Life's Essential 8: Updating and Enhancing the American Heart Association's Construct of Cardiovascular Health: A Presidential Advisory From the American Heart Association

Association between life's essential 8 and diabetic kidney disease: a population-based study

BACKGROUND AND AIMS

Diabetic patients are highly susceptible to cardiovascular and renal diseases. As a newly updated comprehensive index for assessing cardiovascular health (CVH), Life's essential 8 (LE8) has the potential to serve as a practical tool for evaluating the risk of diabetic kidney disease (DKD). We are committed to exploring the relationship between LE8 and its subscales with DKD in diabetic patients, aiming to provide preliminary evidence for the formulation of clinical strategies.

METHODS AND RESULTS

A total of 3,715 NHANES participants were included in this study, representing 18.9 million non-institutionalized residents of the United States. The mean age of all subjects was 59.72 years, and the weighted prevalence of DKD among diabetic patients was 36.39%. After adjusting for potential confounding factors, it was found that compared to the low LE8 group, the risk of developing DKD was significantly lower in the moderate LE8 group (OR: 0.54, 95% CI: 0.43-0.66) and the high LE8 group (OR: 0.18, 95% CI: 0.08-0.42). A similar trend was observed across the subscales of the LE8 score. The results of the fully adjusted restricted cubic spline regression analysis revealed a linear relationship between LE8 and its subscales with DKD. The findings remained consistent in subgroup and sensitivity analyses, with no significant interactions observed between subgroups.

CONCLUSION

Higher scores on the LE8 and its subscales were associated with a lower risk of developing DKD. However, the long-term causal relationship between LE8 and DKD risk necessitates further validation and exploration through large-scale, rigorously designed prospective studies.

Association of Life's Essential 8 with risk of incident cardiovascular disease and mortality among adults with chronic kidney disease

Background

The American Heart Association recently released an updated algorithm for evaluating cardiovascular health (CVH), Life's Essential 8 (LE8). However, few studies have examined the association of LE8 with risk of cardiovascular disease (CVD) and mortality among individuals with chronic kidney disease (CKD). We investigated whether LE8 was associated with subsequent risk of CVD and mortality in the Chinese population of adults with CKD.

Methods

This prospective study included 18,716 adults (55.4 ± 14.0 years, 77.9 % men) with CKD free of CVD at baseline from the Kailuan study. A LE8 score (range 0-100 points) was constructed based on diet, physical activity, smoking, sleep duration, body mass index, blood lipids, blood glucose, and blood pressure. Incident CVD and mortality were identified by electronic health records and registers. Multivariable Cox regression models were used to compute hazard ratios (HRs) and 95 % confidence intervals (CIs).

Results

During a median follow-up of 14.0 and 14.4 years, 2117 cases of CVD and 4190 deaths were documented. After adjusting for potential confounders, comparing the high LE8 score (80-100 points) to the low LE8 score (<50 points), the multivariable HRs (95 % CIs) were 0.28 (0.20, 0.40) for CVD, 0.14 (0.06, 0.34) for myocardial infarction, 0.35 (0.25, 0.50) for total stroke, and 0.68 (0.56, 0.83) for all-cause mortality, respectively.

Conclusions

Among patients with CKD, greater adherence to CVH, as defined by LE8, was significantly associated with a lower risk of CVD and all-cause mortality.

Association of cardiovascular-kidney-metabolic syndrome with all-cause and cardiovascular mortality: A prospective cohort study

Background

Given evidence on the cardiovascular disease (CVD) risk conferred by comorbidity risk factors, the American Heart Association (AHA) recently introduced a novel staging construct, named cardiovascular-kidney-metabolic (CKM) syndrome. This study examined the association of CKM syndrome stages with all-cause and cardiovascular mortality among US adults.

Methods

Data were from the National Health and Nutrition Examination Survey (NHANES) 1999-2018 at baseline linked to the 2019 National Death Index records. For each participant, the CKM syndrome was classified into five stages: stage 0 (no CKM risk factors), 1 (excess or dysfunctional adiposity), 2 (metabolic risk factors and chronic kidney disease), 3 (subclinical CVD), or 4 (clinical CVD). The main outcomes were all-cause and cardiovascular mortality.

Results

Among 34,809 participants (mean age: 46.7 years; male: 49.2 %), the prevalence of CKM stages 0 to 4 was 13.2 %, 20.8 %, 53.1 %, 5.0 %, and 7.8 %, respectively. During a median follow-up of 8.3 years, compared to participants with CKM stage 0, those with higher stages had increased risks of all-cause mortality (stage 2: HR 1.43, 95 % 1.13-1.80; stage 3, HR 2.75, 95 % CI 2.12-3.57; stage 4, HR 3.02, 95 % CI 2.35-3.89). The corresponding hazard ratios (95 % confidence interval) of cardiovascular mortality risks were 2.96 (1.39-6.30), 7.60 (3.50-16.5), and 10.5 (5.01-22.2). The population-attributable fractions for advanced (stages 3 or 4) vs. CKM syndrome stages (stages 0, 1, or 2) were 25.3 % for all-cause mortality and 45.3 % for cardiovascular mortality.

Conclusion

Higher CKM syndrome stages were associated with increased risks of all-cause and cardiovascular mortality. These findings emphasize that primordial and primary prevention efforts on promoting CKM health should be strengthened to reduce mortality risk.

Cardiovascular-Kidney-Metabolic (CKM) Syndrome: A Case-Based Narrative Review

These 4 hypothetical cases highlight new features of the American Heart Association cardiovascular-kidney-metabolic (CKM) health construct. The cases incorporate the CKM staging system, estimates from the PREVENT risk calculator, and clinical approaches related to CKM stages and individual risk profiles. Topics include management considerations for (1) a patient with stage 1 obesity and impaired glucose tolerance, (2) a patient with metabolic risk factors and moderate-risk chronic kidney disease (CKD), (3) a patient with subclinical atherosclerotic cardiovascular disease and multiple comorbid conditions, and (4) a patient with metabolic risk factors, prior myocardial infarction, new-onset heart failure, atrial fibrillation, and CKD.

Social epidemiology of cardiometabolic risk factors in early adolescents

Background

To estimate associations between sociodemographic factors and cardiometabolic risk factors among a demographically diverse sample of U.S. adolescents aged 10-14 years.

Methods

This study analyzed data from the Adolescent Brain Cognitive Development (ABCD) Study (N = 1412), Years 2 and 3 (2018-2021). Cardiometabolic risk factors including hemoglobin A1c and cholesterol (total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and non-HDL-C) were assessed. Multivariable linear regression models were conducted to estimate the associations between sociodemographic factors (age, sex, race and ethnicity, household income, and parental education) and cardiometabolic risk factors (hemoglobin A1c, TC, HDL-C, and non-HDL-C).

Results

The average hemoglobin A1c level was 5.2 % (±0.4 %), the average TC level was 156.6 (±28.9) mg/dL, and the average HDL-C level was 56.0 (±12.9) mg/dL. Out of our sample, 0.5 % had diabetes (hemoglobin A1c ≥ 6.5 %), 7.6 % had high TC (≥200 mg/dL), and 7.4 % had low HDL-C (<40 mg/dL). Older age was associated with lower TC, HDL-C, and non-HDL-C levels. Male sex was associated with higher hemoglobin A1c (beta coefficient [B] 0.04; 95 % confidence interval [CI], 0.00, 0.08; p = 0.037) and lower TC (B -3.14; 95 % CI, -6.17, -0.11; p = 0.042) compared to female sex. Black and Native American race and ethnicity were associated with higher hemoglobin A1c compared to White race. Higher household income was associated with higher TC and HDL-C.

Conclusion

This study of a diverse population of early adolescents identified sociodemographic differences in hemoglobin A1c and cholesterol levels that can inform clinical and public health interventions.

Life's Essential 8 cardiovascular health status of 18-69-year-old individuals in France

Background

In 2022, the previously American Heart Association (AHA) life's simple 7 score (range 0 to 14) measuring cardiovascular health (CVH) has been updated by adding sleep health and providing more granularity to the score (range 0 to 100) to measure the so-called Life's Essential 8 (LE8) score. However, the distribution of the LE8 score in nationwide representative US and non-US populations is scarce. The present study quantifies LE8 score distribution and identifies determinants of high CVH (80-100 points) in French adults.

Methods

CONSTANCES is a nationwide French cohort study that randomly recruited participants aged 18 to 69 years in 24 participating health examination centers in 21 French "départements" in different regions of France between 2012 and 2019. Design weights for age class, sex, socio economic status, and examination center/region were applied to represent the source population. LE8 score was quantified using inclusion data on eight CVH metrics. The prevalence estimates were age-standardized directly using the 2022 EU 28 population. Mixed effects multivariable linear and logistic regression models identified key LE8 score determinants.

Results

The study included 191,335 participants free of prior cardiovascular disease, with an average age of 46.48 years (SD 13.41) and 54 % women, representing 45.17 million individuals aged 18-69 in France. The overall mean LE8 score was 66.11 (68.92 in women vs. 62.79 in men, p = 6.875e-7), 13.21 %, 76.81 %, and 9.43 % achieved high (≥ 80 points), moderate (50-79 points), and poor (< 50 points) LE8 levels, respectively. Diet had the lowest mean score (41.50), while blood glycemia had the highest mean score (95.50). Mixed effects multivariable regression models identified younger age, womanhood, high educational attainment, self-employment, or managerial positions, not living with a partner, fewer depressive symptoms, lower alcohol consumption, rural residence, less socioeconomic deprivation, and absence of CVD family history as predictors of higher LE8 scores.

Conclusions

Only 13.21 % of adults in France achieved a high LE8 score (≥ 80 points), and disparities related to individual and contextual socio-demographic factors and mental health were identified. The findings further underscore the importance of timely implementation of effective and personalized primordial prevention strategies.

