Association Between Temporal Changes in Life’s Simple 7 Cardiovascular Health Metrics and Recurrent Coronary Heart Disease in the Atherosclerosis Risk in Communities (ARIC) Study

BACKGROUND: The risk of recurrence remains high among patients with coronary heart disease (CHD). Life's Simple 7 (LS7), a composite indicator of cardiovascular health, has been associated with a lower risk of incident CHD, but its prognostic value among patients with CHD remains unclear. We aimed to examine the association between temporal changes in LS7 and recurrent CHD. METHODS: Data were from the US ARIC study (Atherosclerosis Risk in Communities). LS7 scores were assessed at Visit 1 (1987-1989) and Visit 3 (1993-1995). LS7 changes were evaluated by change in LS7 category (from poor/fair [0-6] to moderate/ideal [7-14] or from moderate/ideal to poor/fair), cumulative LS7 score (as quartiles), and change in LS7 score (as quartiles). Recurrent CHD was identified through December 31, 2018. Cox models assessed the association between changes in LS7 and recurrent CHD risk. RESULTS: Among 1330 participants (mean [SD] age, 55.2 [5.6] years, 50.2% female) included in transition analyses, 561 (42.2%) experienced recurrent events during 21 359.2 person-years of follow-up. Participants whose LS7 score improved from poor/fair to moderate/ideal showed a reduced risk of recurrent CHD (hazard ratio, 0.54 [95% CI, 0.40-0.74]), whereas those whose score declined from moderate/ideal to poor/fair exhibited an increased risk (hazard ratio, 1.82 [95% CI, 1.44-2.30]). Both a higher cumulative LS7 score and a greater increase in LS7 score were associated with a lower risk of recurrent CHD (hazard ratio, 0.38 [95% CI, 0.30-0.49] for Q4 versus Q1 of cumulative score and hazard ratio, 0.51 [95% CI, 0.38-0.68] for Q4 versus Q1 of Δscore). CONCLUSIONS: Deterioration in LS7 during follow-up was associated with an increased risk of recurrent CHD, whereas improvement in LS7 was associated with a reduced risk. These findings underscore the importance of preserving and improving cardiovascular health and support the potential value of longitudinal cardiovascular health assessment in the ongoing management of patients with CHD.