Objective: To examine the prevalence of the Life’s Simple 7 (LS7) metric and its associations with measures of subclinical atherosclerosis in a community-based cohort of South Asians in the U.S.
Methods: We conducted a cross-sectional analysis of data from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study consisting of 875 South Asians (mean age 55 y, SD=9.4, 47% women). Each LS7 component was assigned a score of 0 (poor), 1 (intermediate) and 2 (ideal) and these scores were summed to derive an overall cardiovascular health score ranging from 0 (poor adherence to AHA guidelines) to 14 (perfect adherence to AHA guidelines).Carotid intima media thickness (cIMT) and coronary artery calcium (CAC) were measures of subclinical atherosclerosis. Multivariate linear and multinomial logistic regression models were used to examine associations between the overall cardiovascular health score, modeled as tertiles, and subclinical atherosclerosis. Covariates included age, sex, insurance type, length of residency in the U.S., and acculturation.
Results: The prevalence of having 0, 1, 2, 3, 4, 5, 6, and 7 ideal metrics was 1.6%, 8.3%, 20.1%, 27.9%, 21.6%, 15.8%, 4.7%, and 0%, respectively. The overall LS7 score ranged from 3-13, with median of 9; men had a lower median score compared with women (9 vs. 10, p<0.05). In adjusted analyses, compared to those in the lowest tertile, those in upper tertiles had lower common cIMT (score:9-10: β= -0.06, 95% CI: -0.09 to -0.02; score:11-13: β= -0.07, 95% CI: -0.11 to -0.04), and internal cIMT (score:9-10: β= -0.14, 95% CI: -0.21 to -0.08; score:11-13: β= -0.14, 95% CI: -0.21 to -0.07). Higher LS7 scores were also associated with decreased odds of CAC. As compared to the lowest tertile of LS7, those in the highest tertile had 70% (OR=0.30, 95% CI: 0.19 to 0.47) lower odds of having CAC between 1 and 400, and 79% (OR=0.21, 95% CI: 0.08 to 0.54) lower odds of having CAC over 400.
Conclusion: This is the first study to show that better cardiovascular health, as defined by the LS7 metrics, is associated with a lower burden of subclinical atherosclerosis in middle- and older-aged U.S. South Asians. Prospective follow-up of MASALA will determine whether the LS7 metric will predict incident atherosclerotic vascular disease events.