Prevalence of American heart association's ¨ Life's Essential 8¨ in a cohort of Latino women

The ideal cardiovascular health (CVH) construct has recently been updated to ¨ Life's Essential 8¨(LE8).

Objective

to determine LE8's prevalence and its association with sociodemographic and socioeconomic determinants in a Latino women cohort in Santiago de Chile.

Methods

Cross-sectional study on 619 women between 35 and 70 years old, representing 1.359.509 women (after expansion factors). LE8 was assessed through a survey on demographic and CV risk factors, as well as anthropometric, blood pressure, and biochemical measurements. The overall LE8 score was estimated for all participants, ranging from 0 to 100 (≥80 points, high CVH and < 50 points, low CVH). Besides, the score for each metric was determined. A descriptive analysis was performed with sample weights for the overall sample, and stratified by age, education, family income level and civil status. A regression analysis was performed adjusted by age group, family income and education level to determine the association of sociodemographic variables with LE8 score.

Results

The mean overall LE8 score was 62.7 points. Only 11.5 % had a high LE8, while 18.2 % had a low score. The best-accomplished metrics were blood glucose and physical activity (PA); the worst were diet and nicotine exposure. The adjusted regression analysis showed significantly higher scores for younger age (+3.2 points for <45yo, p < 0.05) and higher education level (+5 points, p < 0.01 and +12 points, p = 0.000,1 for high school and tertiary education, respectively). Higher LE8 scores in women with high education level were significantly driven by improvements in 5 metrics (lipids, blood pressure, body mass index, diet and PA).

Conclusion

Nearly 1 out of 9 women from Santiago had an ideal LE8 score. Years of education are crucial determinants in the fight to get an ideal CVH.

Association of quantified cardiovascular health status with all-cause mortality risk in prediabetic patients

BACKGROUND

Patients with prediabetes are at increased risk of developing cardiovascular disease. The Life's Essential 8 (LE8) score, updated by the American Heart Association in 2022, is a tool used to quantify cardiovascular health (CVH). Quantifying healthy living status on the basis of the uniform standard LE8 will be useful for confirming whether health interventions can reduce the risk of death in prediabetic patients.

AIM

To investigate the associations between all-cause mortality risk and CVH status (as quantified by the LE8 score) in prediabetic patients.

METHODS

This study included 5344 participants with prediabetes (age: 52.9 ± 15.8 years; 51.6% men). The LE8 score includes four health indicators and four health behaviors. Cox proportional hazard ratios were calculated for all-cause mortality in the high CVH (LE8 ≥ 80), low CVH (LE8 ≤ 50), and moderate CVH (LE8 50-79) subgroups, and restricted cubic spline analyses were performed. Separate analyses of the associations of all-cause mortality risk with each LE8 component and CVH health behaviors and indicators were also performed.

RESULTS

In the median follow-up period of 8.33 years, 658 deaths occurred. Compared with those among participants with high CVH, the covariate-adjusted HRs (95% confidence intervals) for mortality among participants with moderate and low CVH were 2.55 (1.23-5.31) and 3.92 (1.70-9.02), respectively. There was a linear relationship between an improvement in CVH status and a reduction in all-cause mortality risk (P-overall < 0.0001, P-nonlinear = 0.7989). Improved CVH health behaviors had a more significant protective effect on patients with prediabetes than did the improvement in CVH health indicators.

CONCLUSION

High CVH status (as quantified by the LE8 score) is significantly associated with reduced mortality risk in prediabetic adults in the United States.

The Physical Home Food Environment in Relation to Children's Diet Quality and Cardiometabolic Health

BACKGROUND

Home food availability has been identified as an important influence on dietary intake. Less is known about the relationship between the physical home food environment (HFE) and factors of cardiometabolic health in children.

OBJECTIVE

The purpose of this study was to explore the relationship between the physical HFE and diet quality and factors of cardiometabolic health (eg, weight and blood biomarkers).

DESIGN

This was a cross-sectional secondary analysis with 1 or more children per household.

PARTICIPANTS/SETTING

This study included 44 children aged 6 to 12 years from 29 households in the Newark, DE area between August 2020 and August 2021.

MAIN OUTCOME MEASURES

The Home Food Inventory provides an obesogenic score (ie, score indicative of the presence of energy-dense foods) for the overall HFE and HFE subcategories scores; body mass index z-scores were calculated using measured height and weight; diet quality was measured using the Healthy Eating Index 2020 (HEI-2020) total scores; and cardiometabolic biomarkers were obtained from serum blood samples.

STATISTICAL ANALYSES PERFORMED

Unadjusted and adjusted linear mixed model regressions were used to test the association between the physical HFE and each of the outcome variables: body mass index z scores, HEI-2020 total scores, and cardiometabolic biomarkers. HFE subcategories (eg, fruits and vegetables) were also examined with each outcome using linear mixed model regression.

RESULTS

Mean ± SD age of the children was 9.5 ± 1.9 years, 61.4% were female, 59.1% identified as White, and 90.9% were non-Hispanic. Obesogenic score was significantly associated with body mass index z scores (β = .03, P = .029), but not HEI-2020 total scores or cardiometabolic biomarkers. As HFE fruits and vegetables subcategory increased, HEI-2020 total scores significantly increased (β = .73, P = .005) and total cholesterol (β = -1.54, P = .014) and low-density lipoprotein cholesterol levels (β = -1.31, P = .010) significantly decreased. Increased availability of sweet and salty snack food and availability of sugar-sweetened beverages was associated with increased fasting blood glucose (β = 0.65, P = .033) and insulin levels (β = 5.60, P = .035) respectively.

CONCLUSIONS

There is evidence of a relationship between the subcategories of the physical HFE and cardiometabolic factors. Future interventions are needed to understand whether altering the overall HFE or specific subcategories within the HFE can improve cardiometabolic health.

Association between cardiovascular health, cancer and its prognosis: A prospective cohort study

OBJECTIVES

Whether cardiovascular health (CVH) contributes to a reduced risk of cancer incidence and improves cancer prognosis remains unclear. This study aimed to evaluate the associations between CVH and risks of incident cancer and its subsequent CVD development and mortality.

STUDY DESIGN

Prospective cohort study.

METHODS

This study obtained data from the UK Biobank study. CVH was assessed based on Life's Essential 8 (LE8) metrics. The primary outcome was incident cancer, which was defined using ICD-10 code C00-C97, excluding nonmelanoma skin cancer. The hazard ratio and 95 % confidence intervals between CVH and risk of incident cancer and risk of CVD and death after diagnosis of cancer were assessed using multistate Markov and Cox proportional hazards regression models. CVD includes coronary heart disease, atrial fibrillation, heart failure and stroke. The median follow-up period was 12.7 years, and follow-up ended on December 1, 2022.

RESULTS

In total, 218,587 participants were eligible for analysis. During the follow-up, 27,603 (12.6 %) participants experienced incident cancer, 26,630 (12.2 %) experienced incident CVD and 12,399 (5.7 %) died. In fully-adjusted multi-state models, increased CVH scores were significantly associated with a reduced risk of incident cancer (HR per 10-point increment of CVH scores: 0.98, 95 % CI: 0.96-0.99), incident CVD (0.90, 0.89-0.91), and death (0.84, 0.81-0.87). Higher CVH scores were also associated with lower risks of incident CVD (0.90, 0.86-0.94) and death (0.89, 0.87-0.92) among cancer survivors. Notably, participants with a high Townsend deprivation index demonstrated the strongest associations of CVH with cancer and its prognosis, compared to those with low or intermediate levels of the index (P-for-interaction <0.05).

CONCLUSIONS

CVH is notably associated with the reduced risk of cancer and its subsequent development of CVD and death, which is more evident among participants with lower socioeconomic status. Our results highlight the potential of promoting LE8 adherence for primary and secondary prevention of cancer.

Association of depression, traditional risk factor control and genetic risk with incident cardiovascular disease among individuals with prediabetes: A population-based prospective study from UK biobank

BACKGROUND

The relationship between depression and cardiovascular disease (CVD) in individuals with prediabetes, its relative importance compared with traditional risk factors and whether genetic risk modifies this association remain unclear.

AIMS

To explore the potential interactive effects of controlling traditional risk factors and depression on CVD, and to assess how depression compares with traditional risk factors in terms of its relative contribution to CVD risk in individuals with prediabetes.

MATERIALS AND METHODS

We analysed a prospective cohort of 42,020 individuals from the UK Biobank, all free of prevalent CVD. Depression was determined using multiple sources to accurately assess the exposure. The five traditional risk factors considered were sleep duration, smoking, blood pressure (BP), low-density lipoprotein (LDL) cholesterol and renal function. We used Cox proportional hazards regression models to examine the associations between depression, risk factor control and CVD events.

RESULTS

Over a median follow-up of 13.1 years, 5865 individuals developed CVD, including 4764 cases of coronary heart disease and 1415 strokes. Compared with controlling 4-5 risk factors, both depression and controlling 0-1 risk factor significantly increased the risk of CVD in individuals with prediabetes. The corresponding multivariable-adjusted hazard ratios (95% CI) for CVD were 1.18 (1.09-1.28) and 1.44 (1.29-1.60), respectively. Depression ranked second in predicting CVD among the selected risk factors. A synergistic effect between depression and risk factor control was observed for CVD, with a relative excess risk due to interaction of 0.16 (0.06-0.26). Furthermore, these associations were independent of the genetic susceptibility to CVD.

CONCLUSIONS

Among individuals with prediabetes, both depression and suboptimal control of traditional risk factors are associated with an increased risk of CVD, independent of genetic susceptibility.

