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People who had more heart-healthy habits and factors, as assessed by the American Heart Association’s Life’s Simple 7™ metrics for ideal cardiovascular health, had more positive benefits for whole body health, according to a review of research published today in the Journal of the American Heart Association, an open-access, peer-reviewed journal of the American Heart Association.

Life’s Simple 7 was launched by the American Heart Association in 2010 to define and quantify the spectrum of heart health based on seven lifestyle and health measures: not smoking, healthy nutrition, regular physical activity, healthy weight and normal blood pressure, cholesterol and blood sugar levels. In 2022, the metrics were refined to include sufficient sleep and more detailed scoring. The updated cardiovascular health metric is now called Life’s Essential 8™.

While the cardiovascular benefits of optimal cardiovascular health in terms of Life’s Simple 7 were already well-established, this is the first systematic review that examines the benefits to organs beyond the heart and death from cardiovascular disease and other causes, according to study authors.

A few years ago, we learned that heart health and brain health are very closely tied. Through this review, we found that almost every organ system and bodily function also benefits from maintaining the healthy lifestyle behaviors of Life’s Simple 7. We were pleasantly surprised to find that Life’s Simple 7 at optimal levels touched every aspect of health, from head to toe. It goes well beyond just cardiovascular health to encompass whole-body health.”

 Liliana Aguayo, Ph.D., M.P.H., lead study author, research assistant professor at the Nell Hodgson Woodruff School of Nursing and the Global Diabetes Research Center at Emory University in Atlanta

Researchers reviewed nearly 500 research studies published in the decade after Life’s Simple 7 was introduced that had incorporated at least three of Life’s Simple 7 measures. Ideal cardiovascular health was defined as having six or seven of the metrics at high levels.

Among the findings:

• Ideal cardiovascular health scores were consistently associated with benefits in multiple bodily systems from head to toe and from youth to old age. 
• Numerous studies found that people with high Life’s Simple 7 scores compared to people with low scores were more likely to have maintained their brain and lung function, vision and hearing, and kept their teeth and muscle strength as they aged. Several studies found lower frequencies of several chronic diseases including cancer, Alzheimer’s disease, dementia, diabetes and kidney disease among those with high Life’s Simple 7 scores.
• Ideal cardiovascular health resulted in low rates of cardiovascular disease over long-term follow-up as well as economic savings from lower health care costs, according to several studies.
• Other research suggested that even people at a higher genetic risk of heart disease can lower their risk of cardiovascular events by maintaining ideal levels of at least three of the Life’s Simple 7 metrics.
• Previous studies found better cardiovascular health at younger ages to be associated with lower risk for later cardiovascular disease and death and better quality of life, even among people aged 85 years old and older.
• One study found that adolescents were nearly 8 times less likely to have poor cardiovascular health when their mothers had better cardiovascular health during pregnancy, suggesting that cardiovascular disease prevention can start even before conception.
• Up to 4% of individuals worldwide have ideal cardiovascular health (7-metrics at ideal levels). Even at younger ages, prevalence of ideal cardiovascular health, is very low.

 “These findings confirm that healthy lifestyle metrics – eating well, exercising and not smoking – are key components to optimal health, in addition to maintaining healthy weight, normal blood pressure, and cholesterol blood sugar levels, which are the conventional risk factors for cardiovascular disease,” Aguayo said.

“The ideal cardiovascular health metrics in Life’s Simple 7 and now Life’s Essential 8 are based on extensive scientific research that recognizes the majority of heart disease and stroke can be prevented,” said Stacey E. Rosen, M.D., FAHA, volunteer president of the American Heart Association and senior vice president of women’s health and executive director of the Katz Institute for Women’s Health of Northwell Health in New York City. “The findings in this review study indicate that these healthy lifestyle metrics are also a path to improving health and well-being across the board, from head to toe. Preventing cardiovascular disease and reducing cardiovascular disease risk, the centerpieces for Life’s Essential 8, are the core of the American Heart Association’s mission to be a relentless force for a world of longer, healthier lives.”

The review findings are limited due to the scoring system of Life’s Simple 7, which rates each category broadly as ideal, intermediate or poor and is less precise than is now possible under the methods of Life’s Essential 8, according to Aguayo. Because this study relies on published literature, it may under-represent studies with negative or inconclusive findings, researchers said.

The investigators called for more research especially among children, pregnant women and populations in less-studied areas of the world. Also, more research is needed on both the benefits of even small improvements in these health metrics and the mechanisms that are pathways between Life’s Simple 7 or Life’s Essential 8 and better health.

