Life’s Simple 7 score and epigenetic age acceleration: associations and effect modification by race and ethnicity

Accelerated epigenetic aging is hypothesized to contribute to racial and ethnic disparities in cardiovascular outcomes. However, most measures of epigenetic age were developed in predominantly or exclusively White samples. To establish the utility of these measures for health disparities research, it is important to determine whether associations with health differ across racial and ethnic groups. Using data from the National Health and Nutrition Examination Survey 1999–2002, we examined associations of the American Heart Association’s Life’s Simple 7 (LS7) cardiovascular health score with 13 standardized measures of epigenetic age among a nationally representative sample of non-Hispanic Black, non-Hispanic White, Mexican American, other Hispanic, and another race or ethnicity adults aged 50 to 84 (n = 2,401). In covariate adjusted models, a higher score on the LS7 was associated with lower epigenetic age acceleration on the Hannum (β = –0.032, 95% CI: –0.061, –0.004), PhenoAge (β = –0.052, 95% CI: –0.077, –0.026), GrimAge (β = –0.142, 95% CI: –0.171, –0.114), GrimAge2 (β = -0.158, 95% CI: –0.186, –0.130), DunedinPoAm (β = –0.142, 95% CI: –0.177, –0.108), and Telomere (β = 0.032, 95% CI: 0.010, 0.055) measures. Associations of LS7 with the Horvath, Weidner, Vidal-Bralo, Lin, SkinBlood, Zhang, and Yang measures were not statistically significant. With one exception for the Horvath measure, interactions between LS7 and race and ethnicity were non-significant. Better cardiovascular health was associated with lower epigenetic age acceleration, with insufficient evidence of differences by race and ethnicity. Associations were most consistent and robust for measures of epigenetic age trained on physiological age, suggesting that these measures may be useful for research on racial and ethnic disparities in cardiovascular outcomes.