Positive childhood experiences and adult cardiovascular health

OBJECTIVE

To test whether positive childhood experiences (PCEs) assessed prospectively in adolescence predict ideal cardiovascular health in adulthood, even after controlling for experiences of childhood maltreatment. We also tested whether PCEs would moderate the association between childhood maltreatment and adult cardiovascular health and whether sex moderated the association between PCEs and cardiovascular health.

METHOD

Data originated from the National Longitudinal Study of Adolescent to Adult Health (Add Health), a nationally representative longitudinal study in the United States (n = 2,916). Using data from the Wave 1 adolescent assessment (Mage = 15.70 years, 1994-1995), a 12-item index of cumulative self-reported PCEs (e.g., stable caregiver, adult mentor, one good friend, enjoyed school, good neighbors) was created. Childhood maltreatment experiences were self-reported at Wave 3 (Mage = 22.06 years, 2001-2002) and Wave 4 (Mage = 28.53 years, 2008). An ideal cardiovascular health score was calculated in Wave 5 (Mage = 37.47 years, 2016-2018) using the American Heart Association's Life's Essential 8 cardiovascular health index.

RESULTS

Greater PCEs predicted more ideal cardiovascular health (β = .13, p < .001), and greater childhood maltreatment predicted less ideal cardiovascular health in adulthood (β = -.12, p < .001). PCEs did not moderate the association between childhood maltreatment and adult cardiovascular health. Sex moderated the association between PCEs and adult cardiovascular health (β = .09, p = .042), such that the association was stronger for female (β = .20, p < .001) than male (β = .08, p = .073).

CONCLUSION

The finding that PCEs prospectively predict more ideal cardiovascular health in adulthood beyond the effect of childhood maltreatment suggests that promoting PCEs should be tested as part of interventions to prevent adult cardiovascular disease. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Global, regional and national burden of ischaemic heart disease attributable to high body mass index and low physical activity from 1990 to 2021

AIM

This study aimed to estimate the distribution of and changes in the global burden of ischaemic heart disease (IHD) attributable to high body mass index (BMI) and low physical activity (PA) from 1990 to 2021.

METHODS

Data on deaths, disability-adjusted life years (DALYs) and age-standardized rates for IHD attributable to high BMI and low PA were extracted from the Global Burden of Disease 2021 study. Temporal trends by gender, region and Socio-Demographic Index (SDI) were analysed using joinpoint regression. Decomposition, health inequality analysis and Bayesian model were utilized.

RESULTS

From 1990 to 2021, global DALYs and deaths for IHD attributable to high BMI and low PA nearly doubled, despite a decline in age-standardized DALYs ([average annual percent change (AAPC) = -0.26, 95% uncertainty interval (95% UI): -0.45, -0.07), (AAPC = -1.03, 95% UI:-1.18, -0.88]) and deaths rates ([AAPC = -0.53, 95% UI: -0.72, -0.33], [AAPC = -1.13,95% UI: -1.34, -0.92]), respectively. The burden of IHD due to high BMI was predominantly seen in males, while low PA was more prevalent in females. Significant regional and national variation was observed, with the burden shifting from high SDI regions to middle or low SDI regions. Population growth and aging have exacerbated this burden. Health inequities have shown improvement between 1990 and 2021. Projections for the next 15 years suggest rising global age-standardized DALYs and death rates of IHD attributable to high BMI, while those attributable to low PA may decrease.

CONCLUSIONS

Since 1990, the global and regional impact of IHD attributable to high BMI and low PA remains significant, with disparities by gender, age, region and SDI. Countries should implement effective measures to control BMI and promote PA to reduce the IHD burden.

The role of social determinants in alcohol consumption and cardiovascular health: The pathways study

BACKGROUND AND AIMS

The "J"-shaped relationship between alcohol consumption and cardiovascular health is recognized as potentially influenced by residual confounders, and this study aimed to clarify the role that social determinants play in the relationship.

METHODS AND RESULTS

Using NHANES data from 2005 to 2018, this study analyzed 30,648 participants to assess how eight social determinants (employment, income, food security, education, healthcare access, insurance, housing stability, and marital status) influence the relationship between alcohol consumption and cardiovascular disease (CVD). Moderate drinking reduces CVD risk (HR: 0.741, 95%CI: 0.661, 0.831, P < 0.001), while heavy drinking increases it (HR: 1.025, 95%CI: 1.004, 1.095, P = 0.035). Structural equation modeling revealed that ideal social determinants and health metrics contribute significantly to the cardiovascular protective effects of moderate drinking (path proportion: 42.31 %). Conversely, heavy drinking is associated with poorer social determinants and health metrics, masking the cardiovascular protective effect (path proportion: 90.91 %).

CONCLUSIONS

This study quantifies the role of social and health factors in the relationship between alcohol consumption and CVD. Despite identifying direct cardiovascular protective effects of alcohol consumption, global health initiatives should continue to advocate for reduced heavy drinking, given the significant risks involved.

Multimodal Associations of Modifiable Risk Factors on White Matter Injury: The SOL-INCA-MRI Study (HCHS/SOL)

BACKGROUND

Modifiable risk factors play a central role in the development and course of neurodegenerative disorders of later life, including dementias. Although past research has focused on independent associations of modifiable risk factors, including cardiovascular disease risk factors using Framingham cardiovascular risk score, physical activity, dietary quality, body mass index, and sleep, on neurodegeneration, the impact of all 5 factors simultaneously in a multimodal model has not been studied. We examined independent associations and an overall combined model with 5 modifiable risk factors with white matter injury, a recognized risk factor for dementia, ≈10 years later in a diverse Hispanic/Latino population.

METHODS

Participants were from the HCHS/SOL (Hispanic Community Health Study/Study of Latinos) Investigation of Nerocognitive Aging-Magnetic Resonance Imaging longitudinal study (n=2667; clinical visit 1 mean age, 52.01 [8.90] years). We conducted path and mediation analyses across 5 modifiable risk factors obtained at clinical visit 1 (2008-2011) and 2 measures of white matter injury (free water and white matter hyperintensity volume) obtained at the magnetic resonance imaging visit (2018-2022; mean age, 62.37 [9.23] years). We controlled for age at the time of the dependent variable, sex, education, Hispanic/Latino heritage, overall cognitive status, and b-value when free water was included.

RESULTS

We observed 11 significant independent associations across modifiable risk factors and white matter injury measures. The association of Framingham cardiovascular risk score to white matter hyperintensity volume was mediated by free water (indirect mediation: β=2.473; SE=0.207; P<0.001), and the association of physical activity to body mass index was mediated by sleep duration (indirect mediation: β=-0.038; SE=0.019; P=0.050). We combined the 2 mediational pathways and added diet associated with white matter hyperintensity volume (β=0.008; SE=0.007; P=0.004) and physical activity associated with Framingham cardiovascular risk score (β=-0.007; SE=0.002; P=0.001) in the overall model.

CONCLUSIONS

Our findings identified how modifiable risk factors synergistically influence future white matter injury in Hispanic/Latino populations. Such multimodal models may lead to the development of novel and personalized lifestyle clinical interventions for adults at risk for dementia due to elevated white matter hyperintensity volume.

Interventions That Support Lifestyle Behavior Change for Secondary Prevention of Stroke: A Scoping Review

Lifestyle behavioral change is a critical component for secondary prevention of stroke. Although evidence for the effectiveness of lifestyle behavior change is growing, methods to promote and maintain behavior change remain unclear. In this review, we aimed to synthesize the evidence for lifestyle behavior change interventions among patients living with stroke or transient ischemic attack. We searched 7 databases to identify studies, including randomized controlled trials, quasi-experimental, and longitudinal studies examining changes in cardiovascular risk factors. Data were extracted regarding participant characteristics, intervention attributes (eg, provider, behavior change techniques, and modality), and effectiveness for control of risk factors. From 4620 records identified, 73 studies were included. Information about the type of behavior change theory applied was reported in 36% of studies. The social cognitive theory and transtheoretical models were the most commonly cited frameworks. Changes in physical activity (64%) and blood pressure (63%) were the most frequently assessed outcomes. Fewer than half of the studies assessed changes in weight (41%), blood cholesterol (40%), diet (36%), smoking cessation (33%), alcohol consumption (19%), and blood glucose (18%). No studies assessed sleep as a risk factor. Most studies had mixed effects or no change for the risk factor measured. No studies reported negative effects. Interventions associated with improvements were more commonly delivered by a multidisciplinary team and informed by behavior change techniques. Further research is required to identify the most effective methods to promote and sustain lifestyle behavior change among people living with stroke or transient ischemic attack.

Cardiovascular health and its association with dementia, Parkinson's Disease, and mortality among UK older adults

Background

Previous research has primarily examined individual factors of cardiovascular health (CVH) and disease in PD and dementia, but no study has examined CVH measures with PD, dementia, and mortality simultaneously while accounting for potentially confounding factors.

Objectives

To examine the relationship between CVH, all-cause dementia, Parkinson's disease (PD), and mortality, focusing on associations and health transitions from a large population-based study.

Methods

We investigated these relationships using Cox Proportional Hazards and multistate parametric models with Weibull regression from the UK Biobank data (n = 269,816, Age = 50 + y individuals, ≤15y follow-up, 2006-2021).

Results

Full Cox models found poor CVH (measured with standardized reverse-coded Life's Essential 8 total score, LE8zrev), to be associated with increased risks for all-cause dementia (Hazard Ratio (HR) = 1.14, 95 % CI: 1.11-1.18, P < 0.001) and all-cause mortality (HR = 1.31, 95 % CI: 1.29-1.33, P < 0.001). Unlike "Healthy to PD" and "Dementia→Death" transitions, PD→Death (Weibull full model: HR = 1.18, 95 % CI: 1.06-1.31, P = 0.002), Healthy→dementia (HR = 1.15, 95 % CI: 1.12-1.19, P < 0.001), and Healthy→Death (HR = 1.33, 95 % CI: 1.32-1.35, P < 0.001) exhibited a positive relationship with poor CVH.

