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. 2024 Jun 4;4(1):104.
doi: 10.1038/s43856-024-00534-7.

Association of Life's Simple 7 lifestyle metric with cardiometabolic disease-free life expectancy in older British men

Qiaoye Wang  1 , Amand Floriaan Schmidt  2   3 , Lucy T Lennon  4 , Olia Papacosta  4 , Peter H Whincup  5 , Goya Wannamethee  4
Affiliations

Association of Life's Simple 7 lifestyle metric with cardiometabolic disease-free life expectancy in older British men

Qiaoye Wang et al. Commun Med (Lond). .

Abstract

Background: Cardiometabolic diseases (CMD), including myocardial infarction, stroke, and type 2 diabetes, are leading causes of disability and mortality globally, particularly for people at an older age. The impact of adhering to the Life's Simple 7 (LS7) on the number of years an individual will live without CMD in older adults remains less studied.

Methods: This study included a cohort of 2662 British men aged 60-79 years free of CMD at baseline from the British Regional Heart Study (BRHS). Each LS7 factor (BMI, blood pressure, blood glucose, total cholesterol, smoking, physical activity, and diet) was categorized as poor, intermediate, or ideal, and a composite LS7 adherence was determined by summing the number of LS7 ideal levels achieved. Flexible parametric Royston-Parmar proportional-hazards model was applied to estimate CMD-free life expectancy.

Results: Here we show that compared to men with the lowest LS7 adherence [with 18.42 years (95% CI: 16.93, 19.90) of CMD-free life at age 60], men having an ideal LS7 adherence are estimated to gain an additional 4.37 years (95% CI: 2.95, 5.79) of CMD-free life. The CMD-free life gain benefits are consistent across social class groups of manual and non-manual workers. Among LS7 factors, achieving an ideal physical activity provides the largest CMD-free survival benefit: 4.84 years (95% CI: 3.37, 6.32) of additional CMD-free life compared with the physically inactive group.

Conclusions: Our study quantifies and highlights the benefits of adhering to the LS7 ideal levels for living a longer life without CMD in older adults.

Plain language summary

Cardiometabolic diseases, including heart attack, stroke, and type 2 diabetes, are leading causes of disability and deaths globally. To benefit cardiometabolic health, the American Heart Association made a number of recommendations, known as the Life’s Simple 7 lifestyle metric, including not smoking, having adequate physical activity, following a healthy diet pattern, and managing healthy body weight, healthy blood pressure, cholesterol, and blood sugar levels. Our study showed that adopting a healthy lifestyle following these recommendations could potentially increase the cardiometabolic disease-free life expectancy by more than four years for British men at age 60, with achieving an ideal physical activity level provided the largest survival benefit. Our findings highlight the need for public health efforts and interventions to support older adults in achieving optimal cardiometabolic health, particularly with regards to physical activity.

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Conflict of interest statement

The authors declare no competing interests. Amand Floriaan Schmidt is an Editorial Board Member for Communications Medicine, but was not involved in the editorial review or peer review, nor in the decision to publish this article.

Figures

Fig. 1
Fig. 1
The risk of cardiometabolic diseases/death according to baseline Life’s Simple 7 adherence. Hazard Ratios and 95% Confidence Intervals of cardiometabolic diseases or death during follow-up in BRHS participants aged 60–79 in 1998–2000 (n = 2662), according to their baseline Life’s Simple 7 adherence. Model used age as time scale, and adjusted for social class, alcohol intake, and energy intake. CI confidence interval, HR hazard ratio, LS7 Life’s Simple 7.
Fig. 2
Fig. 2. Cardiometabolic disease-free life gained by Life’s Simple 7 adherence.
Years of life gained without cardiometabolic diseases for BRHS participants at age 60 by their baseline Life’s Simple 7 adherence (n = 2662). Reference group is the poor LS7 adherence (achieved 0–1 LS7 ideal level) group [18.42 years (95% CI: 16.93, 19.90) of CMD-free life at age 60]. Error bars shown in the figure represent the 95% CIs. Models used age as time scale, and adjusted for social class, alcohol intake, and energy intake. Royston–Parmar model survival curves were used to estimate the CMD-free life years gained and 95% CIs. CI confidence interval, CMD cardiometabolic diseases, LS7 Life’s Simple 7.
Fig. 3
Fig. 3. Cardiometabolic disease-free life gained by Life’s Simple 7 adherence, stratified by social class.
Years of cardiometabolic disease-free life gained at age 60 by baseline Life’s Simple 7 adherence for BRHS manual workers (n = 1216) and non-manual workers (n = 1346). Reference group is the poor LS7 adherence (achieved 0–1 LS7 ideal level) group. Error bars shown in the figure represent the 95% CIs. Models used age as time scale and adjusted for alcohol intake and energy intake. Royston–Parmar model survival curves were used to estimate the CMD-free life years gained and 95% CIs. CI confidence interval, CMD cardiometabolic diseases, LS7 Life’s Simple 7.
Fig. 4
Fig. 4. Cardiometabolic disease-free life gained by each Life’s Simple 7 metric.
Years of cardiometabolic disease-free life gained at age 60 for BRHS participants by each Life’s Simple 7 lifestyle metric (n = 2662). Participants with poor glucose status were diabetic and excluded from the analysis. Reference group is the poor group for each LS7 metric. Error bars shown in the figure represent the 95% CIs. Models used age as time scale, and adjusted for social class, alcohol intake, and energy intake. Royston–Parmar model survival curves were used to estimate the CMD-free life years gained and 95% CIs. CI confidence interval, BMI body mass index, BP blood pressure, EDI elderly dietary Index; LS7 Life’s Simple 7.
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