. 2022 Oct 19;11(21):e025252. doi: 10.1161/JAHA.122.025252

Table 4.

Association of LS7 Score and Alternate CVH Scores That Include Sleep With CVD (n=1920)

Cardiovascular health scores	Operationalization of sleep metric	Tertiles	CVD prevalence OR (95% CI)^* ^, ^† ^, ^‡	CVD incidence HR (95% CI)^§ ^, ^† ^, ^‡
AHA LS7 score^‖	No sleep metric	Tertile 1 Tertile 2 Tertile 3	1.00 0.74 (0.46–1.19) 0.25 (0.13–0.49)	1.00 0.65 (0.39–1.09) 0.62 (0.37–1.04)
CVH score 1 ^‖ ^, ^¶ AHA LS7+ sleep score based on sleep duration	Ideal sleep score=2: Sleep duration ≥7 h and <9 h Intermediate sleep score=1: Sleep duration ≥6 h and <7 h Poor sleep score=0: Sleep duration <6 h or >9 h	Tertile 1 Tertile 2 Tertile 3	1.00 0.58 (0.35–0.96) 0.29 (0.16–0.54)	1.00 0.82 (0.50–1.35) 0.57 (0.33–0.97)
CVH score 2 ^‖ AHA LS7+sleep score based on sleep characteristics linked to CVD in the literature	Ideal sleep score=2: 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) Intermediate sleep score=1: Meets 2–3 of sleep metrics for ideal sleep score Poor sleep score=0: Meets 0–1 of metrics for ideal sleep score	Tertile 1 Tertile 2 Tertile 3	1.00 0.53 (0.33–0.84) 0.20 (0.10–0.41)	1.00 0.91 (0.56–1.49) 0.66 (0.37–1.18)
CVH score 3 ^‖ AHA LS7+sleep score based on sleep characteristics previously linked to cardiovascular risk in MESA	Ideal sleep score=2: 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) Intermediate sleep score=1: Meets 2–3 of sleep metrics for ideal sleep score Poor sleep score=0: Meets 0–1 of metrics for ideal sleep score	Tertile 1 Tertile 2 Tertile 3	1.00 0.78 (0.48–1.27) 0.32 (0.17–0.60)	1.00 0.58 (0.34–1.00) 0.63 (0.38–1.05)
CVH score 4 ^§ AHA LS7+sleep score based on sleep characteristics recently linked to cardiovascular risk in MESA	Ideal sleep score=2: 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) Intermediate sleep score=1: Meets 2–3 of sleep metrics for ideal sleep score Poor sleep score=0: Meets 0–1 of metrics for ideal sleep score	Tertile 1 Tertile 2 Tertile 3	1.00 0.74 (0.45–1.20) 0.33 (0.18–0.59)	1.00 0.64 (0.38–1.09) 0.53 (0.32–0.89)

Cardiovascular health scores

Operationalization of sleep metric

Tertiles

CVD prevalence OR (95% CI)^* ^, ^† ^, ^‡

CVD incidence HR (95% CI)^§ ^, ^† ^, ^‡

AHA LS7 score^‖

No sleep metric

Tertile 1

Tertile 2

Tertile 3

1.00

0.74 (0.46–1.19)

0.25 (0.13–0.49)

1.00

0.65 (0.39–1.09)

0.62 (0.37–1.04)

CVH score 1 ^‖ ^, ^¶

AHA LS7+ sleep score based on sleep duration

Ideal sleep score=2:

Sleep duration ≥7 h and <9 h

Intermediate sleep score=1:

Sleep duration ≥6 h and <7 h

Poor sleep score=0:

Sleep duration <6 h or >9 h

Tertile 1

Tertile 2

Tertile 3

1.00

0.58 (0.35–0.96)

0.29 (0.16–0.54)

1.00

0.82 (0.50–1.35)

0.57 (0.33–0.97)

CVH score 2 ^‖

AHA LS7+sleep score based on sleep characteristics linked to CVD in the literature

Ideal sleep score=2:

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)

Intermediate sleep score=1:

Meets 2–3 of sleep metrics for ideal sleep score

Poor sleep score=0:

Meets 0–1 of metrics for ideal sleep score

Tertile 1

Tertile 2

Tertile 3

1.00

0.53 (0.33–0.84)

0.20 (0.10–0.41)

1.00

0.91 (0.56–1.49)

0.66 (0.37–1.18)

CVH score 3 ^‖

AHA LS7+sleep score based on sleep characteristics previously linked to cardiovascular risk in MESA

Ideal sleep score=2:

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)

Intermediate sleep score=1:

Meets 2–3 of sleep metrics for ideal sleep score

Poor sleep score=0:

Meets 0–1 of metrics for ideal sleep score

Tertile 1

Tertile 2

Tertile 3

1.00

0.78 (0.48–1.27)

0.32 (0.17–0.60)

1.00

0.58 (0.34–1.00)

0.63 (0.38–1.05)

CVH score 4 ^§

AHA LS7+sleep score based on sleep characteristics recently linked to cardiovascular risk in MESA

Ideal sleep score=2:

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)

Intermediate sleep score=1:

Meets 2–3 of sleep metrics for ideal sleep score

Poor sleep score=0:

Meets 0–1 of metrics for ideal sleep score

Tertile 1

Tertile 2

Tertile 3

1.00

0.74 (0.45–1.20)

0.33 (0.18–0.59)

1.00

0.64 (0.38–1.09)

0.53 (0.32–0.89)

AHA LS7 indicates American Heart Association's Life's Simple 7; AHI, Apnea‐Hypopnea Index; CVD, cardiovascular disease; CVH, cardiovascular health; ESS, Epworth Sleepiness Scale; HR, hazard ratio; MESA, Multi‐Ethnic Study of Atherosclerosis; OR, odds ratio; OSA, obstructive sleep apnea; and WHIIRS, Women's Health Initiative Insomnia Rating Scale.

Logistic Regression Models were used to examine associations of the AHA LS7 score and alternate CVH scores with odds of having a CVD event.

^{^†}

Models were adjusted for age, sex, race/ethnicity, education, health insurance, and alcohol use.

^{^‡}

CVD events were defined as all CVD (CVDa) per MESA protocol. CVDa includes myocardial infarction, resuscitated cardiac arrest, definite angina, probable angina (if followed by revascularization), stroke, stroke death, coronary heart disease death, other atherosclerotic death, other CVD death.

^{^§}

Cox proportional hazards models were used to examine associations of the AHA LS7 score and alternate CVH scores with risk of developing a CVD event.

^{^‖}

The AHA LS7 score was computed on the basis of level of meeting recommendations for body mass index, 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.

^{^¶}

Sleep duration of ≥7 h and <9 h was considered “ideal,” consistent with the definition put forth by the 2016 AHA statement on sleep. 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.