Conclusions

Poor CVH is directly associated with an increased risk of mortality from PD, transition into Dementia, and all-cause mortality without dementia or PD occurrence. Clinicians should aggressively screen for and manage CVH risk measures to reduce the risk of poor cognitive health outcomes.

Healthy lifestyles are associated with alleviating the single-nucleotide polymorphism-based genetic risks of ischaemic stroke, intracerebral haemorrhage and myocardial infarction

BACKGROUND

Both genetic and lifestyle factors contribute to myocardial infarction (MI) and stroke, including ischaemic stroke (IS) and intracerebral haemorrhage (ICH). We explored how and the extent to which a healthy lifestyle, by considering a comprehensive list, could counteract the genetic risk of those diseases, respectively.

METHODS

315 044 participants free of stroke and MI at baseline were identified from the UK Biobank. Genetic risk scores (GRS) for those diseases were constructed separately and categorised as low, intermediate and high by tertile. Lifestyle risk scores (LRS) were constructed separately using smoking, alcohol intake, physical activity, dietary patterns and sleep patterns. Similarly, participants were categorised into low, intermediate and high LRS. The data were analysed using Cox proportional hazard models.

RESULTS

Over a median follow-up of 12.8 years, 4642, 1046 and 9485 participants developed IS, ICH and MI, respectively. Compared with participants with low levels of GRS and LRS, the HRs of those with high levels of GRS and LRS were 3.45 (95% CI 2.71 to 4.41), 2.32 (95% CI 1.40 to 3.85) and 4.89 (95% CI 4.16 to 5.75) for IS, ICH and MI, respectively. Moreover, among participants with high GRS, the standardised 14-year rates of IS events were 4.40% (95% CI 3.45% to 5.36%) among those with high LRS. In contrast, it is only 1.78% (95% CI 1.63% to 1.94%) among those with low LRS. Similarly for MI, the high LRS group had standardised rates of 8.60% (95% CI 7.38% to 9.81%), compared with 3.34% (95% CI 3.12% to 3.56%) in low LRS. Among the high genetic risk group of ICH, the rate is reduced by about half compared low LRS to high LRS, although the rate was low for both (0.36% (95% CI 0.31% to 0.42%) and 0.71% (95% CI 0.36% to 1.05%), respectively).

CONCLUSION

Healthy lifestyles were substantially associated with a reduction in the risk of IS, ICH and MI and attenuated the genetic risk of IS, ICH and MI by at least half, respectively.

Genetic and Lifestyle Risks for Coronary Artery Disease and Long-Term Risk of Incident Dementia Subtypes

BACKGROUND

Shared genetic and lifestyle risk factors may underlie the development of both coronary artery disease (CAD) and dementia. We examined whether an increased genetic risk for CAD is associated with long-term risk of developing all-cause, Alzheimer's, or vascular dementia, and investigated whether differences in potentially modifiable lifestyle factors in the mid- to late-life period may attenuate this risk.

METHODS

A prospective cohort study of 365 782 participants free from dementia for at least 5 years after baseline assessment was conducted within the UK Biobank cohort. Genetic risk was assessed using a genomewide polygenic risk score (PRS) for CAD and lifestyle risk using a modified version of the American Heart Association's Life's Essential 8 Lifestyle Risk Score (LRS). Higher values for both scores were deemed to represent increased risk. Primary outcomes were incident all-cause, Alzheimer's, and vascular dementia diagnoses obtained from self-report and electronic health records. Secondary outcomes were neuroimaging phenotypes measured in 32 028 participants recalled for magnetic resonance imaging. Sensitivity analyses were conducted to test the extent by which biological and behavioral risk factors contributed to observed associations.

RESULTS

A total of 8870 cases of all-cause dementia were observed over a median 13.9-year follow-up. Both genetic (PRS) and lifestyle (LRS) risk scores for CAD were associated with a modestly elevated risk of all-cause dementia (subhazard ratio per SD increase, 1.10 [1.08, 1.12], P<0.001, for PRS and 1.04 [1.02, 1.06], P=0.006, for LRS). This risk appeared largely attributable to underlying vascular dementia diagnoses (subhazard ratio, 1.16 [1.11, 1.21], P<0.001 for PRS and 1.15 [1.09, 1.22], P<0.001, for LRS), because Alzheimer's disease was found to demonstrate moderate associations with PRS alone (subhazard ratio, 1.09 [1.06, 1.13]; P<0.001). LRS was found to have an additive rather than interactive effect with PRS, with individuals in the highest tertiles for both genetic and lifestyle risk for CAD ≈70% more likely to develop vascular dementia during follow-up compared with those in the lowest tertiles for both (subhazard ratio, 1.71 [1.39, 2.11]; P<0.001). This was substantially attenuated in those with a low LRS at baseline, however, regardless of underlying genetic risk (30% reduction for low versus high LRS tertile regardless of PRS tertile; P<0.001 for all). In a subset of individuals recalled for neuroimaging assessments, those in the highest tertiles for genetic and lifestyle risk for CAD demonstrated a ≈25% greater volume of white matter hyperintensities than those in the lowest risk tertiles, but showed little difference in gray matter or hippocampal volumes. Sensitivity analyses identified associations between both biological and behavioral risk scores with white matter hyperintensity burden and vascular dementia, whereas some Alzheimer's dementia associations showed seemingly paradoxical relationships.

CONCLUSIONS

Individuals who are genetically predisposed to developing CAD also face an increased risk of developing dementia in old age. This risk is reduced in those demonstrating healthy lifestyle profiles earlier in the lifespan, particularly in those who may be at an increased risk of developing dementia caused by an underlying vascular pathology.

The overlooked trio: sleep duration, sampling time and physical exercise alter levels of olink-assessed blood biomarkers of cardiovascular risk

Biomarker profiling from biofluids such as blood are widely measured in clinical research, using for example Olink proteomics panels. One such research focus area is cardiovascular disease (CVD), for which chronic sleep restriction (SR) is a risk factor. However, it remains unclear whether blood levels of commonly measured CVD biomarkers are sensitive to acute dynamic factors such as SR, physical exercise (PEx), and time of day. In this crossover design, 16 normal-weight, healthy men underwent three highly standardized in-lab nights of SR (4.25 h/night) and normal sleep (NS, 8.5 h/night) in randomized order, with 88 CVD blood protein biomarkers quantified using the Olink technology (and selected validation using ELISA) in the morning, evening, and immediately before and repeatedly after 30 min of high-intensity exercise. We found significant time-of-day-dependent changes in several CVD biomarkers. Whereas several proteins were exercise-induced across sleep conditions (such as the canonical exerkines IL- 6 and BDNF), exercise-induced proteomic dynamics differed in response to recurrent SR, compared with following NS. Moreover, SR compared with NS resulted in a biomarker profile previously associated with increased prospective risk of several CVDs across large-scale cohorts (such as higher circulating levels of IL-27 and LGALS9). Our findings highlight how dynamic physiology can modulate CVD biomarker levels. These results also underscore the need to consider sleep duration as a key determinant of cardiovascular health-an emphasis reflected in recent American Heart Association guidelines. Further studies in women, older individuals, and patients with prior CVD, and across different chronotypes and dietary schedules are warranted.

Association of the "life's crucial 9" cardiovascular health with all-cause and cardiovascular disease mortality: a national cohort study

BACKGROUND

In 2022, the American Heart Association launched an updated algorithm for quantifying cardiovascular health (CVH), termed Life's Essential 8 (LE8). This new approach has been shown to be associated with various noncommunicable chronic diseases and mortality. However, LE8 did not take into consideration the importance of psychological health on CVH. Recently, a perspective article proposed Life's Crucial 9 (LC9), which would add psychological health as another component to LE8, as a novel metric to assess CVH. This study aims to investigate the association of LC9 with all-cause and cardiovascular disease (CVD) mortality.

METHODS

This study included 23,080 adults from National Health and Nutrition Examination Survey 2005-2018, and mortality was ascertained by linkage to National Death Index records through 31 December 2019. The LC9 scoring algorithm was categorized into low (0-49), moderate (50-79), and high (80-100) CVH. Weighted Cox proportional hazards regression models and restricted cubic spline analysis were applied to evaluate the association of LC9 with mortality.

RESULTS

During a median follow-up of 7.8 years, a total of 2,388 overall deaths were identified, covering 613 CVD deaths. Compared with adults with a low CVH score, those with a high CVH score had 52% (hazard ratio, 0.48; 95% confidence interval, 0.38-0.60) and 64% (0.36; 0.23-0.56) reduced risk of all-cause and CVD mortality. Similarly, a moderate CVH score was associated with 33% (0.67; 0.58-0.78) and 49% (0.51; 0.40-0.64) reduced risk of all-cause and CVD mortality. The population-attributable fractions of high vs. moderate or low CVH score were 46.0% for all-cause mortality and 75.8% for CVD mortality. Elevated blood lipids, high body mass index, and poor sleep quality were the three major contributors to all-cause mortality, whereas nicotine exposure, unhealthy psychology, and elevated blood lipids were the three significant ones to CVD mortality. There were approximately negative linear dose-response relationships of total LC9 score with all-cause and CVD mortality.

CONCLUSIONS

Adhering to a high LC9 score is related to a reduced risk of all-cause and CVD mortality. This new CVH definition shows promise as a primordial preventive strategy to reduce mortality rates.

