Association of Life's Essential 8 With Cardiovascular Disease and Mortality: The Framingham Heart Study

Nov 28, 2023Journal of the American Heart Association

Links Between Life's Essential 8 Health Factors and Heart Disease and Death: The Framingham Heart Study

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Abstract

Mean Life's Essential 8 score at examination 2 was 67 points, with a minimum of 26 points and a maximum of 100 points.

Participants with a Life's Essential 8 score of 68 or higher had a significantly lower risk of cardiovascular disease (CVD) and death compared to those with scores below 68.
The hazard ratio for CVD events in participants with LE8≥68 was 0.47, indicating a substantial reduction in risk.
A total of 966 CVD events and 1195 deaths were observed over a median follow-up of 30 to 33 years.
Participants who maintained low Life's Essential 8 scores throughout their lives were associated with the highest risks for CVD and death.
The hazard ratios for CVD in those with consistently low LE8 scores ranged from 1.8 to 2.3, and the hazard ratio for death was 1.45.

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BACKGROUND: The association of the American Heart Association's updated cardiovascular health score, the Life's Essential 8 (LE8), with cardiovascular disease (CVD) and death is not described in the FHS (Framingham Heart Study).

METHODS AND RESULTS: We evaluated Framingham Offspring participants at examinations 2 and 6 (n=2888 and 1667; and mean age, 44 and 57 years, respectively), free of CVD with information on LE8 components. Using age-sex-adjusted Cox models, we related LE8 and its change (examination 2 to examination 6) with CVD and death risk and compared associations with those of the Life's Simple 7 score. Mean LE8 score at examination 2 was 67 points (minimum, 26 points; maximum, 100 points). At both examinations, participants were reclassified to a different cardiovascular health status, depending on which method (LE8 versus Life's Simple 7) was used (60% of participants in ideal Life's Simple 7 status were in intermediate LE8 category). On follow-up after examination 2 (median, 30 and 33 years for CVD and death, respectively), we observed 966 CVD events, and 1195 participants died. Participants having LE8≥68 (sample median) were at lower CVD and death risk compared with those with LE8<68 (examination 2: CVD hazard ratio [HR], 0.47 [95% CI, 0.41-0.54]; death HR, 0.55 [95% CI, 0.49-0.62]; all<0.001). Participants maintaining low LE8 scores during life course were at highest CVD and death risk (CVD: HRs ranging from 1.8 to 2.3;<0.001; death HR, 1.45 [95% CI, 1.13-1.85];=0.003 versus high-high group). P P P

CONCLUSIONS: Further studies are warranted to elucidate whether the LE8 score is a better marker of CVD and death risk, compared with Life's Simple 7 score.

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Association of Life's Essential 8 With Cardiovascular Disease and Mortality: The Framingham Heart Study

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