Favourable score in AHA’s Life's Simple 7 tied to lower NAFLD prevalence

Higher cardiovascular health score in the American Heart Association (AHA)-defined Life’s Simple 7 (LS7) is associated with a lower prevalence of nonalcoholic fatty liver disease (NAFLD), reports a study, suggesting the potential of LS7 in the prevention of liver disease.

The LS7 metrics uses blood pressure, cholesterol level, body mass index, smoking status, glucose level, diet, and physical activity to measure an individual’s cardiovascular health.

“This study reaffirms the relevance of the AHA's 2020 strategic impact goals in promoting overall well-being and not just cardiovascular health,” the researchers said. “Focusing on the LS7 targets may be an appropriate prevention strategy for promoting hepatic health.”

A total of 3,901 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) cohort were evaluated and had their cardiovascular health score calculated using the LS7 metrics. A score of 0–8 was considered inadequate, 9–10 average, and 11–14 optimal. Multivariable regression was performed to assess association between LS7 score and hepatic health.

The researchers defined NAFLD using noncontrast cardiac computed tomography (CT) and a liver/spleen attenuation ratio (L/S) <1.

Of the participants included in the cross-sectional analysis, 747 (19 percent) had optimal, 1,270 (33 percent) had average, and 1,884 (48 percent) had inadequate cardiovascular health. White participants were most likely to get an optimal score (n=378; 51 percent), while African Americans showed the lowest number with an optimal score (n=120; 16 percent; p<0.001). [Am J Med 2021;134:519-525]

Overall, NAFLD prevalence stood at 18 percent, with a distribution of 7 percent in the optimal, 14 percent in the average, and 25 percent in the inadequate score category (p<0.001).

After adjusting for risk factors, average and optimal health categories correlated with a lower risk of NAFLD compared to those with inadequate scores: odds ratio (OR) for average, 0.44 (95 percent confidence interval, 0.36–0.54); OR for optimal, 0.19 (95 percent CI, 0.14–0.26). This association was similar across gender, race, and age groups.

“Our findings support previous studies that demonstrated an association between NAFLD and ideal cardiovascular health,” the researchers said. [Zhonghua Liu Xing Bing Xue Za Zhi 2015;36:40-44; Liver Int 2019;39:950-955; Am J Med 2018;131:1515.e1-1515.e10; Eur J Gastroenterol Hepatol 2018;30:578-582; Atherosclerosis 2019;284:129-135]

Several studies also reported associations between the LS7 scores and cardiovascular events and risk. [Eur Heart J 2003;24:987-1003; Circulation 2011;123:850-857; J Am Coll Cardiol 2011;57:1690-1696]

Furthermore, other researchers supported the finding that the benefit of an ideal cardiovascular health extended to other outcomes such as stroke, depression, and cognition. [Diabetologia 2016;59:1893-1903; Stroke 2013;44:1909-1914; Int J Cardiol 2016;214:279-283; J Am Heart Assoc 2016;4e002731; PLoS One 2016;11e0150282]

“[The current] study demonstrates the association of optimal cardiovascular health with NAFLD across different ethnic populations and, thus, its potential to promote hepatic health,” the researchers said.

“Further research on the longitudinal association of LS7 and NAFLD risk, including multiethnic populations, is needed,” they added.