Life’s Simple 7 and

Worksite Wellness

Donald M. Lloyd-Jones, MD ScM

Senior Associate Dean

Director, NUCATS Institute

Chair, Dept. of Preventive Medicine

Eileen M. Foell Professor

Northwestern Feinberg School of Medicine

President, AHA Chicago Metro Board

President-Elect, AHA Midwest Affiliate Board

From Cardiovascular Disease

to “Cardiovascular Health”A Quiet Revolution

Death Rates for CVD, 1900-2010

4Heidenreich et al. Circulation 2011;123:933-944

Projected CVD Burden, 2010-2030

Heidenreich et al. Circulation 2011;123:933-9445

Projected Annual Direct and Indirect Costs for

All CVD, 2010-2030

Heidenreich et al. Circulation 2011;123:933-9446

Direct

Indirect

Circulation 2010; 121: 586-613

Considerations in Defining CV Health

• Health is a broader, more positive construct than

just the absence of disease

• Need for evidence base linked to CVD-free survival,

healthy longevity, and QOL

• Simple and accessible to providers, payers and

consumers Allowing all subsets of the population to improve

• Actionable items for individuals, practitioners and

policy-makers

• Measurable and can be monitored over time

202020%

By 2020, to improve the cardiovascular

health of all Americans by 20%, while

reducing deaths from cardiovascular

disease and stroke by 20%.

AHA 2020 Impact Goal

Defining cardiovascular health

• 39% of Americans think they are in ideal CV health

• Prevalence of ideal cardiovascular health in adults is

actually less than 1%

AHA 2020 Strategic Impact Goals

HEALTH BEHAVIORS HEALTH FACTORS

• Smoking

• Diet

• Physical Activity

• Body Weight

• Glucose

• Cholesterol

• Blood Pressure

LIFE’S SIMPLE 7 POOR INTERMEDIATE IDEAL

Smoking StatusAdults >20 years of ageChildren (12–19)

Current SmokerTried prior 30 days

Former ≤ 12 mos Never /quit ≥ 12 mos

Physical ActivityAdults > 20 years of age

Children 12-19 years of age

None

None

1-149 min/wk mod or1-74 min/wk vig

or 1-149 min/wk mod + vig

>0 and <60 min of mod or vig every day

150+ min/wk mod or 75+ min/wk vig or 150+ min/wk

mod + vig

60+ min of mod or vig every day

Healthy DietAdults >20 years of ageChildren 5-19 years of age

0-1 components0-1 components

2-3 components2-3 components

4-5 components4-5 components

Healthy Weight Adults > 20 years of ageChildren 2-19 years of age

≥30 kg/m2

>95th percentile

25-29.9 kg/m285th-95th percentile

<25 kg/m2

<85th percentile

Blood GlucoseAdults >20 years of ageChildren 12-19 years of age

126 mg/dL or more126 mg/dL or more

100-125 mg/dL or treated to goal100-125 mg/dL

Less than 100 mg/dLLess than 100 mg/dL

CholesterolAdults >20 years of ageChildren 6-19 years of age

≥240 mg/dL≥200 mg/dL

200-239 mg/dL or treated to goal170-199 mg/dL

<170 mg/dL

Blood PressureAdults >20 years of age

Children 8-19 years of age

SBP ≥140 or DBP ≥90 mm Hg

>95th percentile

SBP120-139 or DBP 80-89 mm Hg or treated to goal

90th-95th percentile or SBP ≥120 or DBP ≥80 mm Hg

<120/<80 mm Hg

<90th percentile

Cardiovascular Health DefinitionsCardiovascular Health Definition

Evidence Linking CV Health Status and Outcomes

• Total mortality

• Cardiovascular, coronary, and

stroke mortality

• Fatal and non-fatal CVD

- CHD and stroke

- In all race/sex groups

• Incident cancer (!)

