Association of the American Heart Association's new "Life's Essential 8" with all-cause and cardiovascular disease-specific mortality: prospective cohort study.

The American Heart Association recently updated its construct of what constitutes cardiovascular health (CVH), called Life's Essential 8. We examined the association of total and individual CVH metrics according to Life's Essential 8 with all-cause and cardiovascular disease (CVD)-specific mortality later in  life. Data were from the National Health and Nutrition Examination Survey (NHANES) 2005-2018 at baseline linked to the 2019 National Death Index records. Total and individual CVH metric scores including diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipids, blood glucose, and blood pressure were classified as 0-49 (low level), 50-74 (intermediate level), and 75-100 (high level) points. The total CVH metric score (the average of the 8 metrics) as a continuous variable was also used for dose-response analysis. The main outcomes included all-cause and CVD-specific mortality. A total of 19,951 US adults aged 30-79 years were included in this study. Only 19.5% of adults achieved a high total CVH score, whereas 24.1% had a low score. During a median follow-up of 7.6 years, compared with adults with a low total CVH score, those with an intermediate or high total CVH score had 40% (adjusted hazard ratio [HR] 0.60, 95% confidence interval [CI] 0.51-0.71) and 58% (adjusted HR 0.42, 95% CI 0.32-0.56) reduced risk of all-cause mortality. The corresponding adjusted HRs (95%CIs) were 0.62 (0.46-0.83) and 0.36 (0.21-0.59) for CVD-specific mortality. The population-attributable fractions for high (score ≥ 75 points) vs. low or intermediate (score < 75 points) CVH scores were 33.4% for all-cause mortality and 42.9% for CVD-specific mortality. Among all 8 individual CVH metrics, physical activity, nicotine exposure, and diet accounted for a large proportion of the population-attributable risks for all-cause mortality, whereas physical activity, blood pressure, and blood glucose accounted for a large proportion of CVD-specific mortality. There were approximately linear dose-response associations of total CVH score (as a continuous variable) with all-cause and CVD-specific mortality. Achieving a higher CVH score according to the new Life's Essential 8 was associated with a reduced risk of all-cause and CVD-specific mortality. Public health and healthcare efforts targeting the promotion of higher CVH scores could provide considerable benefits to reduce the mortality burden later in life.

Sun J ，Li Y ，Zhao M ，Yu X ，Zhang C ，Magnussen CG ，Xi B ... -  《BMC Medicine》

Status of Cardiovascular Health in US Adults and Children Using the American Heart Association's New "Life's Essential 8" Metrics: Prevalence Estimates From the National Health and Nutrition Examination Survey (NHANES), 2013 Through 2018.

Lloyd-Jones DM ，Ning H ，Labarthe D ，Brewer L ，Sharma G ，Rosamond W ，Foraker RE ，Black T ，Grandner MA ，Allen NB ，Anderson C ，Lavretsky H ，Perak AM ... -  《-》

Association of Achievement of the American Heart Association's Life's Essential 8 Goals With Incident Cardiovascular Diseases in the SHFS.

Paing PY ，Littman AJ ，Reese JA ，Sitlani CM ，Umans JG ，Cole SA ，Zhang Y ，Ali T ，Fretts AM ... -  《Journal of the American Heart Association》

Association between new Life's Essential 8 and the risk of all-cause and cardiovascular mortality in patients with hypertension: a cohort study.

