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Association Between Life's Essential 8 Cardiovascular Health Metrics With Cardiovascular Events
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
The American Heart Association recently launched updated cardiovascular health metrics, termed Life's Essential 8 (LE8). Compared with Life's Simple 7 (LS7), the new approach added sleep health as an eighth metric and updated the remaining 7 health factors and behaviors. The association of the updated LE8 score with long-term cardiovascular disease (CVD) outcomes and death is unknown.
METHODS
We pooled individual-level data from 6 contemporary US-based cohorts from the Cardiovascular Lifetime Risk Pooling Project. Total LE8 score (0-100 points), LE8 score without sleep (0-100 points), and prior LS7 scores (0-14 points) were calculated separately. We used multivariable-adjusted Cox models to evaluate the association of LE8 with CVD, CVD subtypes, and all-cause mortality among younger, middle, and older adult participants. Net reclassification improvement analysis was used to measure the improvement in CVD risk classification with the addition of LS7 and LE8 recategorization based on score quartile rankings.
RESULTS
Our sample consisted of 32 896 US adults (7836 [23.8%] Black; 14 941 [45.4%] men) followed for 642 000 person-years, of whom 9391 developed CVD events. Each 10-point higher overall LE8 score was associated with lower risk by 22% to 40% for CVD, 24% to 43% for congenital heart disease, 17% to 34% for stroke, 23% to 38% for heart failure, and 17% to 21% for all causes of mortality events across age strata. LE8 score provided more granular differentiation of the related CVD risk than LS7. Overall, 19.5% and 15.5% of the study participants were recategorized upward and downward based on LE8 versus LS7 categories, respectively, and the recategorization was significantly associated with CVD risk in addition to LS7 score. The addition of recategorization between LE8 and LS7 categories improved CVD risk reclassification across age groups (clinical net reclassification improvement, 0.06-0.12; P<0.01).
CONCLUSIONS
These findings support the improved utility of the LE8 algorithm for assessing overall cardiovascular health and future CVD risk.
Additional Info
Disclosure statements are available on the authors' profiles:
Association Between Life's Essential 8 Cardiovascular Health Metrics With Cardiovascular Events in the Cardiovascular Disease Lifetime Risk Pooling Project
Circ Cardiovasc Qual Outcomes 2024 Apr 19;[EPub Ahead of Print], H Ning, AM Perak, J Siddique, JT Wilkins, DM Lloyd-Jones, NB AllenFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Life's Essential 8
Cardiovascular disease is still the number one condition in the world, so we need ways that normal people can help themselves to reduce their risk. So a simple list of things was developed called the Life Essentials.
The newest version is the Life's Essential 8 (LE8) and this one has a few upgrades compared with the Life's Essential 7. Think of this like a smartphone upgrade.
There are four health behaviors included: diet, physical activity, nicotine exposure, and sleep. Sleep has been added to this new model. There are also 4 health factors that are included: body mass index, blood pressure, blood glucose, and non-HDL cholesterol.
Non-HDL cholesterol has replaced total cholesterol because it represents all the “bad” cholesterol. Remember HDL particles are the only ones that carry cholesterol away from your heart so they are like the garbage trucks. All the other cholesterol particles deliver cholesterol to your heart and organs. Therefore, non-HDL cholesterol is all the cholesterol that is being delivered, and it is a better predictor of cardiovascular (CV) events.
All these changes to the LE8 are meant to make this model better at predicting who is going to have a CV event. To help in that effort, every parameter gets a score from 0 to 100, where 100 is the best and 0 is the worst. The data used to assign these scores came from six existing cohort studies with 32,896 participants and over 642,262 person-years of follow-up.
Scores from the 8 parameters were averaged together to give a final score out of 100. In the old version (LE7), there were only three possible scores: 0, 1, and 2 for scores. This represented poor, intermediate, and ideal situations. This was useful but a score out of 100 could give a more precise prediction of CV risk.
For example, a blood pressure of less than 120/80 mm Hg is worth 100 points and as the blood pressure increases, the points are reduced until you reach a blood pressure of greater than 160/100 mm Hg which would be 0 points. With these fine increments, the risk assessment can be more precise.
This new model (LE8) can predict CV events and all-cause mortality with better accuracy and it can do that across the whole range of ages. For this version, the authors grouped the participants into three categories: young (20–39 years), middle-aged (40–59 years), and older (60–79 years).
When they compared the assessment of risk between LE8 and LE7, they found that 19.5% of the participants were re-categorized upwards and 15.5% were re-categorized downwards. So, there were significant differences between the two models.
There is a table to help you do the scoring, and it is quite straightforward. However, I think if we had to summarize it quickly for a patient, I would say that the ideal person who gets 100 in each category would have these parameters:
Perhaps we should all strive to be this person. This will be good for us and could reduce the burden on our healthcare system.