A total of 9,379 (2.8%) participants developed during a median follow-up of 13.6 years.
Higher cardiovascular health (CVH) scores, categorized as moderate and high, are associated with a significantly lower risk of heart failure compared to low CVH scores.
Specifically, moderate CVH scores are linked to a 40.4% reduced risk ( 0.596), while high CVH scores are associated with a 54.2% reduced risk (hazard ratio 0.458) of heart failure.
Each standard deviation increase in the (LE8) score correlates with a 25.5% lower risk of developing heart failure.
Participants with low CVH and depressive symptoms show a greater risk for heart failure compared to those without depressive symptoms.
The lowest risk of heart failure is found in individuals with high CVH scores and no depressive symptoms, indicating a protective effect.
Simplified
BACKGROUND: The (LE8) proposed by the American Heart Association for assessing cardiovascular health (CVH) has been demonstrated to be associated with cardiovascular disease, but rarely includes (HF), and the role of psychological factors has not been considered. We aimed to prospectively investigate the independent, joint, and interactive associations of LE8 and depressive symptoms with HF incidence.
METHODS: A total of 336,939 participants recruited from UK Biobank without HF, coronary heart disease, and stroke were included in the cohort study. The LE8 score consisted of four behavioral (diet, physical activity, nicotine exposure, and sleep) and four biological factors (glucose, blood lipids, blood pressure, and body mass index) and was classified into three levels: low, moderate, and high CVH. Depressive symptoms at baseline were identified by self-report and linkage to medical records. Incident HF cases during follow-up were extracted through primary care, hospital admissions, self-reports, and death registrations. Cox proportional hazard models were conducted to examine the associations of LE8 and depressive symptoms with HF incidence, with findings presented as hazard ratios (HRs) (95% confidence interval, CI).
RESULTS: A total of 9379 (2.8%) participants developed HF during a median follow-up of 13.6 years. Compared with low-CVH individuals, the multivariate-adjusted HRs with 95% CI for incident HF were 0.596 (0.565-0.629) and 0.458 (0.408-0.514) in those with moderate and high CVH, respectively. Per standard deviation increment in LE8 was associated with a 25.5% ( = 0.745; 95% CI: 0.729-0.762) lower risk of HF. The stratification analysis indicated that the detrimental effect of low CVH on HF was more pronounced in participants with depressive symptoms compared to those without, with a significant multiplicative interaction (P for multiplicative interaction = 0.016). The joint test showed that the lowest risk of HF was observed in participants with high CVH and no depressive symptoms (HR = 0.344; 95% CI: 0.295-0.401), which may be attributed to a significant additive interaction observed.
CONCLUSIONS: The cohort study revealed that LE8-defined CVH not only could predict the incidence of HF, but also mitigate the increased risk of HF attributable to depressive symptoms. Achieving the high LE8 scores recommended by the AHA to improve CVH will be beneficial in reducing the population burden of HF, especially among patients with depressive symptoms.
Key numbers
0.458
Lower Risk of with High CVH
for incident in high CVH vs. low CVH
9379 of 336,939
Incidence in Study Population
Total cases of during the study follow-up
25.5%
Risk Reduction per SD Increment in
Percentage reduction in risk per standard deviation increase in score
Full Text
We can’t show the full text here under this license.
Declarations. Ethics approval and consent to participate: The Northwest Multi-center Research Ethics Committee (MREC reference: 21/NW/0157) provided ethical approval for the UK Biobank project. All participants gave informed consent before being recruited. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.
