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Interrelationships Between American Heart Association's Life's Simple 7, ECG Silent Myocardial Infarction, and
Muhammad Imtiaz Ahmad1, Parag Anilkumar Chevli1, Harsh Barot1
11 Section on Hospital Medicine Department of Internal Medicine Wake Forest School of Medicine Winston-Salem NC.
Insights
Maintaining ideal cardiovascular health (CVH) reduces silent myocardial infarction (SMI) risk. The combination of poor CVH and SMI significantly increases cardiovascular disease (CVD) mortality risk, highlighting the importance of optimal CVH.
Area of Science:
- Cardiology
- Preventive Medicine
- Public Health
Background:
- Cardiovascular health (CVH) is assessed using metrics like Life's Simple 7 (LS7).
- Silent myocardial infarction (SMI) is myocardial infarction without a clinical diagnosis.
- The interplay between CVH, SMI, and cardiovascular disease (CVD) mortality requires further investigation.
Purpose of the Study:
- To examine the associations between baseline CVH, SMI, and subsequent CVD mortality.
- To determine if SMI modifies the relationship between CVH and CVD mortality.
Main Methods:
- Analysis of 6766 participants from the National Health and Nutrition Examination Survey.
- Categorization of CVH into poor, intermediate, and ideal based on LS7 scores.
- Cox proportional hazard analysis to assess CVD mortality risk, stratified by SMI status.
Main Results:
- Ideal CVH was linked to a 69% lower odds of SMI compared to poor CVH.
- In patients without SMI, intermediate and poor CVH increased CVD mortality risk.
- In patients with SMI, the increased CVD mortality risk associated with intermediate and poor CVH was substantially amplified.
Conclusions:
- Ideal CVH is associated with a reduced risk of developing SMI.
- The co-occurrence of SMI and poor CVH significantly worsens prognosis and increases CVD mortality.
- Maintaining ideal CVH is crucial for preventing adverse cardiovascular outcomes.
Abstract:
Background We examined the interrelationships among cardiovascular health (CVH), assessed by the American Heart Association's Life's Simple 7 (LS7) health metrics, silent myocardial infarction (SMI), and cardiovascular disease (CVD) mortality. Methods and Results This analysis included 6766 participants without a history of coronary heart disease from the Third Report of the National Health and Nutrition Examination Survey. Poor, intermediate, and ideal CVH were defined as an LS7 score of 0 to 4, 5 to 9, and 10 to 14, respectively. SMI was defined as ECG evidence of myocardial infarction without a clinical diagnosis of myocardial infarction. Cox proportional hazard analysis was used to examine the association of baseline CVH with CVD death stratified by SMI status on follow-up. In multivariable logistic regression models, ideal CVH was associated with 69% lower odds of SMI compared with poor CVH. During a median follow-up of 14 years, 907 CVD deaths occurred. In patients without SMI, intermediate CVH (hazard ratio, 1.41; 95% CI, 1.14-1.74) and poor CVH (hazard ratio, 2.77; 95% CI, 2.10-3.66) were associated with increased risk of CVD mortality, compared with ideal CVH. However, in the presence of SMI, the magnitude of these associations almost doubled (hazard ratio, 2.17 [95% CI, 1.42-3.32] for intermediate CVH and hazard ratio, 6.28 [95% CI, 3.02-13.07] for poor CVH). SMI predicted a significant increased risk of CVD mortality in the intermediate and poor CVH subgroups but a nonsignificant increased risk in the ideal CVH subgroup. Conclusions Ideal CVH is associated with a lower risk of SMI, and concomitant presence of SMI and poor CVH is associated with a worse prognosis. These novel findings underscore the potential role of maintaining ideal CVH in preventing future CVD outcomes.