Background: The American Heart Association defines ideal cardiovascular health through the achievement of seven medical and behavioral metrics, dubbed “Life’s Simple 7s” (LS7): abstaining from smoking; maintaining regular physical activity, normal body mass index, blood pressure, glucose, and total cholesterol levels, and eating a healthy diet. We previously reported poor cardiovascular health among US stroke survivors; however, recent prevalence and predictors of cardiovascular health remain unknown.
Objectives: To determine the prevalence, pattern, and predictors of ideal LS7 among stroke survivors in the United States.
Design/Methods: We analyzed prevalence and predictors of achieving ideal LS7 goals in a nationally representative sample of 1,597 US adults (≥18 years) with self-reported stroke, who participated in NHANES from 1988 through 2014. We assessed odds of low (0-1) vs. high (4+) LS7 scores according to sex, race, poverty income ratio (PIR), and education level, before and after adjusting for key sociodemographic and medical covariates.
Results: Few participants (<1%) met all 7 ideal LS7 metrics. The proportion with low LS7 increased from 18% in 1988-1994 to 34% in 2005-2010 (p<0.001) where it remained stable. From 1988-1994 to 2011-2014, BP and cholesterol control improved (proportion with BP ≥140/90 mmHg decreased from 45% to 26% and cholesterol ≥240 mg/dL decreased from 37% to 10%); however, the proportion with obesity increased from 27% to 40%, prediabetes/diabetes increased from 49% to 56%, and healthy diet score >80% decreased from 22% to 1% (all p<0.05). After adjustment, those with low scores were more likely to be black (OR 2.41, 95% CI 1.22-4.76), have PIR ≤200% (OR 2.10, 95% CI 1.09-4.04), and have <12th grade education (OR 4.62, 95% CI 2.38-8.97).
Conclusions: Fewer than 1% of US stroke survivors display ideal cardiovascular health. Although BP and lipid control has improved over the last three decades, rates of obesity, diabetes, and poor diet have increased. Stroke survivors who are black, socioeconomically disadvantaged, or less educated, have greater odds of having poor cardiovascular health, highlighting the need for targeted interventions