Life's crucial 9 is inversely and linearly associated with female infertility prevalence: a cross-sectional analysis from NHANES 2013-2018

Cardiovascular health (CVH) and depression may be associated with female infertility. More recently, it has been suggested that the addition of psychological health assessment to Life's Essential 8 (LE8), known as Life's Crucial 9 (LC9), may be clinically relevant. We aimed to explore the association of LC9 with female infertility and whether LC9 has significantly improved predictive ability for infertility compared to LE8 through NHANES 2013-2018. The LE8 was assessed by the approach proposed by the American Heart Association and included 8 CVH components. LC9 added an additional assessment of depression score based on the Patient Health Questionnaire-9 to LE8. Female infertility was diagnosed by self-report. Multivariate logistic regression analyses were used to explore these associations and to calculate odds ratios (ORs) and 95% confidence intervals (CIs). A total of 2088 women of reproductive age were included in the study, with an infertility prevalence of 13.98%.In the fully adjusted model, higher LC9 scores were associated with reduced odds of female infertility. Women in the highest LC9 quartile (Q2, Q3, and Q4) had consistently lower odds of infertility compared to those in the lowest quartile (Q1), with a significant linear trend observed. The components of LC9 that were found to be inversely associated with infertility included sleep health, body mass index, blood glucose, and depression.The relationship between LC9 and infertility was modified by both age and race/ethnicity. However, LC9 did not demonstrate a significant improvement in its predictive value for infertility when compared to LE8.This study indicate that LC9 is associated with a decreased likelihood of female infertility, suggesting its potential as a comprehensive cardiovascular health metric in this context. However, the study also found that LC9 did not significantly enhance the predictive ability for female infertility when compared to the established LE8 framework. These findings suggest that the inclusion of depression assessment in LE8 may not be essential for the prediction and prevention of female infertility, despite the observed association between depression and infertility. This underscores the need for further research to refine the integration of psychological health into cardiovascular health metrics and to explore targeted interventions for improving reproductive outcomes.

Association between atherogenic index of plasma with all-cause and cardiovascular mortality in individuals with Cardiovascular-Kidney-Metabolic syndrome

BACKGROUND

Cardiovascular-Kidney-Metabolic (CKM) syndrome, as a new clinical concept, emphasizes the multifaceted interaction between metabolic disorders, chronic kidney disease (CKD), and cardiovascular disease (CVD). Some evidence suggests atherogenic index of plasma (AIP) is strongly linked to cardiovascular mortality. However, data on its association with mortality across CKM syndrome remain scarce. Our study aimed to investigate the association between AIP and all-cause and cardiovascular mortality among individuals with CKM syndrome.

METHODS

This study included 15,703 participants with CKM syndrome from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018. The AIP index is calculated as log10(triglycerides/high-density lipoprotein cholesterol [TG/HDL-C]). Mortality outcomes were determined by linking NHANES participants with the National Death Index (NDI), with follow-up data available through December 31, 2019. Kaplan-Meier (K-M) survival curves, Cox regression analysis, restricted cubic spline (RCS) and subgroups analysis were used to explore the relationship between AIP levels and mortality in individuals with CKM syndrome.

RESULTS

Over a median follow-up of 7.67 years, a total of 1570 deaths were documented, including 344 cardiovascular deaths. Kaplan-Meier survival analysis demonstrated that the lowest all-cause and CVD mortality rates were observed in the lowest AIP tertile. Compared with individuals in the lowest AIP tertile, Cox analysis indicated that those in highest tertile were associated with a higher risk of all-cause and CVD mortality (HR = 1.19, 95% CI 1.08-1.31, P < 0.001; HR = 1.38, 95% CI 1.22-1.57, P < 0.001) after adjusting for covariates, respectively. As a continuous variable, AIP levels had an approximate positive linear dose-response relationship with all-cause and CVD mortality. Subgroup analysis revealed no significant interactions with the examined variables, except for gender.

CONCLUSIONS

This study demonstrated that elevated AIP levels in individuals with CKM syndrome are strongly linked to higher mortality risks, notably all-cause mortality in advanced stages and CVD mortality across both non-advanced and advanced stages. These findings further highlight the importance of AIP as a valuable risk biomarker, providing a simple and effective tool for identifying mortality risk in individuals with CKM syndrome.

Adherence to life's essential 8 is associated with delayed white matter aging

BACKGROUND

The American Heart Association introduced Life's Essential 8 (LE8) to promote cardiovascular health and longevity. However, its impact on brain ageing and interactions with genetic risk factors of dementia, such as APOE4, remains unclear. This study investigates the relationship between LE8 and white matter brain ageing and evaluates the moderating effects of the APOE4 allele.

METHODS

This cross-sectional study utilized data from the UK Biobank, including genetic, neuroimaging, and health-related data from touchscreen questionnaires, physical examinations, and biological samples. Participants were non-pregnant whites with LE8 variables, diffusion tensor imaging (DTI) data, and APOE4 genetic information available, excluding those with extreme white matter hyperintensities. Regional fractional anisotropy measures from DTI data were used to predict white matter brain age via random forest regression. The white matter brain age gap (BAG) was calculated by subtracting chronological age from predicted brain age.

FINDINGS

The analysis included 18,817 participants (9430 women and 9387 men; mean age 55.45 years [SD: 7.46]). Higher LE8 scores were associated with a lower white matter BAG, indicating delayed brain ageing. The effect was more pronounced in non-APOE4 carriers (124 days younger per 10-point increase, 95% CI: 102-146 days; p < 0.001) compared to APOE4 carriers (84 days younger per 10-point increase, 95% CI: 47-120 days; p < 0.001). Potential interaction between APOE4 and LE8 on brain ageing was observed for some age and sex groups but with only borderline significance, further investigation in larger and more targeted studies is needed to validate the finding.

INTERPRETATION

Adherence to LE8 is associated with delayed brain ageing, with genetic factors such as APOE4 potentially moderating this effect in specific age and sex groups. The overall benefit from a healthier lifestyle in individuals' brain ageing across genetic, sex, and age groups underscore the importance and broad applicability of behavioural lifestyle interventions in promoting brain health.

FUNDING

US National Institute of Health, University of Maryland, Montgomery County of Maryland.

Longitudinal association of cumulative risk factors in early life, genetic risk, and healthy lifestyles during adulthood with the risk of type 2 diabetes

BACKGROUND

The combined influence of early life risk factors on the type 2 diabetes (T2D) development is not well-studied, and it is unclear whether these associations can by modified by genetic risk and healthy lifestyles in later life.

METHODS

We studied 148,621 participants in the UK Biobank. We calculated early-life risk scores (ERS) by summing the cumulative number of three early-life risk factors: low birth weight, maternal smoking during pregnancy, and non-breastfed as a baby. We estimated polygenic risk scores (PRS) for T2D and calculated participants' modifiable healthy lifestyle score (MHS) during adulthood.

RESULTS

A total of 7,408 incident T2D were identified. ERS showed a positive dose-response association with T2D risk. Compared with participants with 0 ERS, those with 3 ERS had the highest risk of developing T2D (hazard ratio [HR]: 1.93; 95% confidence interval [CI]: 1.65, 2.26). This association was not modified by T2D-PRS or MHS. In the joint exposure analyses, compared with participants with the lowest risk exposure (i.e., lowest ERS combined with lowest T2D-PRS/healthy lifestyle in later life), we observed highest risk of T2D among individuals with the highest ERS combined with the highest tertile of T2D-PRS (HR = 6.67, 95% CI: 5.43, 8.20) or an unhealthy lifestyle in later life (HR = 4.99, 95% CI: 3.54, 7.02), respectively.

CONCLUSIONS

Early-life risk factors are associated with a higher risk of T2D in a dose-response manner, regardless of genetic risk or later-life healthy lifestyle. Therefore, identifying early-life modifiable risk factors is helpful to develop strategies of T2D prevention.

Association Between Sleep Duration and Cognitive Frailty in Older Chinese Adults: Prospective Cohort Study

Background

Disturbed sleep patterns are common among older adults and may contribute to cognitive and physical declines. However, evidence for the relationship between sleep duration and cognitive frailty, a concept combining physical frailty and cognitive impairment in older adults, is lacking.

Objective

This study aimed to examine the associations of sleep duration and its changes with cognitive frailty.

Methods

We analyzed data from the 2008-2018 waves of the Chinese Longitudinal Healthy Longevity Survey. Cognitive frailty was rendered based on the modified Fried frailty phenotype and Mini-Mental State Examination. Sleep duration was categorized as short (<6 h), moderate (6-9 h), and long (>9 h). We examined the association of sleep duration with cognitive frailty status at baseline using logistic regressions and with the future incidence of cognitive frailty using Cox proportional hazards models. Restricted cubic splines were used to explore potential nonlinear associations.

Results

Among 11,303 participants, 1298 (11.5%) had cognitive frailty at baseline. Compared to participants who had moderate sleep duration, the odds of having cognitive frailty were higher in those with long sleep duration (odds ratio 1.71, 95% CI 1.48-1.97; P<.001). A J-shaped association between sleep duration and cognitive frailty was also observed (P<.001). Additionally, during a mean follow-up of 6.7 (SD 2.6) years among 5201 participants who were not cognitively frail at baseline, 521 (10%) participants developed cognitive frailty. A higher risk of cognitive frailty was observed in participants with long sleep duration (hazard ratio 1.32, 95% CI 1.07-1.62; P=.008).

Conclusions

Long sleep duration was associated with cognitive frailly in older Chinese adults. These findings provide insights into the relationship between sleep duration and cognitive frailty, with potential implications for public health policies and clinical practice.

Does the psychological risk exposure increase carotid plaque detection among the Chinese midlife population? A latent class and regression analysis

AIMS

The aim of this study was to determine whether the psychological risk exposures increase carotid plaque detection in the Chinese midlife population.

