Appendix 1.

Definition of Life’s Simple 7 Cardiovascular Health Metrics.

Metric	Life’s Simple 7 Cardiovascular Health
	Poor	Intermediate	Ideal
Blood pressure	Treated BP≥140/90 mm Hg, and BP ≥140/90 mm Hg	SBP 120-139 mm Hg or DBP 80-89 mm Hg or treated to <120/80 mm Hg	<120/80 mm Hg, without BP-lowering meds
Cholesterol	≥240 mg/dL	200-239 mg/dL or treated to <200 mg/dL	<200 mg/dL, without lipid-lowering medication
Glucose	HbA1c >6.4%	HbA1c 5.7%-6.4% or treated with insulin or oral meds to HbA1C <5.7%	HbA1c <5.7%, without meds
Smoking	Current smoker	Former smoker	Never smoker
Body mass index	BMI≥30 kg/m²	25-29.9 kg/m²	<25 kg/m²
Physical activity	No activity	1-149 minutes moderate/vigorous per week	≥150 minutes moderate/vigorous per week
Dietary intake	HEI<50	HEI 50-80	HEI>80

AHA indicates American Heart Association; FPG, fasting plasma glucose; BMI, body mass index; BP, blood pressure; SBP, systolic blood pressure; DBP, diastolic blood pressure; HbA1C, hemoglobin A1c; HEI, Healthy Eating Index;

The AHA definitions for poor, intermediate, and ideal health were used for blood pressure, cholesterol, BMI, and physical activity; however, modified definitions were used for FPG, smoking, and health diet score.

Glucose, AHA defined poor health as FPG ≥126 mg/dL or HgbA1C ≥7%, intermediate health as FPG 100 to 125 mg/dL or HgbA1C <7%, and ideal health as FPG <100 mg/dL.

Smoking, AHA defined poor health as current smoker, intermediate health as quit smoking <12 months, and ideal health as never smoker or quit smoking ≥12 months.

HEI score includes 3 of 5 primary criteria included in the AHA healthy dietary score: fruits and vegetables, whole grains, and sodium. Not included are sugar-sweetened beverages and fish consumption.