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 and Risk of All-Cause and Cardiovascular Mortality in US Adults With Arthritis: A Retrospective Cohort Study Utilizing NHANES Database.

Life's Essential 8 (LE8) is a recently updated algorithm for evaluating cardiovascular health (CVH). This study investigates the association between LE8 and mortality risk among individuals with arthritis in the United States. We conducted a retrospective cohort study using data from the US National Health and Nutritional Examination Survey (NHANES) 2005-2018. Participants with arthritis were included. Mortality data, including underlying causes of death, were obtained through linkage to national death records up to December 31, 2019. LE8 components (diet, physical activity, nicotine exposure, sleep, body mass index, blood lipids, glucose, and pressure) were measured and scored from 0 to 100. The total LE8 score, calculated as the unweighted average of all components, was categorized into low (0-49), moderate (50-79), and high (80-100) CVH. We employed Kaplan-Meier curves to estimate survival probabilities and weighted Cox proportional hazards regression models to evaluate hazard ratios (HRs) with 95% confidence intervals (CIs) for all-cause and cardiovascular disease (CVD) mortality. Stratified analyses and interaction tests were performed to explore potential effect modifications. Among 4519 participants with arthritis (median follow-up: 7.67 years), we observed 793 all-cause deaths, including 213 CVD deaths. Every 10-point increase in the LE8 score was associated with a 17% lower risk of all-cause mortality (HR: 0.83, 95% CI: 0.77-0.89) and a 25% lower risk of CVD mortality (HR: 0.75, 95% CI: 0.66-0.85). Compared to the lowest CVH tertile, individuals in the highest tertile demonstrated a 38% lower risk of all-cause mortality (HR: 0.62, 95% CI: 0.41-0.92) and a 62% lower risk of CVD mortality (HR: 0.38, 95% CI: 0.18-0.80). Kaplan-Meier survival curves revealed significantly higher survival probability for patients with high CVH compared to those with lower CVH (log-rank p < 0.05). Stratified analyses confirmed consistent associations across various subgroups. Similar findings were observed in sensitivity analyses focusing on osteoarthritis and other arthritis subtypes. Higher adherence to LE8 recommendations is associated with reduced risks of all-cause and cardiovascular mortality among US adults with arthritis.

Yao F ，Zhang J ，Li X ，Sun M ，Shih PC ，Li T ... -  《-》

Association of the American Heart Association's new "Life's Essential 8" with all-cause mortality in patients with chronic kidney disease: a cohort study from the NHANES 2009-2016.

People with chronic kidney disease (CKD) are more likely to die prematurely, and this increased risk of death is primarily attributable to deaths from cardiovascular disease (CVD). We aim to investigate the relationship between Life's Essential 8 (LE8), a newly proposed cardiovascular health (CVH) measurement system, and all-cause mortality of CKD patients among US adults. A total of 3,169 CKD patients aged 20 and older from the National Health and Nutritional Examination Survey in 2009-2016 were involved in this study. Participants were divided into low (0-49), moderate (50-79) and high (80-100) CVH groups according to LE8 score (range 0-100). The mortality was ascertained from the National Death Index. Cox proportional hazards regression and restricted cubic spline were used to investigate the relationship. Among the 3,169 CKD patients, the median age was 66.0 (25.0) years and 1,671 (52.7%) were female, and the median follow-up time was 6.00 years. The median LE8 score of the study cohort was 57.5 (19.4). CKD patients with low CVH, health behavior (HB) and health factors (HF) scores presented with higher all-cause mortality (both log-rank P-values < 0.001). After adjusted for multiple confounders, patients in higher CVH group had a lower risk of all-cause mortality, with a HR (95%CI) of 0.32 (0.19-0.55). Similar results were observed in high HB group [HR 0.36 (0.25-0.50)]. The restricted cubic spline showed a significant inverse relationship between LE8, HB and HF scores with CKD all-cause mortality, while the protective effect seemed weaker for HF score. Above results remained robust in the sensitivity analysis. Stronger inverse associations were revealed in middle-aged patients and patients with higher education levels. LE8 and its subscales scores were inversely associated with all-cause mortality in patients with CKD. Promoting CVH in CKD patients is a potential way to improve their long-term survival rate.

Han Y ，Di H ，Wang Y ，Zhang Y ，Zeng X ... -  《BMC PUBLIC HEALTH》

Association of life's essential 8 with chronic cardiovascular-kidney disorder: a prospective cohort study.

The coexistence of cardiovascular disease and chronic kidney disease, termed chronic cardiovascular-kidney disorder (CCV-KD), is increasingly prevalent. However, limited studies have assessed the association between cardiovascular health (CVH), assessed by the American Heart Association's Life's Essential 8 (LE8), and CCV-KD. We conducted a prospective cohort study using data from UK Biobank. Participants without cardiovascular disease and chronic kidney disease at baseline and having complete data on metrics of LE8 were included (N = 125,986). LE8 included eight metrics, and the aggregate score was categorized as low (< 50 points), intermediate (50 to < 80 points), and high (≥ 80 points), with a higher score indicating better CVH health. Adjusted Cox proportional hazard models were conducted to explore the association of CVH with the risk of CCV-KD. The adjusted proportion of population attributable risk (PAR%) was used to calculate the population-level risk caused by low or intermediate CVH. During a median follow-up of 12.5 years, 1,054 participants (0.8%) had incident CCV-KD. Participants with intermediate and high CVH had 54% (HR = 0.46, 95% CI: 0.40-0.54, P < 0.001) and 75% (HR = 0.25, 95% CI: 0.18-0.34, P < 0.001) lower risks of incident CCV-KD compared with those in low CVH group. There was an approximately dose-response linear relationship between the overall LE8 score and incident CCV-KD. The risk of incident CCV-KD decreased by 30% (HR = 0.70, 95% CI: 0.67-0.74, P < 0.001) for a 10-point increment of LE8 score. The adjusted PAR% of lower overall CVH was 47.4% (95% CI: 31.6%-59.8%). Better CVH, assessed by using LE8 score, was strongly associated with decreased risk of incident CCV-KD. These findings imply optimizing CVH may be a preventive strategy to reduce the burden of CCV-KD.

Huang X ，Liang J ，Zhang J ，Fu J ，Deng S ，Xie W ，Zheng F ... -  《BMC PUBLIC HEALTH》