Spirituality and Cardiovascular Health in the HANDLS Study: Evidence for Within-Race Differences

Objective:� This cross-sectional study explored the associations between spiritual transcendence (ST) ? prayer/meditation fulfillment, connectedness, and universality ? and the American Heart Association?s Life?s Simple 7 (LS7), and if variations across and within racial and socioeconomic groups emerged. Methods:� Data were taken from the Healthy Aging in Neighborhoods of Diversity across the Life Span study and included 1,110 midlife and older African American (AA) and White adults (mean [standard deviation] age=56.13 [8.91] years; 65.0% above poverty; 78.1% � high school education). ST was self-reported. LS7 comprised physical activity, smoking, diet, body mass index, cholesterol, glucose, and blood pressure. Higher LS7 reflects better cardiovascular health (CVH). Multiple linear regression estimated associations between ST and LS7. A 3-way interaction term (ST, race, and either education or poverty status) was included in models adjusted for sex and age. Results:� A 3-way interaction was observed for ST, race, and poverty status (b=1.29, SE=0.35, P<0.001). Simple slopes showed a positive association for White adults living above poverty only (b=0.54, SE=0.15, P<0.001). Exploratory analyses found a nonlinear 3-way interactive effect including ST, race, and age (i.e., U-shaped; b=0.04, SE=0.02, P=0.048). Both lesser and greater ST were associated with higher LS7 for older AA adults exclusively (b=0.03, SE=0.01, P=0.024). Conclusion:� Although spirituality was associated with overall CVH, it was not beneficial for everyone equally. If tailored appropriately, the integration of spirituality into care practices may promote better CVH.