Life's simple 7 and its association with trajectories in depressive symptoms among urban middle-aged adults

Background: The American Heart Association Life's Simple 7 (LS7) is a composite metric assessing cardiovascular health on a scale of 0-14 comprised of nutrition, physical activity, cigarette use, body mass index, blood pressure, cholesterol and glucose. Methods: Using data from the Healthy Aging in Neighborhoods of Diversity across the Life Span study [n = 1465, Age at visit 1 (v1: 2004-2009): 30-66 y, 41.7 % male, 60.6 % African American], we investigated associations of trajectories in depressive symptoms (2004-2017) with Life's simple 7 scores after similar to 8.6 years follow-up (2013-2017). Analyses used group-based zero-inflated Poisson trajectory (GBTM) models and multiple linear or ordinal logistic regression. GBTM analyses generated two classes of depressive symptoms trajectories ("low declining" and "high declining"), based on intercept and slope direction and significance. Results: Overall, "high declining depressive symptoms" vs. the "low declining" group was associated with -0.67 +/- 0.10 lower scores on LS7 total score (P < 0.001) in analyses adjusted for age, sex, race and the inverse mills ratio. This effect was markedly attenuated to -0.45 +/- 0.10 score-points (P < 0.001) upon adjustment for socioeconomic factors and to -0.27 +/- 0.10 score-points (P < 0.010) in fully adjusted analyses, with a stronger association detected among women (beta +/- SE: -0.45 +/- 0.14, P = 0.002). An association between elevated depressive symptoms over time ("high declining" vs "low declining") and LS7 total score was detected among African American adults (beta +/- SE: -0.281 +/- 0.131, beta = 0.031, full model). Moreover, the "high declining" vs. "low declining" depressive symptoms group was associated with a lower score on LS7 physical activity (beta +/- SE: -0.494 +/- 0.130, P < 0.001). Conclusions: Poorer cardiovascular health was linked to higher depressive symptoms over time.