AHA 2010: Seven Factors Linked to Better Cardiovascular Health

Marcia Frellick

MESA trial finds association between lower coronary artery calcium and carotid artery thickness and adherence to AHA "Life's Simple 7" health factors.

More than 20 years of data show that those who achieve seven key health factors have greater longevity and quality of life. The American Heart Association calls them “Life’s Simple 7” and they include:

  • Not smoking
  • Keeping a healthy body weight (BMI of less than 25 kg/m)
  • Having at least 150 minutes of moderate-intensity physical activity or 75 minutes of vigorous-intensity activity (or a combination) each week
  • Eating a healthy diet
  • Keeping cholesterol under 200 mg/dL
  • Keeping blood pressure below 120/80 mm Hg
  • Keeping fasting glucose less than 100 mg/dL

“The assumption has always been that the low rate of cardiovascular disease among people who achieve ideal levels of the health factors is because of the lower burden of atherosclerosis, but this has not been well-studied,” said Tamar Polonsky, MD, lead researcher of the Multi-Ethnic Study of Atherosclerosis (MESA) at Northwestern University Feinberg School of Medicine in Chicago. “So our objective was to determine the association of cardiovascular health with the presence and extent of subclinical cardiovascular disease.”

MESA studied men and women ages 45 to 84 without cardiovascular disease at the time of enrollment. Participants were recruited in 2000 and 2002 and all models were adjusted for age, race and ethnicity and then stratified by sex. The study was complicated by the fact that so few of the patients — only six in the entire cohort -- obtained all seven of the optimal health criteria. Researchers included people who met 6-7 of the ideal criteria in the top group. The rest were classified into intermediate and poor groups. “The greatest percentage achieved only 2-3 of the health criteria – about 40 percent for both men and women,” Polonsky said Monday at the American Heart Association Scientific Sessions 2010 in Chicago.

The MESA study measured the patients’ coronary artery calcium score and carotid intima-media thickness at the start of the study and after an average of three years. Researchers found that the prevalence of coronary artery calcium and carotid artery thickness, both factors for cardiovascular disease, was significantly lower among the ideal group compared with groups who scored at the levels of intermediate or poor for the health factors. Carotid artery thickness increased steadily with worsening health factor levels for both men and women.

“About 50 percent of the men had 6-7 of the ideal factors and a CAC score greater than 0, compared to about 67 percent of the men who had 0-1 of the health criteria. We see a similar pattern for women. About 28 percent of the women had 6-7 of the ideal factors and a CAC greater than 0 compared to 43 percent who had 0-1 ideal health criteria,” Polonsky said.

Polonsky acknowledged some limitations of the study—primarily that researchers were only able to measure factors later in adulthood, that data relied on self-reported information and there was a relatively short period between follow-up health scans. But she said it pointed out the urgency of discovery. “The study showed that that people with higher cardiac factors had lower incidence of cardiovascular disease, but they also had a slower progression,” Polonsky said. She also noted that these results suggest that “the people at the opposite extremes -- the 0-1 -- are on the fast track to developing potentially overt clinical disease. The strength of the association was similar among men and women and across racial and ethnic groups and this really emphasizes the importance of delivering this message to all parts of the population.”