The American Heart Association recently introduced a new model for cardiovascular health (CVH) known as Life's Essential 8 (LE8). The impact of LE8 on hypertensive individuals is currently unclear. In our study, we investigated the correlation between comprehensive and individual CVH indicators as defined by LE8, and the mortality rates in hypertension patients. We analyzed a total of 8,448 hypertensive individuals aged ≥ 20 years who participated in the National Health and Nutrition Examination Survey from 2007 to 2016. These participants were nonpregnant and noninstitutionalized. We identified their mortality by linking their data to the National Death Index until December 31, 2019. The overall cardiovascular health (CVH) was assessed using the LE8 score, which ranged from 0 to 100. Additionally, we evaluated the scores for each component of diet, physical activity, tobacco/nicotine exposure, sleep duration, body mass index, non-high-density lipoprotein cholesterol, blood glucose, and blood pressure. The CVH were categorized into low (0-49), moderate (50-79), and high (80-100) CVH. Over an average follow-up period of 7.41 years, 1,482 (17.54%) of the participants died, among which 472 deaths were attributed to CVD. When compared to adults with lower total CVH scores, those with elevated total CVH scores displayed a 37% reduced risk of mortality from all causes (adjusted hazard ratio [aHR] = 0.63, 95% confidence interval [CI] = 0.45-0.88). In relation to CVD-specific mortality, the corresponding aHRs for moderate and high total CVH scores were 0.76 (0.60-0.97) and 0.54 (0.31-0.94), respectively. Furthermore, after adjusting for potential confounders, it was observed that higher scores on the LE8 index were associated with a reduced risk of both all-cause mortality (aHR for every 10-score increase, 0.91; 95% CI = 0.86-0.96) and CVD-specific mortality (aHR for every 10-score increase, 0.82; 95% CI = 0.75-0.90). Notably, a linear dose-response relationship was observed in this association. Similar patterns were identified in the relationship between health behavior and both all-cause and CVD-specific mortality. Achieving a higher CVH score, as per the new LE8 guidelines, has been found to be associated with a reduced risk of mortality from all causes and specifically from CVD in patients with hypertension. Therefore, public health and healthcare initiatives that focus on promoting higher CVH scores could potentially yield significant benefits in terms of reducing mortality rates among individuals with hypertension.

He L ，Zhang M ，Zhao Y ，Li W ，Zhang Y ... -  《BMC PUBLIC HEALTH》

'Life's Essential 8' cardiovascular health with premature cardiovascular disease and all-cause mortality in young adults: the Kailuan prospective cohort study.

Whereas cardiovascular disease (CVD) metrics define risk in individuals aged over 40 years, the earliest lesions of CVD appear well before this age. Cardiovascular health (CVH) was proposed to improve cardiovascular risk factors and was updated recently. This study aimed to explore the associations of baseline and long-term CVH assessed by 'Life's Essential 8' metrics with premature CVD and all-cause mortality in young Chinese adults. A total of 16 011 CVD-free participants aged 18-40 years were enrolled from the Kailuan cohort study. The CVH score ranged from 0 to 100 and was categorized into low, moderate, and high. Cox regressions were used to assess the hazard ratios (HRs) for the associations of baseline, time-updated mean, and time-varying CVH with the risk of outcomes. During a median follow-up of 13 years, we identified 271 cases (1.7%) of CVD and 219 cases (1.4%) of all-cause mortality. A lower CVH was associated with a higher risk of CVD and all-cause mortality; the adjusted HR in the low CVH vs. the high CVH group was 7.34 [95% confidence interval (CI), 3.19-16.89] and 2.54 (95% CI, 1.27-5.06) for baseline CVH, 4.38 (95% CI, 2.14-8.97) and 1.99 (95% CI, 1.06-3.71) for time-updated CVH, and 8.19 (95% CI, 2.70-24.88) and 4.28 (95% CI, 1.70-10.81) for time-varying CVH, respectively. We observed an inverse gradient association of baseline and long-term CVH with the risk of premature CVD and all-cause mortality in young adults, emphasizing the importance of keeping health behaviours and factors earlier in life. This longitudinal prospective cohort study showed an inverse gradient association of baseline and long-term cardiovascular health, as measured by the new updated Life's Essential 8 metrics, with the risk of premature cardiovascular disease and all-cause mortality in Chinese young adults, emphasizing the importance of keeping health behaviours and factors earlier in life.Baseline and longitudinal low cardiovascular health (CVH) status (measured by time-updated mean and time-varying CVH score) was associated with a higher risk of cardiovascular disease (CVD) and all-cause mortality in young adults aged <40 years.Among the eight metrics of LE8, lower scores of health factors were associated with a higher risk of CVD and all-cause mortality in young adults, while the associations of health behaviours with CVD and all-cause mortality were non-significant.

Xing A ，Tian X ，Wang Y ，Chen S ，Xu Q ，Xia X ，Zhang Y ，Zhang X ，Wang A ，Wu S ... -  《-》