Life’s Simple 7 and Risk of Peripheral Artery Disease: Results from the PREDIMED Study and an Updated Meta-Analysis

Abstract

Background: Peripheral artery disease (PAD) is a major vascular condition often overlooked in prevention strategies. We aimed to evaluate the association between cardiovascular health, measured by Life's Simple 7 (LS7), and the risk of PAD in a high-risk Mediterranean population. Methods: This prospective analysis included 7122 participants from the PREDIMED study (Prevención con Dieta Mediterránea) at high cardiovascular risk but free of cardiovascular disease at baseline. LS7 scores (0-14 points) were calculated using seven metrics: smoking status, body mass index, physical activity, blood pressure, total cholesterol, glucose metabolism, and adherence to the Mediterranean diet. Participants were categorized into inadequate (0-5), average (6-8), and optimal (9-14) cardiovascular health. Multivariable Cox regression models and Nelson-Aalen curves assessed the association between LS7 and PAD incidence over a median 4.8-year follow-up. A meta-analysis combining these results with three prior studies was also performed. Results: A total of 87 incident PAD cases were identified. Compared to participants with inadequate cardiovascular health, those with average and optimal LS7 scores exhibited significantly lower PAD risk (adjusted hazard ratio [HR] 0.37; 95% confidence interval [CI]: 0.22-0.61, and HR 0.25; 95% CI: 0.10-0.65, respectively). Each one-point increase in the LS7 score (range 0 to 14) was associated with an 22% lower PAD risk (HR 0.78; 95% CI: 0.68-0.90). The meta-analysis yielded a pooled HR of 0.81 (95% CI: 0.76-0.87), confirming consistent inverse associations across populations. Conclusions: Greater adherence to LS7 metrics is associated with a significantly reduced risk of PAD in high-risk Mediterranean individuals. Promoting LS7 adherence may represent an effective strategy for preventing both cardiovascular disease and PAD.