METHODS AND RESULTS

This study utilized baseline data from an ongoing prospective cohort study (One Cardiovascular Health Study). Psychological risk exposure was created by including anxiety symptoms, depressive symptoms, and perceived stress through latent class analysis. The results showed that the average age of the 1301 subjects was 37.01 ± 5.59 and 79.55% were female. The rate of carotid plaque was 4.1%. Psychological risk was categorized into three classes: low (n = 735), medium (n = 472), and high (n = 94). After multiple adjustments in the regression model, individuals categorized in the high psychological risk group exhibited significantly higher probabilities of carotid plaque compared with those in the low psychological risk group (OR: 3.744, 95% CI: 1.568-8.937, P = 0.003). The area under the curve for a composite of age, gender, total cholesterol, total triglyceride, and psychological risk stood at 0.762 (95% CI: 0.703-0.820), surpassing combinations excluding psychological risk (P < 0.05). Comparable outcomes were observed for anxiety symptoms and depressive symptoms, but not for perceived stress.

CONCLUSION

Psychological risk exposure was an independent contributor to carotid plaque detection in the Chinese midlife population. Incorporating psychological risk exposure alongside traditional carotid plaque risk factors may enhance the accuracy of diagnosing carotid plaques. Future research should focus on developing screening strategies and targeted interventions to address psychological risk.

Cumulative Life's Essential 8 Scores and Cardiovascular Disease Risk

Importance

Most literature on the association between cardiovascular health (CVH) and incident cardiovascular disease (CVD) and mortality has relied on single midlife measurements. Understanding how cumulative CVH over time influences later-life CVD and mortality may aid early prevention.

Objective

To determine whether cumulative CVH, as measured by the American Heart Association Life's Essential 8 (LE8) from age 18 to 45 years, is associated with incident CVD and mortality in midlife.

Design, Setting, and Participants

This cohort study, the Coronary Artery Risk Development in Young Adults (CARDIA) study, collected CVH data for participants from 4 US centers from 1985 to 2020. Multivariate Cox proportional hazard models assessed the associations of (1) cumulative LE8 score by quartile, (2) cumulative LE8 score and score at age 45 years, and (3) cumulative LE8 score and LE8 score slope from age 18 to 45 years with incident CVD and mortality after age 45 years.

Main Outcomes and Measures

Incident CVD and all-cause mortality. Cumulative LE8 score was calculated as the area under the curve of the LE8 score (0-100, higher is better CVH) over time from age 18 to 45 years.

Results

There were 4832 CARDIA participants (2690 [55.7%] female and 2142 [44.3%] male) with a mean (SD) cumulative LE8 score from age 18 to 45 years of 2018.8 (95.0) point × years. Compared with quartile 1 (Q1, ie, lowest CVH), Q2, Q3, and Q4 had significantly lower hazards for CVD (Q2 HR, 0.44; 95% CI, 0.32-0.61; Q3 HR, 0.26; 95% CI, 0.18-0.38; Q4 HR, 0.12; 95% CI, 0.07-0.21) and mortality (Q2 HR, 0.51; 95% CI, 0.36-0.71; Q3 HR, 0.38; 95% CI, 0.26-0.55; Q4 HR, 0.29; 95% CI, 0.18-0.45) after age 45 years. When cumulative LE8 score from age 18 to 45 years and LE8 score at age 45 years were in the model together, both were significantly associated with lower risk for CVD. Likewise, both cumulative LE8 score and positive slope of (improving) LE8 score from age 18 to 45 years were significantly associated with lower hazards for incident CVD after age 45 years.

Conclusions and Relevance

Greater cumulative CVH and improvement in CVH during young adulthood, as well as better CVH in middle age, were all independently associated with lower risk for incident CVD in midlife. These results emphasize the importance of maintaining and improving CVH throughout young adulthood.

Prospective Associations of Maternal Cardiometabolic Health With Children Cardiometabolic Health at Ages 3 to 6 Years

OBJECTIVE

Maternal cardiometabolic health (MCMH) may have critical effects on offspring lifetime cardiometabolic health (CMH), whereas evidence on the relationship between MCMH during pregnancy and children CMH (CCMH) at ages 3∼6 years remains unknown.

METHOD

The study included 1478 mother-child dyads from the Shanghai Maternal-Child Pairs Cohort study. MCMH was examined at a mean of 27.8 (24-36) weeks' gestation based on 8 metrics of the "Life Essential 8" framework involving prepregnancy body mass index, total cholesterol, glucose level, blood pressure, physical activity, sleep, diet quality, and nicotine exposure. CCMH was examined at the age of 3 to 6 based on 5 metrics including body mass index, physical activity, sleep health, diet quality, and nicotine exposure. To validate the robustness of the main analysis, 499 children were selected to reevaluate CCMH by 6 metrics (adding blood pressure) for sensitivity analysis.

RESULTS

Among 1478 mother-child dyads, the mean (SD) MCMH during pregnancy and CCMH scores were 67.07 (SD 8.82) and 73.80 (SD 10.75), respectively. After adjusting important confounders, each 10-point increase in (more favorable) MCMH score was significantly associated with a higher CCMH score [β: .85; 95% confidence interval (CI): .22, 1.47]. Subgroup analysis showed similar results in girls but not in boys. For cardiometabolic risk factors in children, the risk of overweight/obesity and hypertension in children decreased with increased MCMH score [overweight/obesity, relative risks (RRs): .98, 95% CI: .96, .99; hypertension, RRs: .66, 95% CI: .47, .92]. Sensitivity analysis showed similar results.

CONCLUSION

Better MCMH in pregnancy was associated with better CCMH at ages 3∼6 years.

Feasibility of Radar Vital Sign Monitoring Using Multiple Range Bin Selection

Radars are promising tools for contactless vital sign monitoring. As a screening device, radars could supplement polysomnography, the gold standard in sleep medicine. When the radar is placed lateral to the person, vital signs can be extracted simultaneously from multiple body parts. Here, we present a method to select every available breathing and heartbeat signal, instead of selecting only one optimal signal. Using multiple concurrent signals can enhance vital rate robustness and accuracy. We built an algorithm based on persistence diagrams, a modern tool for time series analysis from the field of topological data analysis. Multiple criteria were evaluated on the persistence diagrams to detect breathing and heartbeat signals. We tested the feasibility of the method on simultaneous overnight radar and polysomnography recordings from six healthy participants. Compared against single bin selection, multiple selection lead to improved accuracy for both breathing (mean absolute error: 0.29 vs. 0.20 breaths per minute) and heart rate (mean absolute error: 1.97 vs. 0.66 beats per minute). Additionally, fewer artifactual segments were selected. Furthermore, the distribution of chosen vital signs along the body aligned with basic physiological assumptions. In conclusion, contactless vital sign monitoring could benefit from the improved accuracy achieved by multiple selection. The distribution of vital signs along the body could provide additional information for sleep monitoring.

Cardiovascular-Kidney-Metabolic Syndrome: A New Paradigm in Clinical Medicine or Going Back to Basics?

Cardiovascular, renal, and metabolic diseases are pathophysiologically interdependent, posing a significant global health challenge and being associated with a substantial increase in morbidity and mortality. In 2023, the American Heart Association (AHA) defined this complex network of interconnected health conditions as the cardiovascular-kidney-metabolic (CKM) syndrome. This syndrome is based on common pathophysiological mechanisms, including chronic inflammation, oxidative stress, hyperglycemia and insulin resistance, activation of the renin-angiotensin-aldosterone system (RAAS), and neurohormonal dysfunction, which trigger a vicious cycle where the impairment of one organ contributes to the progressive deterioration of the others. An integrated approach to these conditions, rather than treating them as separate entities, supports a holistic management strategy that helps to reduce the burden on public health and improve patients' quality of life. Existing management focuses on lifestyle modification, glycemic and lipid control, and the use of nephroprotective and cardioprotective therapies. This narrative review aims to synthesize and contextualize existing information on the complex interactions between these systems and on diagnostic approaches, as well as to provide an overview of the available therapeutic options.

Association of life's essential 8 with leukocyte telomere length and mitochondrial DNA copy number: Findings from the population-based UK Biobank study

OBJECTIVES

To explore the association of Life's Essential 8 (LE8) levels with leukocyte telomere length (LTL) and mitochondrial DNA copy number (mtDNA-CN).

DESIGN

A cross-sectional study.

SETTING AND PARTICIPANTS

225,692 participants aged 37-73 year from the UK Biobank cohort enrolled from 2006 to 2010.

MEASUREMENTS

The LE8 score (0-100) was divided into low (<50), moderate (50-79), and high cardiovascular health (CVH) (≥80) categories, based on health behaviors and factors defined by the American Heart Association. LTL was measured by a validated quantitative polymerase chain reaction method. mtDNA-CN was reacted by standardized SNP probe intensities. The association of CVH (as both a continuous and categorical variable) with LTL and mtDNA-CN was examined using multiple linear regression.

RESULTS

Of 225,692 participants, 5.3% had low CVH, 81.2% had moderate CVH, and 13.4% had high CVH. Participants with higher CVH were usually younger, female, better educated, of higher socioeconomic status, and with a lower prevalence of comorbidities. After adjusting for confounders, a higher LE8 score is associated with longer LTL (Beta = 0.075, P < 0.05) and increased mtDNA-CN (Beta = 0.094, P < 0.05). We also observed that this association was evident in the health behavior score (diet, physical activity, nicotine exposure, and sleep) and the health factors score (BMI, non-HDL cholesterol, blood glucose, and blood pressure), with a stronger positive association of health factors with LTL and mtDNA-CN (Beta = 0.019, P < 0.05; Beta = 0.037, P < 0.05).

