Association of the American Heart Association’s new “Life’s Essential 8” with all-cause and cardiovascular disease-specific mortality: prospective cohort study

1. Higher cardiovascular health scores on the American Heart Association’s Life’s Essential 8 are associated with reduced risk of both all-cause and cardiovascular disease mortality, with a linear dose-response relationship.

Evidence Rating Level: 2 (Good)

In 2022, the American Heart Association (AHA) made an update to their cardiovascular health (CVH) recommendations. Known as the Life’s Essential 8 goals, the AHA added the goal of sleep health and refined the Life’s Simple 7 established in 2010. There has yet to be a study done to validate this metric. Therefore, this prospective cohort study investigated the association between scores on Life’s Essential 8 with cardiovascular disease (CVD) mortality and all-cause mortality in American adults. This study utilized self-reported and objective data from the ongoing, cross-sectional National Health and Nutrition Examination Survey (NHANES) between 2005 and 2018, as well as mortality data from the National Death Index. A total of 19,951 adults between 30 and 79 years old were included. Metrics corresponding to the Life’s Essential 8 included diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipid levels, blood pressure, and blood glucose. The total CVH score was divided into low, intermediate, and high categories with 0-49, 50-74, and 75-100 points respectively. Over a median (IQR) follow-up of 7.6 (4.3-10.9) years, the results demonstrated significant risk reductions in all-cause mortality, in both intermediate (hazard ratio 0.60, 95% CI 0.51-0.71) and high (HR 0.42, 95% CI 0.32-0.56) CVH score categories, compared to patients with low CVH scores. BMI and blood lipid scores were not individually associated with all-cause mortality, whereas physical activity, nicotine exposure, and diet being the most significant contributors individually. Furthermore, there were significant risk reductions in CVD mortality in both intermediate (HR 0.62, 95% CI 0.46-0.83) and high (HR 0.36, 95% CI 0.21-0.59) CVH scores, compared to low CVH scores. The CVH metrics of physical activity, sleep health, BMI, and blood pressure were not significantly associated with risk reductions in CVD mortality individually, but demonstrated a similar trend of higher CVH scores generally correlating with lower mortality, with physical activity, blood pressure, and blood glucose being the most significant contributors. As well, the study demonstrated a roughly linear dose-response association between total CVH scores with all-cause and CVD mortality. Overall, this study showed an association between higher CVH scores on the AHA’s Life’s Essential 8 goals and both all-cause and CVD mortality.

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