Author + information
- Received December 4, 2018
- Revision received March 25, 2019
- Accepted March 25, 2019
- Published online July 29, 2019.
- Alicia Uijl, MSca,b,∗ (, )
- Stefan Koudstaal, MD, PhDb,c,
- Ilonca Vaartjes, PhDa,
- Jolanda M.A. Boer, PhDd,
- W.M. Monique Verschuren, MD, PhDd,
- Yvonne T. van der Schouw, MD, PhDa,
- Folkert W. Asselbergs, MD, PhDb,c,e,
- Arno W. Hoes, MD, PhDa and
- Ivonne Sluijs, PhDa
- aJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- bHealth Data Research UK London, Institute for Health Informatics, University College London, London, United Kingdom
- cDepartment of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- dNational Institute for Public Health and the Environment, Bilthoven, the Netherlands
- eInstitute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, United Kingdom
- ↵∗Address for correspondence:
Dr. Alicia Uijl, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, the Netherlands.
Objectives The aim of this study is to determine whether combinations of specific Life’s Simple 7 (LS7) components are associated with reduced risk for heart failure (HF).
Background The American Heart Association recommends the concept of LS7: healthy behaviors that have been shown to reduce cardiovascular disease.
Methods A total of 37,803 participants from the EPIC-NL (European Prospective Investigation Into Cancer and Nutrition–Netherlands) cohort were included (mean age: 49.4 ± 11.9 years, 74.7% women). The LS7 score ranged from 0 to 14 and was calculated by assigning 0, 1, or 2 points for smoking, physical activity, body mass index, diet, blood pressure, total cholesterol, and blood glucose. An overall ideal score (11 to 14 points) was present in 23.2% of participants, an intermediate score (9 or 10 points) in 35.3%, and an inadequate score (0 to 8 points) in 41.5%.
Results Over a median follow-up period of 15.2 years (interquartile range: 14.1 to 16.5 years), 690 participants (1.8%) developed HF. In Cox proportional hazards models, ideal and intermediate LS7 scores were associated with reduced risk for HF compared with the inadequate category (hazard ratio: 0.45 [95% confidence interval (CI): 0.34 to 0.60] and hazard ratio: 0.53 [95% CI: 0.44 to 0.64], respectively). Our analyses show that combinations with specific LS7 components, notably glucose, body mass index, smoking, and blood pressure, are associated with a lower incidence of HF.
Conclusions A healthy lifestyle, as reflected in an ideal LS7 score, was associated with a 55% lower risk for HF compared with an inadequate LS7 score. Preventive strategies that target combinations of specific LS7 components could have a significant impact on decreasing incident HF in the population at large.
The EPIC-Netherlands study is supported by the Europe Against Cancer Programme of the European Commission; the Dutch Ministry of Health, Welfare and Sports; the Netherlands Organization for Health Research and Development; and the World Cancer Research Fund. This work has received support from the European Union/European Federation of Pharmaceutical Industries and Associations Innovative Medicines Initiative 2 Joint Undertaking BigData@Heart grant 116074. Dr. Asselbergs is supported by the University College London Hospitals National Institute for Health Research Biomedical Research Centre. Dr. Vaartjes is supported by a grant from the Dutch Heart Foundation (grant DHF project Facts and Figures). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 4, 2018.
- Revision received March 25, 2019.
- Accepted March 25, 2019.
- 2019 American College of Cardiology Foundation
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