Abstract 02: American Heart Association (AHA)’s Life’s Simple 7 and Risk of Lower Extremity Peripheral Artery Disease (PAD): The Multi-Ethnic Study of Atherosclerosis (MESA)
Bibliographic record
Abstract
Background: Approximately 8.5 million Americans are affected by lower extremity PAD, which is associated with a substantially greater risk of cardiovascular (CV) events, mortality and functional decline. In 2010, the AHA initiated new CV health metrics (Life’s Simple 7) to monitor the goal of significantly improving CV health by the year 2020. The extent to which Life’s Simple 7 may be associated with risk of PAD or change in the ankle brachial index (ABI), the major clinical diagnostic criterion for PAD, has not been established. Methods: MESA is a population-based prospective cohort of 6814 Caucasian, African-American, Hispanic and Chinese men and women from six US field centers. The baseline exam occurred in 2000-02. Life’s Simple 7 at baseline included AHA definitions of poor, intermediate and ideal health behaviors (diet, body mass index, smoking, physical activity) and health factors (blood pressure, glucose, cholesterol), and was modeled continuously on a 0-14 point scale, with a higher score indicating better CV health. The scale was also categorized into overall inadequate (0-7points), average (8-11) and optimum (12-14) CV health. Incident PAD was defined as an ABI≤0.90 at Exam 3 (2004-05) or Exam 5 (2010-12), removing participants both with ABI>1.40 and prevalent PAD at baseline. Cox models were used for incident PAD analyses and change in the ABI over time was assessed using mixed models. All models were adjusted for age, sex and race/ethnicity. Results: The mean±SD Life’s Simple 7 score was 8.4±2.1, with 33.8% of participants classified as inadequate, 59.6% average, and 6.6% classified as having optimum CV health. Adjusted rates of PAD per 1000 person-years were 7.3 for inadequate, 3.2 for average and 1.1 for optimum CV health. Each point higher on the Life’s Simple 7 scale was associated with a 20% lower risk of incident PAD (95% CI (0.76-0.85); p<0.001). Compared to inadequate CV health, participants with average and optimum health had a 55% lower risk (95% CI (0.37-0.56), p<0.001) and an 85% lower risk (95% CI (0.06-0.38); p<0.001) of incident PAD, respectively. Each point higher on the scale was associated with a higher average ABI over a median follow-up time of 9.4 years (0.006 (95% CI (0.005, 0.007), p<0.001). Compared to those with inadequate health, participants with average and optimum health maintained a 0.021 (95% CI (0.016, 0.027, p<0.001) and a 0.030 (95% CI (0.018, 0.041, p<0.001) greater average ABI over the follow-up period, respectively. Conclusions: Maintaining average or optimum CV health results in a substantially reduced risk of incident PAD and also in maintaining a higher average ABI over time, even when accounting for age, sex and race/ethnicity. Encouraging improvement in health behaviors, and treatment to achieve and maintain better levels of CV health metrics, may contribute to decreasing the rate of PAD.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".