Life's Simple 7: Not Simple at All?

Caroline Helwick

September 10, 2019

NEW ORLEANS — Life's Simple 7 (LS7), the American Heart Association's 2010 program for enhancing cardiovascular health in the US population, has fallen far short of its lofty goals, new research suggests.

Out of a possible 14 points for ideal health, average individual scores are less than half that. Over an 18-year period ending 2016, health status has actually declined, researchers reported here at the American Heart Association's Hypertension 2019 Scientific Sessions.

"Non-Hispanic white women under the age of 45 had the best scores — 50% were in what we call the ideal range (10 - 14) — but no other group came close to this," said Brent Egan, MD, of the University of South Carolina School of Medicine, Greenville.

The LS7 program was developed by the American Heart Association to track and improve cardiovascular risk and outcomes as part of its strategic Impact Goal for 2020 and beyond.

Demographic factors were associated with large differences in LS7 scores. No group had optimal scores or showed a reduction in risk factors over time, though in general fewer people are now smoking. Also, compared with the earliest period (1999-2004), no improvements in cardiovascular risk factors were observed for the later time periods.

Life's Simple 7

LS7 focuses on seven metrics related to cardiovascular and total health: smoking, diet, physical activity, body weight, blood pressure, cholesterol, and blood glucose levels in the absence of pharmacological treatment. The 10-year goal was a 20% reduction in cardiovascular disease and stroke-related mortality by 2020 and a 20% improvement in cardiovascular health for all Americans.

Individuals who achieve the seven metrics have been shown to not only have less cardiovascular disease, but also less kidney disease, lung disease, and even cancer. "It's a way to total health," Egan said. "If we could improve Life's Simple 7, we would have a lot less disease. What we've looked at here are the factors that help determine whether people have higher or lower scores on these metrics."

LS7 variables were assessed in 32,803 participants of the National Health and Nutrition Examination Survey (NHANES) program between 1999 and 2016. All were 20 years of age and older; non-Hispanic white, non-Hispanic black, or Hispanic; and free of cardiovascular disease.

For each LS7 item, 0 points were assigned for poor status, 1 point for intermediate status, and 2 points for optimal status. The maximum LS7 score was 14.

In the analysis, mean LS7 scores were below the ideal range of 10 to 14 in all demographic groups, with values ranging from a high of 9.3 for non-Hispanic white females < 45 years of age to a low of 6.3 for non-Hispanic black females ≥ 45 years old. LS7 scores fell dramatically with age.

"In our multivariable analysis, we found that age was the most powerful factor. People who were over the age of 45 were only about 10% likely to have good LS7 scores. There's a huge age-related decline," Eagan noted.

LS7 scores were higher in non-Hispanic whites and Hispanics than non-Hispanic blacks, in women (vs men), and in better-educated and higher-income participants. In the multivariable analysis, some of the strongest variables were as follows (odds ratios are shown for factors associated with ideal vs low LS7 scores):

  • College degree: 4.04

  • Income ≥ 400% of poverty level: 2.80

  • Women gender: 1.37

  • Non-Hispanic black race: 0.44

  • Age ≥ 45 years: 0.11

Individuals with health insurance did not fare better than those without, he added, "because health insurance doesn't seem to prevent these problems."

Compared with non-Hispanic whites, who had the highest mean scores, non-Hispanic blacks had much lower scores. Hispanics, on the other hand, had scores comparable to non-Hispanic whites, despite less income, education, and health insurance.

This may partly be explained by the better nutrition documented among Hispanics than among non-Hispanic blacks, which was observed in spite of similarities in socioeconomic status. "That is something important to understand because we often link nutrition to education and income," he commented.

The findings highlight the need for culturally tailored and complementary public and population health programs, beginning early in life, to promote healthy lifestyle patterns and timely access to and adherence with evidence-based care, the investigators maintained.

"Successful programs could reduce the age-related rise in cardiometabolic and other chronic diseases and improve health equity," Egan said.


J. Brian Byrd, MD, MS, assistant professor of internal medicine at the University of Michigan, Ann Arbor, called the research "a very nice piece of work."

Byrd felt a couple of the findings were especially interesting. "For one, the study suggests that our intuition that poverty explains poor [health] measures does not appear to be fully supported. In fact, this study is evidence to the contrary that poverty is not the complete answer. According to these data, the story is more complex, although I'm certain that income plays a role," he said.

"The most discouraging finding was that in the period 2005 to 2010, people were succeeding more in keeping risk factors under control, compared to more recent years," he added. "Things seem to be getting worse over time."

The study suggests there is a need for more awareness and more motivation to live in healthy ways, he said. "But it's complicated, at the end of the day. The message is important with respect to getting risk factors under control in all populations, to improve health."

Egan and Byrd have disclosed no relevant financial relationships.

American Heart Association's Hypertension 2019 Scientific Sessions: Abstract P2060. Presented September 7, 2019.

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