CONCLUSIONS

Higher CVH is associated with longer LTL and increased mtDNA-CN.

Risk-Based Primary Prevention of Heart Failure: A Scientific Statement From the American Heart Association

The growing morbidity, mortality, and health care costs related to heart failure (HF) underscore the urgent need to prioritize its primary prevention. Whereas a risk-based approach for HF prevention remains in its infancy, several key opportunities exist to actualize this paradigm in clinical practice. First, the 2022 American Heart Association/American College of Cardiology/Heart Failure Society of America HF guidelines provided recommendations, for the first time, on the clinical utility of multivariable risk equations to estimate risk of incident HF. Second, the American Heart Association recently developed the PREVENT (Predicting Risk of Cardiovascular Disease Events) equations, which not only enable prediction of incident HF separately, but also include HF in the prediction of total cardiovascular disease. Third, the predominant phenotype of HF risk has emerged as the cardiovascular-kidney-metabolic syndrome. Fourth, the emergence of novel therapies that prevent incident HF (eg, sodium-glucose cotransporter-2 inhibitors) and target multiple cardiovascular-kidney-metabolic axes demonstrate growing potential for risk-based interventions. Whereas the concept of risk-based prevention has been established for decades, it has only been operationalized for atherosclerotic cardiovascular disease prevention to date. Translating these opportunities into a conceptual framework of risk-based primary prevention of HF requires implementation of PREVENT-HF (Predicting Risk of Cardiovascular Disease Events-Heart Failure) equations, targeted use of cardiac biomarkers (eg, natriuretic peptides) and echocardiography for risk reclassification and earlier detection of pre-HF, and definition of therapy-specific risk thresholds that incorporate net benefit and cost-effectiveness. This scientific statement reviews the current evidence for accurate risk prediction, defines strategies for equitable prevention, and proposes potential strategies for the successful implementation of risk-based primary prevention of HF.

Cardiovascular Health Trajectories and Prevalent Metabolic Dysfunction-Associated Steatotic Liver Disease in Midlife: The CARDIA Study

BACKGROUND

Metabolic-dysfunction associated steatotic liver disease (MASLD) is associated with prevalent cardiovascular disease. More favorable cardiovascular health (CVH) profiles are associated with a lower prevalence of MASLD in cross-sectional studies. The relationship between long-term CVH patterns and MASLD prevalence in midlife remains unknown.

METHODS AND RESULTS

Participants (aged 18-30 years at baseline) of the CARDIA (Coronary Artery Risk Development in Young Adults) study who had individual CVH components measured at 7 examinations over 20 years and liver fat assessed by noncontrast computed tomography at year 25 follow-up were included. CVH score was defined using published American Heart Association definitions. Group-based trajectory modeling was used to identify CVH trajectories. MASLD was defined as liver attenuation of ≤51 Hounsfield units with at least 1 metabolic risk factor after excluding other causes of liver fat. Logistic regression was used to examine associations of CVH trajectory groups and MASLD prevalence. At baseline, 39% of 2529 participants had high and 5% had low CVH, respectively. MASLD prevalence at year 25 was 23% (n=587). Five distinct CVH trajectories were identified. Between the 2 groups that started at similar CVH scores, those whose CVH declined over time had a higher prevalence of MASLD at year 25 (7.0% in high-stable versus 23.0% high-decreasing; 24.4% in moderate-stable versus 35.7% in moderate-decreasing). Lower and decreasing trajectories were associated with higher year-25 MASLD prevalence compared with the high-stable trajectory.

CONCLUSIONS

Achieving and maintaining high CVH scores starting in young adulthood lowers the risk of prevalent MASLD in midlife.

Community-Based and Public Health Initiatives Drive Cardiovascular Disease Prevention: A State-of-the-Art Review

BACKGROUND

Because of the massive global healthcare burden that cardiovascular diseases (CVD) present, it is critical that effective, highly scalable prevention strategies be identified and implemented to meet this unique health challenge.

PURPOSE

The purpose of this review is to analyze and synthesize current research initiatives for CVD prevention at both community-based and practice-based levels.

CONCLUSIONS

This state-of-the-art review article highlights successful intervention strategies and their outcomes, explores the implications for population-based practice, and discusses the importance of long-term behavior change in achieving sustained CVD prevention. The article also discusses the need for building community capacity through engagement and collaboration and advocates for culturally appropriate dissemination strategies to ensure equitable access to new technologies and interventions in CVD prevention.

CLINICAL IMPLICATIONS

This review suggests that clinicians and researchers should integrate evidence-based, community-engaged, and culturally tailored strategies into practice and future research to promote long-term behavior change and equitable CVD prevention.

Neighborhood Safety and Hypertension Risk: A Systematic Review

BACKGROUND

Responding to the increasing focus on residential environments, our systematic review aimed to consolidate existing empirical evidence regarding the impact of neighborhood safety on blood pressure. We also summarized the mediating and moderating mechanisms through which neighborhood safety influences blood pressure, alongside their direct effects, to offer insights for future research.

METHODS

We searched 5 electronic databases (PubMed, Ovid MEDLINE, CINAHL Complete, ProQuest Dissertations and Theses Global, and Web of Science) for the period up to and including December 27, 2022. The initial search yielded 4944 studies reviewed, of which 19 met our criteria and were reviewed.

RESULTS

Our findings consistently show that living in a safe neighborhood is associated with lower blood pressure outcomes. While most cross-sectional studies found that the association was not statistically significant (7/10 studies showed insignificant results), longitudinal studies that tracked changes in neighborhood safety over time (4/5 studies) showed significant negative associations between neighborhood safety and blood pressure. Additionally, some studies identified sex (n=3), age (n=2), and neighborhood characteristics (n=4) as significant moderators, with the strength of the association between neighborhood safety and blood pressure varying across different demographic groups and neighborhood contexts.

CONCLUSIONS

Our findings suggest that unsafe neighborhoods may increase blood pressure and hypertension risk, warranting further research and interventions. This review also highlights the importance of adopting longitudinal designs, especially those using time-varying measures of neighborhood environments.

Childhood Family Income and Adult Cardiovascular Health: Indirect Effects Through Childhood Neighborhood Socioeconomic Advantages and Disadvantages in a Prospective Sample of Young Men

BACKGROUND

Childhood family income may impact men's cardiovascular health (CVH), partly through exposure to neighborhood advantages and disadvantages experienced across childhood.

METHODS AND RESULTS

One hundred thirty-one boys (52.7% Black or bi/multiracial) born into low-income households in an urban environment were followed throughout childhood and completed a health assessment in adulthood. Childhood family income and home addresses were collected when participants were ages 1.5 to 17 years (13 waves). Annual income was averaged across waves to calculate mean childhood family income. Addresses were geocoded and linked with Census data to estimate neighborhood socioeconomic advantage and disadvantage at the Census-tract level and averaged across waves to estimate cumulative childhood neighborhood advantage and disadvantage. At age 32 years, participants underwent a physiological assessment, and CVH was estimated using Life's Essential 8 metrics: body mass index, blood pressure, cholesterol, glycated hemoglobin, sleep, smoking, and physical activity (diet not available). The Hayes' MEDCURVE macro was used to estimate indirect effects of childhood family income on adult CVH through neighborhood socioeconomic advantage and disadvantage across childhood. Higher childhood family income was associated with better CVH among men through greater exposure to childhood neighborhood advantage. Greater childhood family income was also protective for men's CVH through reduced exposure to childhood neighborhood disadvantage; however, the indirect effect through neighborhood disadvantage varied by childhood income and was the most robust among men raised in relatively higher-income households throughout childhood.

CONCLUSIONS

Improving socioeconomic neighborhood conditions may have the potential to benefit adult CVH among racially diverse boys born into low-income urban environments.

Impact of Insufficient or Excessive Sleep Duration on Cognitive Function After Stroke: The Norwegian Cognitive Impairment After Stroke Study

BACKGROUND

The impact of sleep duration on cognition, particularly in the context of poststroke cognitive impairment, is not fully understood. Therefore, our objective was to investigate how sleep duration after stroke predicts poststroke cognitive impairment.

METHODS AND RESULTS

Patients admitted with acute stroke between 2015 and 2017 were consecutively recruited to the Nor-COAST (Norwegian Cognitive Impairment After Stroke) study and invited to follow-up assessments at 3 and 18 months. Time in bed, used as a surrogate for sleep duration at 3 months post stroke, was measured using the activPAL thigh-worn sensor over a 3-day period. Sleep duration was categorized into 3 groups: <7 hours (insufficient), 7 to 9 hours (reference), and ≥9 hours (excessive). Cognitive impairment was assessed based on the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria at 3- and 18-month follow-up. Out of the 815 patients, we included 443 (54%) prestroke cognitive healthy with valid activPAL registration in this analysis. Mean±SD age was 71.2±11.4 years, 185 (42%) were women, 363 (82%) had prestroke modified Rankin Scale score <2, and 345 (78%) suffered a minor stroke (National Institutes of Health Stroke Scale score ≤5). On average, participants spent 8.3±1.4 hours in bed each night, 17.2% had a sleep duration <7 hours, and 25% slept more than 9 hours. Insufficient (odds ratio [OR], 3.6 [95% CI, 1.3-10.2], and OR, 1.4 [95% CI, 0.5-3.8]) and excessive (OR, 2.8 [95% CI, 1.1-7.5], and OR, 3.3 [95% CI, 1.3-8.1]) sleep duration were associated with an increased risk of cognitive impairment at 3- and 18-month follow-up, respectively.

CONCLUSIONS

Insufficient or excessive sleep duration was associated with poststroke cognitive impairment.