Study details, background and design:

• Researchers screened 4,624 published research manuscripts that cited the original article introducing Life’s Simple 7 or mentioned several of the Life’s Simple 7 factors for optimal cardiovascular health. Of those, they identified 483 original studies that met study criteria, including low risk of bias, as the final review set.
• Conference abstracts, publications in non-peer-reviewed journals, publications in languages other than English and publications focused on a particular medical condition, such as metabolic syndrome, were excluded from the final review group.
• The research reviewed studies published between January 2010 and January 2021.

This review was partially funded by a Strategically Focused Research Network grant from the American Heart Association as well as a grant from the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the American Heart Association.

Pneumococcal vaccination for older adults in care homes could help to prevent more cases and deaths, requiring only 20% more doses than the current 23-valent pneumococcal polysaccharide vaccine (PPV23) program for adults aged 56 years. However, investigators noted that 20-valent pneumococcal conjugate vaccine (PCV20) would have a greater impact against invasive disease and death than PPV23.¹

“The increased risk of pneumococcal infections in care homes is driven by the advanced age and increased prevalence of frailty and comorbidity in the residents,” the study authors said.¹ “The risk of widespread transmission and outbreaks of infectious diseases is also higher in care home settings than in the general population, and outbreaks of respiratory viral infections can increase the risk of secondary bacterial pneumonia, especially pneumococcal pneumonia.”

Older adults often have different symptoms when developing pneumonia, which makes it difficult to diagnose. Although a fever and cough with phlegm can happen in older adults, the symptoms are less severe than in younger people or do not occur at all. Other symptoms, such as diarrhea or worsening confusion, can be more noticeable. Furthermore, older adults are more likely to have chronic diseases, such as lung disease or heart disease, which makes them more susceptible to pneumonia. Because older patients will likely need medical attention in a hospital, prevention, such as with vaccination, is key to preventing invasive disease.²

There are 2 different classifications for pneumococcal disease: community-acquired pneumonia and hospital-acquired pneumonia. However, there are also subset classifications, including nursing home-acquired pneumonia, which is considered hospital-acquired due to the increased risk of infection and likelihood of multidrug resistance. Nursing home-acquired pneumonia occurs in approximately 1 to 2 patients for every 1000 days of nursing home residency, and patients diagnosed with pneumonia and requiring hospitalization can have mortality ranging from 13% to 41%.³

In the current study, investigators used data from the UK Health Security Agency, including laboratory-confirmed invasive pneumococcal disease (IPD) cases. Care homes were defined as residential care and nursing homes for patients 65 years and older. From 2022 to 2023, there were 2574 IPD cases in 10,629,867 individuals 65 years and older in England. Of these patients, 603,109 patients were aged 65 years. The study authors reported that PPV23 serotypes were responsible for approximately 69.4% of cases compared with 60.8% for PC20.¹

The incidence for IPD from PPV23 serotypes was 16.9 per 100,000 people and PCV20 serotype IPD was 14.7 per 100,000. For both types, the incidence was higher for males. As for case fatality, overall, the rate was 25.2%, with 24.9% for PPV23 and 24.6% for PCV20. The study authors stated that when using a fatality rate of 14.6% and assuming 18% effectiveness of PPV23 against death, vaccinating all adults 65 years and older in England would prevent 31 PPV23 IPD deaths over 5 years and PCV20 would prevent 43 deaths for PCV20 IPD, according to the results. When calculating the rates for patients in care homes specifically, the study authors reported that 117 PPV23 and 317 PCV20 IPD cases would be prevented if all residents got the respective vaccination.¹

“We found that vaccinating new residents has the potential to substantially reduce the burden of pneumococcal disease and deaths in care homes for older adults when compared with the general population of adults aged 65 years who are currently eligible for pneumococcal vaccination,” the study authors said.¹ “PCV20 is likely to have a greater effect against IPD and death than PPV23.”

READ MORE: Pneumococcal Resource Center

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REFERENCES

1. Abdullahi F, Patel T, Stoker K, et al. Pneumococcal vaccination for new residents entering older adult care homes in England: national observational surveillance study. Lancet Healthy Longev. 2025;6(6):100726. doi:10.1016/j.lanhl.2025.100726

2. InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Pneumonia: Learn More – Pneumonia in older people: What you should know. [Updated 2021 May 18]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK525776/

3. Stamm DR, Katta S, Stankewicz HA. Nursing Home–Acquired Pneumonia. [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537355/

A new risk prediction tool developed by the American Heart Association (AHA) estimated cardiovascular disease (CVD) risk in a diverse patient cohort more accurately than current models, according to a recent study published in Nature Medicine.   

