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The percentage of people with ideal heart health – measured by scoring seven lifestyle and biological markers – declined over two decades, according to a study that found people who maintain higher health scores over time have less risk of cardiovascular disease and death.

The research, published Thursday in the Journal of the ľ¹ÏÖ±²¥, included detailed medical visits and measurements for 3,460 adults from 1991 to 2008. It showed the number of participants with an ideal cardiovascular health score dropped over that time – from 8.5 percent to 5.9 percent. The decline, the study said, was mostly because of poorer results in body mass index, blood pressure, blood sugar and cholesterol.

Meanwhile, the research also showed that people who maintained their ideal health throughout the study period had lower risk of heart disease and lower risk of dying, while those who had lower scores for a long time, even if they improved, had a greater risk of death and heart disease.

“We all know what we need to do to maintain a healthy heart,” said the study’s lead author, Vanessa Xanthakis, assistant professor at Boston University School of Medicine. “But we are still not doing it. More and more studies are coming out linking poor cardiovascular health with poor outcomes, including stroke, dementia, cancer and other types of diseases.”

People who started with a low score and kept a low score through the study were almost twice as likely as those who kept their score high to develop cardiovascular disease. Yet, those who started low and were able to improve by the end of 20 years still had a 70 percent higher risk.

“This reinforces the notion that you have to start early,” Xanthakis said. “You have to improve your cardiovascular health as early in your life as possible.”

The ľ¹ÏÖ±²¥ created what it calls Life’s Simple 7 in 2010 to help track improvements in the health of Americans. The measures are: tobacco use, diet, physical activity, body mass index, blood pressure, total cholesterol and blood sugar. Some of Life’s Simple 7 are tracked through medical exams. Others can be checked on your own.

Using the seven-item heart health scoring, the study categorized participants as being in “poor,” “intermediate” or “ideal” cardiovascular health. The categories also have been used in several recent studies. In 2014, researchers concluded that even medium scores helped prevent loss of memory and other brain functions. Last summer, research looking into heart failure and Life’s Simple 7 showed the better the score, the lower the risk. And a study in February concluded that recovery after a heart attack in midlife was better for those with higher scores.

“This is a robust finding, that one’s cardiovascular health status as measured by Life’s Simple 7 has a profound impact on future events,” said Wayne Rosamond, an epidemiology professor at the University of North Carolina’s Gillings School of Global Public Health. He wasn’t involved in the current study but took part in the research on heart attacks published in February.

“Life’s Simple 7 can be an empowering concept. It’s powerful to say, ‘I can do some things to optimize my own cardiovascular health,’ which is a different notion than simply trying to avoid having a heart attack or stroke,” Rosamond said. “It’s a more positive focus to take in improving one’s health. The earlier you establish ideal levels of these behaviors and factors, and the longer you hold onto them, the better you will be.”

Xanthakis agrees, and said the research shows the need for more comprehensive public health policy, starting with local communities and extending to national efforts.

“This is an important public health concern,” she said. “Cardiovascular disease is linked to high costs from hospitalizations and medications. More people are living with cardiovascular disease today than in previous years. We need to boost efforts to target smoking cessation, weight control, introduce healthy diets, emphasize regular physical activity, and screen and control for high levels of blood pressure, blood sugar and cholesterol.”

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