Abstract P174: Stress and Depression Are Associated With Life’s Simple 7 Among African Americans With Hypertension: Findings From the Jackson Heart Study
Authors: Langford Aisha T , Butler Mark , Booth John N , Bress Adam , Tanner Rikki M , Kalinowski Jolaade , Blanc Judite , Seixas Azizi , Shimbo Daichi , Sims Mario , Ogedegbe Olugbenga , Spruill Tanya M 
Published: March 2019

Introduction:
The American Heart Association created the Life’s Simple 7 (LS7) metric to promote optimal cardiovascular health (CVH) via managing blood pressure (BP), controlling cholesterol, reducing blood sugar, getting active, eating better, losing weight, and quitting smoking. The degree to which psychosocial factors impact one’s ability to achieve LS7 recommendations is unclear. We hypothesized that hypertensive African Americans with high stress levels and high depressive symptoms would have poorer CVH compared to those with low stress and low depressive symptoms.

Methods:
Cross-sectional analyses included 1,845 participants with hypertension from the Jackson Heart Study, a community-based cohort of African Americans. Hypertension was defined as clinic BP ≥140/90 mm Hg or self-reported use of antihypertensive medication at the baseline exam (2000-2004). Outcomes were the continuous LS7 composite score and individual components (each defined as poor, intermediate or ideal). The Weekly Stress Inventory was used to identify high stress (top quartile vs. all others). The Center for Epidemiologic Studies Depression (CES-D) scale was used to identify high depressive symptoms (CES-D ≥16 vs. <16). We examined associations between stress and depressive symptoms with composite LS7 scores and individual LS7 metrics. We compared four groups: (1) high stress alone, (2) high depressive symptoms alone, (3) high stress and high depressive symptoms, and (4) low stress and low depressive symptoms (reference). Models were progressively adjusted for age, sex, education, employment, insurance status, and cardiovascular risk factors.

Results:
The mean age was 58.9 ± 10.8 years, 31% of participants were male, and 9.6% had both high stress and high depressive symptoms. Participants with both high stress and high depressive symptoms had a lower composite LS7 score than those with low stress and low depressive symptoms (6.0 vs. 6.5, p=0.004). The association was present after adjusting for demographic and socioeconomic factors (p=.029) but not in fully adjusted models (p>0.05). Neither high stress alone nor high depressive symptoms alone were associated with LS7 score in any model (p>0.05). Other key findings included significant associations between high stress and depressive symptoms and poorer levels of health for smoking (OR [95% CI]= 0.53 [0.34-0.81]) and physical activity (OR [95% CI]= 0.68 [0.50-0.94]) in fully adjusted models.

Conclusion:
African Americans with the combination of high stress and high depressive symptoms had poorer overall CVH compared with those reporting low stress and low depressive symptoms, and were less likely to have ideal smoking and physical activity. Future studies should evaluate prospective effects of this psychosocial risk profile on CVH, which may inform behavioral approaches to improving CVH.