• Venous thromboembolism/PE

• End-stage renal disease

• Atherosclerosis and arterial stiffness

in children and young adults

• Cognition in younger and older

adults

• Depression

• QOL in adults

- Healthy days now

- QOL in future

• Compression of morbidity

• Healthcare charges

Number of Ideal CV Health Metrics and

20-Year Incidence of CVD: ARIC

0

0.2

0.4

0.6

0.8

1

1.2

0 1 2 3 4 5 6 7

No. of Ideal Metrics

HR

(9

5%

CI)

fo

r C

VD

Folsom et al. JACC 2011

0.1%2.8%9.3%18.6%26.7%25.3%14.5%2.5%

Number of Ideal CV Health Factors and

Behaviors and 20-Year Incidence of CVD

Folsom et al. JACC 2011

Wilkins, JAMA 2012

• LR for Total CVD (CHD, Stroke, HF, CVD death):– Men: 60%; Women: 56%

– Varies by aggregate RF burden

Wilkins, JAMA 2012 16

Compression of Morbidity

1.8 y

3.5 y

14 y

17 Rasmussen-Torvik et al., Circulation. 2013;127:1270-1275

CVH and Incident CancerARIC Study

18 Rasmussen-Torvik et al., Circulation. 2013;127:1270-1275

Unhealthy Days in Men and Women by

CV Health Status: NHANES

Allen, Lloyd-Jones, Unpublished data

CV Health and Healthy DaysNHANES 2007-2010; N~7000

In the last 30 days… Poor CVH Intermediate

CVH

Ideal CVH

Odds Ratio (95% CI)

Excellent general health 1.0 2.6 (2.1, 3.3) 6.4 (4.8, 8.4)

Physical health not good ≥14 days 1.0 0.6 (0.5, 0.8) 0.4 (0.3, 0.6)

Mental health not good ≥14 days 1.0 0.7 (0.6, 0.8) 0.4 (0.3, 0.5)

Inactive ≥14 days 1.0 0.6 (0.5, 0.9) 0.3 (0.2, 0.5)

Mean Difference (Days)

Unhealthy days - -1.5 (-2.1, -1.0) -3.2 (-4.0, -2.4)

Days of poor physical health - -1.2 (-1.7, -0.6) -1.7 (-2.3, -1.0)

Days of poor mental health - -1.0 (-1.4, -0.5) -2.2 (-2.8, -1.7)

Unable to perform usual activities - -0.6 (-1.0, -0.2) -0.8 (-1.2, -0.4)

Allen, Lloyd-Jones, Unpublished dataLarger effects in women; similar across R/E groups

21

• 2932 CARDIA ppts– Aged 18-30 at baseline (mean 25)

• Measures of cognition at Y25– DSST

– Modified Stroop Test

– Rey Auditory Verbal Learning Test

Reis, et al. Annals of Neurology. 2013;73(3):170-179.

CVH in Young Adulthood and Cognition

in Mid-Life

Reis et al., Annals of Neurology. 2013;73(3):170-179

AHA Statistical Update 2012

Loss of CV Health Across the LifespanNHANES 2007-2008

41.2

29.4

9.7

2.5

9.17.2

2.10.1

0

5

10

15

20

25

30

35

40

45

12 to 19 20 to 39 40 to 59 ≥60

≥5 Metrics

≥6 Metrics

Age Group

Pe

rce

nt

with

Id

ea

l CV

H M

etr

ics

Evidence that CV Health is Modifiable and that

Change Matters

• Loss of CVH with aging

• Low estimated heritability (~15%)

• Evidence of preservation with dietary

intervention from infancy to adolescence

• Evidence of preservation with healthy behaviors

from young adulthood to middle age

• Behavior change in young adulthood matters

Liu, Circulation 2012

Healthy Lifestyle through Young Adulthood and

Ideal CVH in Middle Age: CARDIA

0 10 20 30 40

BL +3 or 4

+ 2

+ 1

No change

- 1

- 2

BL -3 or 4

Prevalence (%) of Coronary Calcium at Year 20

He

alth

y Li

fest

yle

Fac

tor

Ch

ange

Y0

to

Y2

0

Healthy Lifestyles

• Lean body mass

• Low alcohol

• Healthy diet

• Phys. activity

• Nonsmoker

Spring et al. Circulation 2014

And it didn’t matter

which one changed!

Behavior Change Matters!

27 Fonarow et al. Circulation 2015

My Life Check / Life’s Simple 7

My Life Check Summary Report

Thank You!

Questions?