National Trends in American Heart Association Revised Life's Simple 7 Metrics Associated With Risk of Mortality Among US Adults

IMPORTANCE: The American Heart Association (AHA) introduced the Life’s Simple 7 (LS7) metrics to assess and promote cardiovascular health. However, several shortcomings of these metrics have been identified. Therefore, a revised set of LS7 metrics was developed. OBJECTIVES: To evaluate national trends in the metrics addressed by the revised LS7 and the individual and combined associations of the revised LS7 metrics with all-cause and cause-specific mortality and to compare these measures with the AHA recommended LS7 metrics. DESIGN, SETTING, AND PARTICIPANTS: This national cross-sectional study used data from the National Health and Nutrition Examination Survey from 1988 to 2016. The revised LS7 metrics included a combination of the body mass index and waist to hip ratio, Healthy Eating Index–2010, and a lower blood pressure threshold of greater than or equal to 130/80 mm Hg in addition to physical activity, smoking, total cholesterol, and fasting blood glucose. Data for this study were analyzed from June 1, 2017, to December 31, 2017. MAIN OUTCOMES AND MEASURES: The primary outcome was all-cause mortality. The secondary outcome was cancer and cardiovascular disease (CVD) mortality. RESULTS: Data were available for 13 606 adults in 1988 to 1994 (7329 [53%] female; mean [SD] age, 47 [17.7] years), 6360 in 1999 to 2004 (3442 [54%] female; mean [SD] age, 47 [18.6] years), 10 618 in 2005 to 2010 (5428 [51%] female; mean [SD] age, 47 [17.5] years), and 10 773 in 2011 to 2016 (5474 [50%] female; mean [SD] age, 48 [17.4] years). Compared with a revised LS7 score of 0 to 1, the adjusted hazard ratios for a revised LS7 score of 5 to 7 were 0.46 (95% CI, 0.35-0.61) for all-cause mortality, 0.42 (95% CI, 0.25-0.68) for cancer mortality, and 0.37 (95% CI, 0.24-0.55) for CVD mortality, respectively. The adjusted hazard ratios for participants who met 6 or more AHA recommended ideal LS7 metrics were 0.49 (95% CI, 0.33-0.74) for all-cause mortality, 0.60 (95% CI, 0.29-1.25) for cancer mortality, and 0.24 (95% CI, 0.13-0.47) for CVD mortality. Participants with a body mass index of 29.9 or less but without central obesity were independently associated with lower risk of all-cause and CVD mortality. Blood pressure was associated with 36.7% or more of the observed population-attributable fraction of mortality. CONCLUSIONS AND RELEVANCE: The individual revised LS7 metrics with modified criteria regarding weight, blood pressure, and diet provide more information about factors associated with cancer mortality than the original AHA LS7 metrics.