN-TORVIK, LAURA - Northwestern University; ALLEN, NORRINA - Northwestern University; BURKE, GREGORY - Wake Forest University; SZKLO, MOYSES - Johns Hopkins University; CUSHMAN, MARY - University Of Vermont College Of Medicine; MCCLELLAND, ROBYN - University Of Washington; WASSEL, CHRISTINA - University Of Vermont College Of Medicine

Submitted to: American Journal of Preventive Medicine
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 10/25/2018
Publication Date: 12/13/2018
Citation: Unkart, J.T., Allison, M.A., Criqui, M.H., McDermott, M.M., Wood, A.C., Folsom, A.R., Lloyd-Jones, D., Rasmussen-Torvik, L.J., Allen, N., Burke, G., Szklo, M., Cushman, M., McClelland, R.L., Wassel, C.L. 2018. Life's Simple 7 and peripheral artery disease: The Multi-Ethnic Study of Atherosclerosis. American Journal of Preventive Medicine. https://doi.org/10.1016/j.amepre.2018.09.021.
DOI: https://doi.org/10.1016/j.amepre.2018.09.021

Interpretive Summary: Obesity is a risk factor for peripheral artery disease (PAD), which affects approximately 8.5 million Americans and increases the risk of death due to cardiovascular events significantly in both men and women. Low ankle brachial index (ABI) is used in diagnosing PAD. Additionally, several cardiovascular problems, death, and other health problems including quality of life issues are related to ABI. In 2010, the American Heart Association (AHA) developed a metric, the Life's Simple 7 (LS7), in order to monitor the progress towards AHA's 2020 impact goal to improve cardiovascular health by 2020. LS7 can be used to calculate an overall cardiovascular health score, and to assess the risk of developing many diseases, such as cancer, stroke, diabetes, and heart failure. However, the relationship of LS7 with the risk of PAD has not been studied. To address this, we used data from 5,529 ethnically diverse men and women that participated in the Multi-Ethnic Study of Atherosclerosis (MESA). Overall, we found that participants who scored higher on the LS7 metric were significantly less likely to develop PAD over a 15 year period and had lower ABI. Regarding individual LS7 components, not all of the components were related to PAD and ABI. LS7 categories for smoking, glucose level, and blood pressure were found to be significantly related to the development of PAD. LS7 categories cholesterol, physical activity, healthy diet and body weight were not related to the development of PAD. The findings of this study further strengthen the importance of the LS7 and the need to aggressively target populations that do not meet optimum levels of cardiovascular health. The information from this study will be useful to clinicians who have to counsel individuals at risk of PAD on the best strategies to adopt, and to help those with PAD prevent disease progression. The information in this study may also be useful to those who have to make policy decisions on guidelines for maintaining good health, and organizations such as the AHA.

Technical Abstract: In 2010, the American Heart Association initiated Life's Simple 7 with the goal of significantly improving cardiovascular health by the year 2020. The association of Life's Simple 7 with risk of peripheral artery disease has not been thoroughly explored. Racially diverse individuals from the Multi-Ethnic Study of Atherosclerosis (2000-2012) were followed for incident peripheral artery disease (ankle brachial index <=0.90) and decline in ankle brachial index (>=0.15) over approximately 10 years of follow-up. Cox and logistic regression were used to assess associations of individual Life's Simple 7 components (score 0-2) and overall Life's Simple 7 score (score 0-14) with incident peripheral artery disease and ankle brachial index decline, respectively, adjusted for age, sex, race/ethnicity, education, and income. Analyses were performed in 2016-2018. Of 5,529 participants, 251 (4.5%) developed incident peripheral artery disease; 419 (9.8%) of 4,267 participants experienced a decline in ankle brachial index. Each point higher for the overall Life's Simple 7 score was associated with a 17% lower rate of incident peripheral artery disease (hazard ratio=0.83, 95% CI=0.78, 0.88, p<0.001). Additionally, each point higher in overall Life's Simple 7 was associated with a 0.94-fold lower odds of decline in ankle brachial index (OR=0.94, 95% CI=0.87, 0.97, p=0.003). Four components (smoking, physical activity, glucose, and blood pressure) were associated with incident peripheral artery disease and two (smoking and glucose) with decline in ankle brachial index. Better cardiovascular health as measured by Life's Simple 7 is associated with lower incidence of peripheral artery disease and less decline in ankle brachial index. Use of the Life's Simple 7 to target modifiable health behaviors may aid in decreasing the population burden of peripheral artery disease-related morbidity and mortality.