Relationship of American Heart Association's Life Simple 7, Ectopic Fat and Insulin Resistance in 5 racial/ethnic groups

Document Type

Journal Article

Publication Date



The Journal of clinical endocrinology and metabolism




Cardiovascular health; Ectopic fat; Insulin resistance; Life’s Simple 7


BACKGROUND: The inverse association between ideal cardiovascular health (CVH) as measured by the American Heart Association's Life Simple 7 (LS7) and cardiovascular disease (CVD) incidence is well documented. However, research exploring the association between CVH and specific risk factors for cardiometabolic disease is sparse in diverse cohorts. METHODS: This study included 7717 participants from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) and the Multi-Ethnic Study of Atherosclerosis (MESA) cohorts. We assigned each LS7 component a 0, 1, and 2 and summed these scores to derive an overall CVH score. Visceral, subcutaneous, and intermuscular fat area, pericardial fat volume, and hepatic fat attenuation were measured using non-contrast computed tomography. Multivariable linear regression was used to examine associations between CVH categories and each log-transformed ectopic fat depot, as well as the homeostatic assessment for insulin resistance (HOMA-IR). RESULTS: In adjusted analysis, compared to those with ideal CVH, participants with poor CVH demonstrated 63.4% (95% CI, 54.3 - 73.0) higher visceral fat area, 84.0% (76.5 - 92.1) higher pericardial fat volume, 61.6% (50.7 - 73.2) higher subcutaneous fat area, and 40.6% (30.2 - 52.0) higher intermuscular fat area, and 15.1% (13.1 - 17.2) higher hepatic fat (all p<0.001). Also, poor CVH was associated with 148.2% (131.1 - 166.7) higher HOMA-IR. We also found significant heterogeneity in the strengths of association by race/ethnicity for each ectopic fat depot. CONCLUSION: Poor and intermediate CVH, as defined by LS7 metrics, were associated with significantly higher measures of ectopic fat and insulin resistance among individuals from 5 racial/ethnic groups.


Exercise and Nutrition Sciences