Comparative Discrimination of Life’s Simple 7 and Life’s Essential 8 to Stratify Cardiovascular Risk: Is the Added Complexity Worth It?

Oct 13, 2023Circulation

Comparing Life's Simple 7 and Life's Essential 8 for Predicting Heart Disease Risk: Is the Extra Detail Helpful?

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Abstract

Among 11,609 participants, both Life's Simple 7 (LS7) and Life's Essential 8 (LE8) metrics were associated with a 10-year cardiovascular disease (CVD) risk of approximately 5% for those at the 99th percentile of scores.

Both LS7 and LE8 metrics yield scores where higher values indicate lower CVD risk.
Participants with LS7 and LE8 scores around the first percentile had a 20% risk of CVD, representing a 4× higher risk than those at the 99th percentile.
Estimated 10-year CVD risk was 8.4% for individuals at the 35.8th percentile of LS7 and 8.5% for those at the 39.4th percentile of LE8 scores.
The age-race-sex adjusted c-statistic for LS7 was 0.691, while for LE8 it was 0.695, indicating similar discrimination capabilities between the two metrics.
Both metrics are associated with incident CVD, suggesting that LS7 may be a simpler option for the general population.

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BACKGROUND: Life's Simple 7 (LS7) is an easily calculated and interpreted metric of cardiovascular health based on 7 domains: smoking, diet, physical activity, body mass index, blood pressure, cholesterol, and fasting glucose. The Life's Essential 8 (LE8) metric was subsequently introduced, adding sleep metrics and revisions of the previous 7 domains. Although calculating LE8 requires additional information, we hypothesized that it would be a more reliable index of cardiovascular health.

METHODS: Both the LS7 and LE8 metrics yield scores with higher values indicating lower risk. These were calculated among 11 609 Black and White participants free of baseline cardiovascular disease (CVD) in the Reasons for Geographic and Racial Differences in Stroke study, enrolled in 2003 to 2007, and followed for a median of 13 years. Differences in 10-year risk of incident CVD (coronary heart disease or stroke) were calculated as a function LS7, and LE8 scores were calculated using Kaplan-Meier and proportional hazards analyses. Differences in incident CVD discrimination were quantified by difference in the c-statistic.

RESULTS: For both LS7 and LE8, the 10-year risk was approximately 5% for participants around the 99th percentile of scores, and a 4× higher 20% risk for participants around the first percentile. Comparing LS7 to LE8, 10-year risk was nearly identical for individuals at the same relative position in score distribution. For example, the "cluster" of 2013 participants with an LS7 score of 7 was at the 35.8th percentile in distribution of LS7 scores, and had an estimated 10-year CVD risk of 8.4% (95% CI, 7.2%-9.8%). In a similar location in the LE8 distribution, the 1457 participants with an LE8 score of 60±2.5 at the 39.4th percentile of LE8 scores had a 10-year risk of CVD of 8.5% (95% CI, 7.1%-10.1%), similar to the cluster defined by LS7. The age-race-sex adjusted c-statistic of the LS7 model was 0.691 (95% CI, 0.667-0.705), and 0.695 for LE8 (95% CI, 0.681-0.709) (for difference, 0.12). P

CONCLUSIONS: Both LS7 and LE8 were associated with incident CVD, with discrimination of the 2 indices practically indistinguishable. As a simpler metric, LS7 may be favored for use by the general population and clinicians.

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Comparative Discrimination of Life’s Simple 7 and Life’s Essential 8 to Stratify Cardiovascular Risk: Is the Added Complexity Worth It?

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