Fuster-BEWAT score versus American Heart Association's Life's Simple 7 To predict subclinical target organ damage: findings from a large-scale Asian population
Authors: Wang H.Y , Sun Y.X , Dou K.F , He J 
Published: November 2020

Abstract

Background
The AHA's Life's Simple 7 score is recommended for use in primordial prevention. Simpler tools not requiring laboratory tests, such as the Fuster-BEWAT score (FBS) (blood pressure [B], exercise [E], weight [W], alimentation [A], and tobacco [T]), are also available. We aimed to investigate the relationships of FBS and Life's Simple 7 with several subclinical markers of target organ damage (TOD) representing myocardial structure and function (i.e., ECG-LVH and LV diastolic dysfunction), carotid structure (i.e., carotid intima-media thickness), and vascular function (i.e., arterial stiffness) in the framework of general Chinese population.

Methods
The study population consisted of 11,163 community-based adults (mean age 53.9 years; 54% female) who were recruited in the NCRCH (Northeast China Rural Cardiovascular Health) study between January 2013 and August 2013. A SD + SV4 ≥2.3 mV for female subjects and ≥2.8 mV for male subjects were considered positive for LVH according to Peguero–Lo Presti criteria. Participants with LV diastolic dysfunction was defined as septal e' velocity &lt;7 cm/s, average E/e' ratio&gt;14, or left atrial volume index&gt;34 mL/m2. Carotid intima-media thickness &gt;0.9mm was assessed for the detection of carotid wall thickness. The highest tertile of pulse pressure/stroke volume indexed to height2.04 (&gt;2.76 mm Hg/ml) was chosen to reflect increased arterial stiffness.

Results
With poor Life's Simple 7 and FBS as references, subjects with ideal Life's Simple 7 and FBS presented substantially lower adjusted odds of having ECG-LVH (OR, 0.57; 95% CI, 0.49–0.66 vs. OR, 0.54; 95% CI, 0.46–0.64), LV diastolic dysfunction (OR, 0.34 [0.26–0.45] vs. OR, 0.43 [0.33–0.57]), carotid wall thickness (OR, 0.66 [0.51–0.87] vs. OR, 0.68 [0.50–0.93]), and arterial stiffness (OR, 0.22 [0.19–0.26] vs. OR, 0.21 [0.18–0.25]). In a similar model, per each additional metric at recommended optimal level of Life's Simple 7 (0–7) and FBS (0–5) was predictive to a similar degree of reduced odds of all subclinical TOD. Similar levels of significantly discriminating accuracy were found for Life's Simple 7 and FBS with respect to ECG-LVH (Life's Simple 7: C-statistic of 0.623; FBS: C-statistic of 0.625), LV diastolic dysfunction (FBS C-statistic of 0.729; CVHS C-statistic of 0.721), carotid wall thickness (FBS: C-statistic of 0.720; Life's Simple 7: C-statistic of 0.721) and arterial stiffness (FBS: C-statistic of 0.701; Life's Simple 7: C-statistic of 0.704).

Conclusions
Both scores exhibited comparable discriminatory values for detection of subclinical TOD in a large sample of middle-aged adults, highlighting the potential usefulness and clinical relevance of FBS as an easy, practical, and affordable option for elucidating the impact of CV risk behaviors and factors on subclinical CVD in settings where limited access to laboratory analysis and resource-constrained health-care areas hinder the possibility of estimating CV risk.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Natural Science Foundation of China