The Magnificent Seven

Today we pay homage to the number seven. The number is seven is special, cropping up in diverse aspects of life and across the years of history. For example, one can sail the seven seas. There were seven wonders in the ancient world. “The Magnificent Seven” was a movie from 1960, one of the best westerns of all time. “The Magnificent Seven” is also the name of a song by the Clash, chronicling the seven hours of the workday in London in the 1980’s. Seven-card stud is a form of poker. Mickey Mantle wore number seven! How is seven significant in the cardiology realm?

In 2010, the American Heart Association (AHA) defined and set national goals for cardiovascular health. The goal, “By 2020 to improve the cardiovascular health of all Americans by 20% while reducing deaths from cardiovascular disease and stroke by 20%”.  The AHA defined seven health factors or behaviors that were associated with cardiovascular health. The AHA called these factors Life’s Simple 7 and they are: physical activity, blood cholesterol, healthy diet, blood pressure, healthy weight, blood glucose(sugar) and smoking.  Each factor was broken into three categories: parameters associated with ideal cardiovascular health, parameters associated with intermediate cardiovascular health and those associated with poor cardiovascular health.  In addition, points are awarded for falling into each category: 0 points for poor health, 1 point for intermediate and 2 points for ideal health.  Here are the categories:

Health Factor or Behavior	Poor Cardiovascular Health (Warning) (0 points)	Intermediate Cardiovascular Health (Needs Improvement) (1 point)	Ideal Cardiovascular Health (Excellent) (2 points)
1. Physical Activity	Little to none	1-149 min/week moderate exercise or < 74 min/week vigorous exercise	150 or more min/week moderate exercise or 75 or more min/week vigorous exercise
2. Cholesterol	=> 240 mg/dl	200-239 mg/dl or treated to goal	< 200 mg/dl
3. Healthy Diet Portions per day:    5 cups fruit/vege    4 oz whole wheat    < 1500 mg of            sodium Portions per week:    2-3 servings fish    < 450 calories       from sugared drinks	0-1 components	2-3 components	4-5 components
4. Blood Pressure	Systolic => 140 Diastolic => 90	Systolic 120-139 Diastolic 80-89	Systolic < 120 Diastolic < 80
5. Healthy Weight Body mass index (BMI)	BMI => 30	BMI 25-29.9	BMI < 25
6. Blood Glucose Blood sugar while fasting	=> 126 md/dl	100-125 mg/dl	< 100 mg/dl
7. Smoking	Current smoker	Quit < 12 months ago	Never smoked or quit > 12 months ago

It is now nine years into the AHA campaign. Has there been an impact from Life’s Simple 7?  The overall rates of heart disease and stroke have been declining for a number of years. However, the death rates for heart disease and stroke, which had been declining as well, have leveled off and may even be increasing. Some of this may be explained in the context of Life’s Simple 7. The percentage of adults who meet ideal status for smoking, blood pressure and cholesterol have been increasing. Unfortunately these gains are offset as the percentage of adults whose BMI and glucose in the ideal range have been decreasing (leading to the obesity and diabetes epidemic).  In fact the prevalence of obesity increased from 22% in the 1990’s to 35% in 2012, while diabetes tripled (2.5% in 1990 to 7.2% in 2013). However, following Life’s Simple 7 can improve longevity. One study followed 7600 adults for about 6 years. The study found that participants who met 5 or more of the ideal metrics had an 88% reduction in heart deaths compared to those who met none of the ideal metrics. An analysis from 2014 showed that heart disease improved by only 6% since 2010, far short of the goal of 20% reduction by 2020. Yet following Life’s Simple 7 can help keep the heart strong. Many studies have looked at congestive heart failure and Life’s Simple 7.  A healthy lifestyle score was developed summing the points in each category (the range is from 0 to 14).  An inadequate score was 0 to 8, an intermediate score was 9 or 10 and an ideal score was 11 to 14.  Participants with an intermediate score had a 47% lower chance of congestive heart failure compared to those with an inadequate score. Individuals with an ideal score had a 55% lower chance of heart failure. In addition, those with intermediate and ideal scores had better preservation of the heart’s structure and function (lower risk for a thickened heart and weakening of the heart muscle).

It certainly seems that adhering to the lifestyle promoted by Life’s Simple 7 will go a long way towards reducing heart disease and improving longevity.  So, don’t gamble with your life. Don’t bet on the cards falling your way. Instead, follow Life’s Simple 7 (or the Magnificent Seven) for years of a heart healthy life.