Table 1.

Operationalization of the AHA LS7 and New CVH Scores^*

Cardiovascular health metric	Ideal (score=2)	Intermediate (score=1)	Poor (score=0)
Smoking	Never smoker	Former smoker	Current smoker
Diet†	Meets 4–5 recommendations	Meets 2–3 recommendations	Meets 0–1 recommendations
Physical activity‡	≥150 min/wk moderate intensity or ≥75 min/wk vigorous intensity or ≥150 min/wk moderate+vigorous intensity	1–149 min/wk moderate intensity or 1–74 min/wk vigorous intensity or 1 to 149 min/wk moderate+vigorous intensity	No moderate or vigorous activity
BMI	<25 kg/m2	25–29.9 kg/m2	≥30 kg/m2
Blood pressure	SBP <120 and DBP <80 mm Hg untreated	SBP 120–129 or DBP: <80 mm Hg or treated to ideal level	SBP ≥130 or DBP ≥80 mm Hg
Total cholesterol	<200 mg/dL	200–239 mg/dL or treated to ideal level	≥240 mg/dL
Fasting glucose	<100 mg/dL	100–125 mg/dL or treated to ideal level	≥126 mg/dL
Sleep in CVH score 1§	Sleep duration ≥7 h and<9 h	Sleep duration ≥6 h and <7 h	Sleep duration <6 h or >9 h
Sleep in CVH score 2	Meets all the following sleep metrics: Sleep duration ≥7 h and <9 h WHIIRS <9 (no clinically significant insomnia) ESS ≤10 (no excessive daytime sleepiness) AHI <15 events/h (no moderate to severe OSA)	Meets 2–3 of sleep metrics for ideal sleep score	Meets 0–1 of sleep metrics for ideal sleep score
Sleep in CVH score 3	Meets all the following sleep metrics: Sleep duration ≥7 h and <9 h ‐Sleep efficiency ≥85% ‐ESS ≤10 (no excessive daytime sleepiness) ‐AHI <15 events/h (no moderate to severe OSA)	Meets 2–3 of sleep metrics for ideal sleep score	Meets 0–1 of sleep metrics for ideal sleep score
Sleep in CVH score 4	Meets 4–5 of metrics below: Sleep duration ≥7 h and <9 h Sleep efficiency ≥85% ESS≤10 (no excessive daytime sleepiness) AHI<15 events/h (no moderate to severe OSA) Sleep duration SD and sleep onset timing SD <90 min (low night‐to‐night variability)	Meets 2–3 of sleep metrics for ideal sleep score	Meets 0–1 of sleep metrics for ideal sleep score

AHA LS7 indicates American Heart Association Life Simple 7; AHI, apnea‐hypopnea index; BMI, body mass index; CVH, cardiovascular health; DBP, diastolic blood pressure; ESS, Epworth Sleepiness Scale; OSA, obstructive sleep apnea; SBP, systolic blood pressure; and WHIIRS, Women's Health Initiative Insomnia Rating Scale.

^*The AHA LS7 score was computed on the basis of level of meeting recommendations for BMI, cholesterol, blood pressure, blood glucose, diet, physical activity, and smoking. Participants received a score of 0–2 based on their level of meeting each metric. Component scores were summed to create the AHA LS7 score, which ranges from 0 to 14. CVH scores of 1–4 consist of the AHA LS7 metrics plus a sleep score (sleep score range, 0–2) and therefore range from 0 to 16, such that higher scores are indicative of more favorable CVH.

^† The diet score was based on habitual dietary intake from a validated 120‐item food frequency questionnaire, modified from the Insulin Resistance Atherosclerosis Study instrument. A healthy diet score was computed on the basis of meeting the AHA recommendations for intakes of fruits and vegetables, fish, whole grains, sodium, and sugar‐sweetened beverages. The AHA diet recommendations are as follows: (1) fruits and vegetables: ≥4.5 cups per day; (2) fish: ≥two 3.5‐oz servings per week (preferably oily fish); (3) fiber‐rich whole grains (≥1.1 g of fiber per 10 g of carbohydrate): ≥three 1‐oz‐equivalent servings per day; (4) sodium: <1500 mg per day; (5) sugar‐sweetened beverages: ≤450 kcal (36 oz) per week.

^‡ The times spent in vigorous and moderate physical activity were self‐reported on the MESA Typical Week Physical Activity Survey.

^§ Sleep duration of ≥7 h and <9 h was considered “ideal” consistent with the definition put forth by the 2016 AHA statement on sleep (reference 11). Sleep duration ≥6 h and <7 h was considered “intermediate” given that many cohort studies in the literature, including in MESA, define short sleep as sleeping <6 h/night.