Ideal cardiovascular health and cardiovascular related events: a systematic review and meta-analysis

Femke Te Hoonte; Merve Spronk; Qi Sun; Kangrui Wu; Shiqi Fan; Ziyi Wang; Michiel L Bots; Yvonne T Van der Schouw; Alicia Uijl; Robin W M Vernooij

doi:10.1093/eurjpc/zwad405

Ideal cardiovascular health and cardiovascular related events: a systematic review and meta-analysis

Eur J Prev Cardiol. 2023 Dec 27:zwad405. doi: 10.1093/eurjpc/zwad405. Online ahead of print.

Authors

Femke Te Hoonte¹, Merve Spronk¹, Qi Sun¹, Kangrui Wu¹, Shiqi Fan^{1

2}, Ziyi Wang¹, Michiel L Bots¹, Yvonne T Van der Schouw¹, Alicia Uijl^{1

3

4}, Robin W M Vernooij^{1

2}

Affiliations

¹ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands.
² Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands.
³ Department of Cardiology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
⁴ Division of Cardiology, Department of Medicine, Karolinska Institute, Stockholm, Sweden.

PMID: 38149986
DOI: 10.1093/eurjpc/zwad405

Abstract

Aims: The aim of this study was to systematically review and quantitatively summarise the evidence on the association between Life Simple's 7 (LS7) and multiple cardiovascular diseases (CVD) and cardiometabolic diseases (CMD).

Methods: EMBASE and PubMed were searched from January 2010 to March 2022 for observational studies that investigated the association between ideal cardiovascular health (CVH) with CVD or CMD outcomes in an adult population. Two reviewers independently selected studies according to the eligibility criteria, extracted data, and evaluated risk of bias. Data were analysed with a random-effect meta-analysis.

Results: This meta-analysis included 59 studies (1,881,382 participants). Participants with ideal CVH had a considerably lower risk of a variety of CVDs and CMDs as compared to those with poor CVH, varying from 40% lower risk for atrial fibrillation (AF) (HR = 0.60 [95% CI 0.44-0.83]) to 82% lower risk for myocardial infarction (HR = 0.18 [95% CI 0.12-0.28]). Intermediate CVH was associated with 27%-57% lower risk in CVDs and CMDs compared to poor CVH, with the highest hazard for AF (HR = 0.73 [95% CI 0.59-0.91]), and the lowest hazard for peripheral arterial disease (HR = 0.43 [95% CI 0.30-0.60]).

Conclusion: Ideal and moderate CVH were associated with a lower incidence of CVDs and CMDs than poor CVH. LS7 holds significant potential for promoting overall CVH and thereby contributing to the prevention of CVDs.

Keywords: American Heart Association; Cardiometabolic diseases; Cardiovascular diseases; Cardiovascular health; Life’s Simple 7; Preventive medicine.

Plain language summary

Healthy lifestyle is very important to prevent cardiovascular diseases (CVD) and cardiometabolic diseases (CMD), such as diabetes and kidney diseases. Therefore, in 2010, the American Heart Association introduced Life’s Simple 7 (LS7), a scoring system using seven lifestyle factors to measure cardiovascular health in populations and these factors are diet, physical activity, smoking, blood pressure, blood lipids, blood sugar, and weight. In this review, we investigated the relationship between LS7 score and CVDs or CMDs. Higher LS7 score, meaning a healthier lifestyle score, was related to lower risks of CVDs. Promoting healthy lifestyle (higher LS7 score) could possibly lead to prevention of CVDs.