Genetic Risk and First-Trimester Cardiovascular Health Predict Hypertensive Disorders of Pregnancy in Nulliparous Women

BACKGROUND

Hypertensive disorders of pregnancy (HDPs) (preeclampsia/eclampsia and gestational hypertension) are a leading cause of maternal and perinatal morbidity and mortality and are associated with long-term maternal cardiovascular disease. High genetic risk and poor cardiovascular health (CVH) are each associated with HDPs, but whether genetic risk for HDP is modified by CVH status in early pregnancy is unknown.

OBJECTIVES

In this study, the authors sought to test the independent and joint associations of genetic risk and first-trimester CVH with development of HDP.

METHODS

We examined genotyped participants from the nuMoM2b (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be), a prospective observational cohort that enrolled nulliparous individuals with singleton pregnancies from 2010 to 2013 at 8 U.S. clinical sites. Genetic risk was calculated according to a validated genetic risk score for HDP. A first-trimester CVH score was closely adapted from the American Heart Association Life's Essential 8 model. Genetic risk and CVH were each categorized as low (bottom quintile), intermediate (quintile 2-4), or high (top quintile). The primary outcome was development of HDP. Multivariable-adjusted logistic regression was used to test the independent and joint associations of genetic risk and CVH with development of HDPs.

RESULTS

Among 7,499 participants (mean age 27.0 years), the median first-trimester CVH score was 77.1 (Q1-Q3: 67.1-85.7). Overall, 1,032 participants (13.8%) developed an HDP (487 [6.5%] preeclampsia, 545 [7.3%] gestational hypertension). Genetic risk and CVH were each independently and additively associated with HDP (high vs low genetic risk: adjusted OR [aOR]: 2.21 [95% CI: 1.78-2.77; P < 0.001]; low vs high CVH: aOR: 2.92 [95% CI: 2.28-3.74; P < 0.001]). There was no significant interaction between genetic risk and CVH regarding risk of HDPs (Pinteraction > 0.05). HDP incidence ranged from 4.5% (low genetic risk, high CVH) to 25.7% (high genetic risk, low CVH). Compared with low CVH, high CVH was associated with 53%-74% lower risk of HDP across genetic risk strata. Findings were consistent when examining preeclampsia/eclampsia and gestational hypertension separately.

CONCLUSIONS

Lower genetic risk and higher first-trimester CVH were independently and additively associated with lower risk of developing HDPs in nulliparous individuals. Favorable CVH in early pregnancy may mitigate high genetic risk for HDP.

Life's Essential 8 scores, socioeconomic deprivation, genetic susceptibility, and new-onset chronic kidney diseases

BACKGROUND

The American Heart Association recently released a new cardiovascular health (CVH) metric, Life's Essential 8 (LE8), for health promotion. However, the association between LE8 scores and the risk of chronic kidney disease (CKD) remains uncertain. We aimed to explore the association of LE8 scores with new-onset CKD and examine whether socioeconomic deprivation and genetic risk modify this association.

METHODS

A total of 286,908 participants from UK Biobank and without prior CKD were included between 2006 and 2010. CVH was categorized using LE8 scores: low (LE8 scores <50), moderate (LE8 scores ≥50 but <80), and high (LE8 scores ≥80). The study outcome was new-onset CKD, ascertained by data linkage with primary care, hospital inpatient, and death data. Cox proportional hazard regression models were used to investigate the association between CVH categories and new-onset CKD.

RESULTS

During a median follow-up of 12.5 years, 8857 (3.1%) participants developed new-onset CKD. Compared to the low CVH group, the moderate (adjusted hazards ratio [HR], 0.50; 95% confidence interval [CI]: 0.47-0.53) and high CVH (adjusted HR, 0.31; 95% CI: 0.27-0.34) groups had a significantly lower risk of developing new-onset CKD. The population-attributable risk associated with high vs. intermediate or low CVH scores was 40.3%. Participants who were least deprived (vs. most deprived; adjusted HR, 0.75; 95% CI: 0.71-0.79) and with low genetic risk of CKD (vs. high genetic risk; adjusted HR, 0.89; 95% CI: 0.85-0.94) had a significantly lower risk of developing new-onset CKD. However, socioeconomic deprivation and genetic risks of CKD did not significantly modify the relationship between LE8 scores and new-onset CKD (both P-interaction >0.05).

CONCLUSION

Achieving a higher LE8 score was associated with a lower risk of developing new-onset CKD, regardless of socioeconomic deprivation and genetic risks of CKD.

Multidimensional Sleep Health: Definitions and Implications for Cardiometabolic Health: A Scientific Statement From the American Heart Association

Poor sleep health is associated with cardiometabolic disease and related risk factors, including heart disease, stroke, elevated blood pressure and lipid levels, inflammation, glucose intolerance, obesity, physical inactivity, poor diet, unhealthy substance use, poor mental health, and increased all-cause and cardiovascular mortality, and is associated with social determinants of cardiovascular health and health disparities. Therefore, sleep duration has been recognized by the American Heart Association as one of Life's Essential 8. Although chronic sleep duration is the sole metric used in Life's Essential 8, sleep health represents a multidimensional construct. This scientific statement outlines the concept of multidimensional sleep health (sleep duration, continuity, timing, regularity, sleep-related daytime functioning, architecture, and absence of sleep disorders) as it applies to cardiometabolic health. Considerations of how these dimensions are related to cardiometabolic health and patterned by sociodemographic status are explained, and knowledge gaps are highlighted. Additional data are needed to understand better how these various dimensions of sleep should be assessed and how interventions targeting sleep health in clinical and community settings can be leveraged to improve health.

Wearing WHOOP More Frequently Is Associated with Better Biometrics and Healthier Sleep and Activity Patterns

Wearable devices are increasingly used for health monitoring, yet the impact of consistent wear on physiological and behavioral outcomes is unclear. Leveraging nearly a million days and nights of longitudinal data from 11,914 subscribers, we examined the associations between the frequency of wearing a wrist-worn wearable device (WHOOP Inc., Boston, MA, USA) and 12-week changes in biometric, sleep, and activity profiles, modeling both between- and within-person effects. Higher average wear frequency and week-to-week increases in wear were associated with a lower resting heart rate (RHR), higher heart rate variability (HRV), longer and more consistent sleep, and greater weekly and daily physical activity duration (Ps < 0.01). A within-person multiple mediation analysis indicated that increased sleep duration partially mediated the association between wear frequency and a standardized (z-scored) RHR (indirect effect = -0.0387 [95% CI: -0.0464, -0.0326]), whereas physical activity minutes did not (indirect effect = 0.0003 [95% CI: -0.0036, 0.0040]). A Granger causality analysis revealed a modest but notable association between prior wear frequency and future RHR in participants averaging ≤5 days of weekly wear (p < 0.05 in 10.92% of tests). While further research is needed, our findings provide real-world evidence that sustained wearable engagement may support healthier habits and improved physiological outcomes over time.

Sedentary Behavior and Light-Intensity Physical Activity During Pregnancy and Cardiovascular Health: A Science Advisory From the American Heart Association

The Physical Activity Guidelines for Americans supports sitting less and moving more. Growing evidence suggests that a waking behavior profile with less sedentary behavior and more light-intensity physical activity is associated with more favorable cardiovascular health. Remarkably, little is known about how these behaviors relate to cardiovascular health during pregnancy. The purpose of this American Heart Association science advisory is to describe the existing evidence on device-measured sedentary behavior and light-intensity physical activity in relation to cardiovascular health during pregnancy and to make specific calls to action for future research to improve health outcomes and to promote health equity. Outcomes included adverse pregnancy outcomes associated with increased risk of cardiovascular disease and the American Heart Association's Life's Essential 8 health factor components (blood pressure, lipids, glucose, and gestational weight gain). Findings from observational studies are mixed, with preliminary evidence demonstrating an association between high sedentary behavior and increased risk of hypertensive disorders of pregnancy, shorter gestational age at delivery, low or high birth weight, and elevated maternal blood pressure, lipids, glucose, and gestational weight gain. Findings for light-intensity physical activity are limited by fewer studies and are less compelling. Experimental evidence evaluating the impact of decreasing sedentary behavior or increasing light-intensity physical activity on pregnancy cardiovascular health is weak. Future observational studies with rigorous longitudinal designs and larger, diverse samples are needed to characterize associations and to inform the design of adequately powered randomized controlled trials testing the impact of decreasing sedentary behavior and increasing light-intensity physical activity on cardiovascular health during pregnancy.

The Association of Elevated Depression Levels and Life's Essential 8 on Cardiovascular Health With Predicted Machine Learning Models and Interpretations: Evidence From NHANES 2007-2018

Background and Objective: The association between depression severity and cardiovascular health (CVH) represented by Life's Essential 8 (LE8) was analyzed, with a novel focus on ranked levels and different ages. Machine learning (ML) algorithms were also selected aimed at providing predictions to suggest practical recommendations for public awareness and clinical treatment. Methods: We included 21,279 eligible participants from the National Health and Nutrition Examination Survey (NHANES) 2007-2018. Weighted ordinal logistic regression (LR) was utilized with further sensitivity and dose-response analysis, and ML algorithms were analyzed with SHapley Additive exPlanations (SHAP) applied to make interpretable results and visualization. Results: Our studies demonstrated an inverse relationship between LE8 and elevated depressive levels, with robustness confirmed through subgroup and interaction analysis. Age-specific findings revealed middle-aged and older adults (aged 40-60 and over 60) which showed higher depresion severity, highlighting the need for greater awareness and targeted interventions. Eight ML algorithms were selected to provide predictive results, and further SHAP would become ideal supplement to increase model interpretability. Conclusions: Our studies demonstrated a negative association between LE8 and elevated depressive levels and provided a suite of ML predictive models, which would generate recommendations toward clinical implications and subjective interventions.