Introduction: The American Heart Association’s Life’s Simple 7 (AHA LS7) is a measure of cardiovascular health that evaluates seven lifestyle behaviors and clinical risk factors to track the population’s progress towards the AHA 2020 strategic goals. Sleep is an emerging lifestyle risk factor for cardiovascular disease that is not currently included in the AHA LS7. Our aim was to assess the relation of sleep with the AHA LS7 within a diverse sample of women.
Hypothesis: We hypothesized that a longer sleep duration, good sleep quality, low risk for obstructive sleep apnea (OSA), and absence of insomnia and snoring would be associated with a higher global AHA LS7 score and its component scores, as measures of compliance to overall and individual AHA LS7 guidelines.
Methods: Baseline data from the AHA Go Red for Women Strategically Focused Research Network cohort at Columbia University Medical Center, an ongoing prospective study, were examined (n=323, >50% minority/Hispanic, mean age: 39y, range: 20-76y). Sleep was self-reported using validated questionnaires. A standardized scoring system was used to compute the global AHA LS7 score using criteria for smoking, diet, physical activity, body mass index (BMI), blood pressure (BP), total cholesterol, and fasting glucose. Women received a score of 2 (optimal), 1 (average), or 0 (poor) based on their compliance with each AHA LS7 guideline. The seven component scores were summed to create the global AHA LS7 score. T-tests, Fischer’s exact test and multivariable-adjusted regression models were used to evaluate associations between sleep and the global AHA LS7 score and its components.
Results: The median global AHA LS7 score was 10; 31.3%, 33.3% and 35.3% of women had a score of 0-8 (poor), 9-10 (average), and 11-14 (optimal), respectively. Participants with sleep duration ≥7 hours, lack of insomnia and snoring, and low risk for OSA were more likely to meet ≥4 of the AHA LS7 metrics (p≤0.04). Those with sleep duration ≥7 hours, good sleep quality, no insomnia and snoring, and at low risk of OSA were more likely to meet the AHA LS7 optimal guideline for physical activity, BMI, BP, glucose, and cholesterol (p≤0.04). In multivariable-adjusted linear regression models, a lower global AHA LS7 score was associated with a higher Pittsburgh Sleep Quality Index, indicative of poorer sleep quality (β=-0.08, p=0.019), higher insomnia severity index (β=-0.05, p=0.027), and higher risk for OSA (β=-0.84, p=0.016).
Conclusions: In this cohort of women, better sleep habits were associated with meeting the AHA LS7 guidelines. Our results warrant confirmation in larger prospective studies and within other population groups, but nonetheless highlight the potential importance of screening for sleep habits in conjunction with other lifestyle behaviors to identify those at risk of cardiovascular disease.