Cardiovascular Health, 2010 to 2020: A Systematic Review of a Decade of Research on Life's Simple 7

In 2010, the American Heart Association introduced Life's Simple 7, a construct to measure, monitor, and modify cardiovascular health (CVH) across the lifespan. We aimed to summarize the knowledge on outcomes, prevalence, determinants, and mechanisms of Life's Simple 7. We systematically searched PubMed, Web of Science, and Scopus databases for publications in English examining Life's Simple 7 or 3 or more CVH metrics from January 1, 2010 to January 1, 2021. Risk of bias was assessed with the Mixed Methods Appraisal Tool for studies of outcomes, prevalence, and determinants. Of 4624 publications screened, 483 were included; most had low risk of bias. Studies of outcomes (n=259) showed that ideal/high CVH (score ≥12/14 or 6/7 ideal metrics) consistently associates with benefits in multiple bodily systems from brain to toe and from gestation to extreme old age. Low prevalence of ideal/high CVH (n=84) was reported worldwide. Longitudinal studies (n=144) showed CVH is higher at younger ages and declines with age. CVH disparities persist, with lower CVH among underrepresented individuals, in lower levels of urbanization, and greater exposure to adverse social determinants. Studies of mechanisms (n=23) showed the benefits of ideal/high CVH are partly due to lower inflammation and pathways yet to be defined. Less is known about CVH among children and diverse populations, the benefits of modest improvements, and underlying mechanisms. Consistent evidence supports targeting social, psychological, and prenatal factors to improve individual and population CVH across the lifespan. Publication bias and overrepresentation of studies reporting significant associations cannot be excluded.