The tool, called the Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) equations which was developed in 2023, could help healthcare providers more accurately identify patients who have higher CVD risk and enhance preventive care efforts, according to Sadiya Khan, ‘09 MD, ‘14 MSc, ’10, ’12 GME, the Magerstadt Professor of Cardiovascular Epidemiology and co-first author of the study. 

“Evaluating the new PREVENT equations in a diverse sample of patients is critical to provide primary care providers and cardiologists with further assurance that they can utilize these equations to accurately predict patients’ CVD risk, particularly in vulnerable populations,” said Khan, who is also an associate professor of Medical Social Sciences in the Division of Determinants of Health and of Preventive Medicine in the Division of Epidemiology. 

More than 127 million U.S. adults had cardiovascular disease (CVD) between 2017 and 2020, according to a recent report from the American Heart Association. Given the high burden of CVD, CVD risk prediction equations have been developed to optimize preventive care and improve patient outcomes including, most recently, the AHA’s PREVENT equations, in which the development was led by Khan.  

To recognize that race is a social construct, rather than a biological risk factor, the PREVENT equations do not include race as a predictor, which has raised concerns about the model underestimating CVD risk in racial and ethnic minority groups, according to Khan.   

“There has been growing awareness of race as a social construct that has led to discussions about the role of race in clinical algorithms. As such, the new PREVENT equations did not include race as a predictor. However, removing race as a predictor has also raised concerns that it may underestimate risk in individuals who are more likely to experience racism or discrimination, which increase CVD risk. Therefore, the present study examined how the PREVENT equations perform in a high-risk veteran population that is incredibly diverse,” Khan said.  

In the current study, the investigators utilized data from the VHA data warehouse representing more than 2.5 million U.S. veterans between the ages of 30 and 79 years who did not have a history of CVD or kidney failure. Patients in the cohort identified with the following race and ethnicity groups: as Asian/Native Hawaiian/Pacific Islander, Hispanic, non-Hispanic Black and non-Hispanic white or as other/unknown.  

Using the PREVENT equations to calculate patients’ 10-year risk for CVD, the investigators found that PREVENT performed similarly well across race and ethnicity groups and estimated CVD risk more accurately than the Pooled Cohort Equations, which are the current clinical standard for atherosclerotic CVD risk prediction.  

“Race is a complex social construct that is often used as a proxy to represent lived experiences of racism and discrimination. But the pervasive effects of racism also influence CVD risk factors, such as high blood pressure and diabetes, which are included in the PREVENT equations. Thus, even without race in the equations, PREVENT captures the effects of racism on CVD risk through these risk factors,” Khan said.  

According to Khan, the findings also support that race is not needed for accurate CVD risk estimation.  

“Providing a person different clinical care based on their race is potentially harmful because it suggests that race is a biological determinant of risk or that there are differences in how Black Americans develop heart disease that are inherent to racial identity. In contrast, raising awareness for the impact of adverse social factors and structural racism in the development of risk factors and CVD is critical. We know that Black Americans are more likely to have high blood pressure and diabetes, key risk factors for CVD, and that these risk factors often develop at a younger age, which lead to greater burden and earlier onset of CVD,” Khan said.  

Overall, the PREVENT model could help primary care providers and cardiologists confidently identify patients with higher CVD risk and enhance preventive care measures before symptom onset, according to Khan.  

“If a healthcare provider can use models like PREVENT to predict which patients are more likely to develop CVD, including heart failure, then they can emphasize preventive lifestyle measures, such as structured exercise programs, or consider medications such as the GLP-1 receptor agonist medications (e.g., semaglutide) earlier to potentially improve cardiovascular outcomes in their patient,” Khan said. 

Khan said her team is continuing to study the performance of PREVENT in different settings, including global settings. They are also exploring how well PREVENT can be used to reduce the risk of CVD and studying different interventions that may be considered based on someone’s risk profile to personalize care. 

“If we can accurately identify patients who would benefit from earlier interventions, lifestyle changes or medication management to help prevent the onset of CVD, then we can improve patient outcomes and reduce healthcare spending costs. Accurate predictive models are an invaluable part of preventive medicine,” Khan said. 

This work was supported by the American Heart Association grant 24DECCAEG1258968.