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

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.

Neuroimmune circuits in the plaque and bone marrow regulate atherosclerosis

Atherosclerosis remains the leading cause of death globally. Although its focal pathology is atheroma that develops in arterial walls, atherosclerosis is a systemic disease involving contributions by many organs and tissues. It is now established that the immune system causally contributes to all phases of atherosclerosis. Recent and emerging evidence positions the nervous system as a key modulator of inflammatory processes that underlie atherosclerosis. This neuroimmune cross-talk, we are learning, is bidirectional, and immune-regulated afferent signalling is becoming increasingly recognized in atherosclerosis. Here, we summarize data and concepts that link the immune and nervous systems in atherosclerosis by focusing on two important sites, the arterial vessel and the bone marrow.

Life's essential 8 and specific cancer risk and mortality in men and women: a population-based cohort analysis of 332,417 United Kingdom participants

BACKGROUND

This study aimed to explore the association between Life's Essential 8 (LE8) and the risk of cancer occurrence and cancer-associated mortality across 24 cancer types. The cardiovascular health (CVH) score is constructed based on the overall LE8 score, providing a more direct measure of CVH and its potential relationship with cancer risk.

METHODS

This cohort enrolled participants from a prospective cohort of the United Kingdom Biobank, including individuals aged 37-73 years, with 332,417 cancer-free participants. CVH scores were assessed using the LE8 metrics. The primary outcome of this study was the risk of cancer events, and the secondary outcome was cancer mortality. Competitive models were used to examine the associations between each 10-point increment in the CVH score and the outcomes, with stratified analyses conducted for both men and women to assess sex differences.

RESULTS

The mean CVH score was 64.4(55.6,72.5) in men and 70.0 (61.2,78.1) in women (P < 0.001). During a mean follow-up time of 12.0 years, 12.32% (95% confidence interval [CI]: 12.21-12.43%) of participants developed cancer, and 2.13% (95% CI: 2.08-2.18%) died from cancer. A 10-point rise in CVH score was negatively associated with overall cancer occurrence in men (hazard ratio [HR]: 0.97, 95% CI: 0.96-0.98) and women (HR: 0.96, 95% CI: 0.95-0.97), along with reduced cancer mortality risk in both sexes. Moreover, sex differences were observed in the impact of a 10-point CVH increase on esophageal, gastric, colorectal, and liver cancers.

CONCLUSIONS

Lower CVH scores were associated with an increased overall cancer risk and higher cancer-related mortality, highlighting the need for cancer screening in patients with low CVH scores.

The role of the control of "life's essential 8" for prevention on heart failure and all-cause mortality in patients with hypertension: the Kailuan cohort study

BACKGROUND

Hypertension can lead to an increased risk of heart failure and death. The life's essential 8 (LE8) is an eight-factor measure of cardiovascular health recently released by the American Heart Association for use in measuring cardiovascular health. However, evidence on the beneficial effects and necessity of LE8 control is still lacking, especially for hypertension.

METHODS

The study population was drawn from the Kailuan cohort, hypertensive population at baseline with the non-hypertensive population matched 1:1 according to age and sex were involved in this analysis. The cut off value for each factor in LE8 was 50 (≥ 50 as controlled, < 50 as uncontrolled). The primary outcomes involved heart failure and all-cause mortality. Cox proportional risk regression models were used to analyze the relationship between the degree of LE8 control and the risk of heart failure and all-cause mortality among hypertensive participants. Hazard ratio (HR) and 95% confidence interval (95% CI) were calculated.

RESULTS

A baseline population of 69,032 Kailuan cohort with a mean age of 53.08 years (SD 10.59) was included in the study. During a mean follow-up period of 13.17 years (SD 2.57), 1308 (3.8%) heart failures and 5391 (15.6%) deaths occurred among hypertensive patients. In the hypertensive population, there was a negative dose response between the degree of LE8 control and the risk of heart failure or death (P for trend < 0.001). Compared with the group with the control less than or equal to 2 risk factors of LE8, the group with 6 or more risk factors of control had a 55% lower risk of heart failure (HR 0.45, 95% CI 0.26-0.77; P < 0.05) and a 31% lower risk of death (HR 0.69, 95% CI 0.50-0.93; P < 0.05). Compared with the non-hypertensive population, the risk of heart failure and death decreased with increasing of the number of risk factor controlled in LE8, down to a minimum of 1.27-fold (HR 1.27, 95%CI 1.13-1.42; P < 0.05) and 1.25-fold (HR 1.25, 95%CI 1.19-1.32; P < 0.05), respectively. In addition, the association between hypertension and heart failure or mortality was higher in participants aged < 60 years compared with older individuals (P for interaction < 0.05).

CONCLUSIONS

Enhanced control of LE8 is significantly associated with a reduced risk of heart failure and mortality in hypertensive patients, as well as a decreased likelihood of hypertension-related heart failure or mortality.

Life satisfaction as compared with traditional risk factors in relation to incident cardiovascular diseases

BACKGROUND

Emerging evidence suggests a role of psychological well-being in the development of cardiovascular disease (CVD), but supportive data remain limited. This study assessed the prospective associations between life satisfaction and incident CVD, as well as the relative importance of life satisfaction compared to traditional risk factors.

METHODS

The study included 153,810 participants free of CVD at baseline, with measurements of life satisfaction on general happiness, personal health, family relationships, friendships, and financial situation, followed up until December 31, 2022. Cox proportional hazards models were used to estimate associations between life satisfaction and incident CVD. The relative importance of life satisfaction in predicting CVD was measured by explained R2 values.

RESULTS

During a median follow-up of 12.9 years, 14,370 incident CVD events occurred, including 10,070 CHD and 2,895 strokes. Individuals with low life satisfaction had an 80% higher risk of CVD compared to those with high life satisfaction (hazard ratio [95% confidence interval], 1.84 [1.63-2.07] for CVD, 1.83 [1.59-2.10] for CHD, and 1.74 [1.31-2.31] for stroke). Life satisfaction was ranked as the fourth-strongest CVD risk factor, following hypertension, race, and income. Low satisfaction with all individual aspects was significantly associated with higher risks of CVD and CHD (P < 0.05), while satisfaction with personal health showing the strongest association.

CONCLUSIONS

This study indicates that life satisfaction is robustly associated with incident CVD and may be considered one of the strongest predictors of CVD risk, alongside traditional risk factors. Our findings support the inclusion of life satisfaction in cardiovascular health metrics.

Longitudinal association between stigma and suicidal ideation among patients with major depressive disorder

BACKGROUND

To explore the longitudinal associations between stigma and suicidal ideation among patients with major depressive disorder (MDD).

METHODS

Data were from patients with MDD in the Depression Cohort in China. At baseline and weeks 4, 8, 12, 24, 48, and 72, the presence (yes and no) and severity (scores) of suicidal ideation were evaluated using the Beck Scale for Suicide Ideation, and stigma was assessed using the Depression Stigma Scale. Generalized linear mixed models were used to explore the association between stigma and suicidal ideation.

RESULTS

Among 1123 patients with a mean age of 27.9 (SD, 7.3) years, 71.1 % were female. Restricted cubic splines showed positive linear dose-response associations of personal stigma and perceived stigma with the likelihood and severity of suicidal ideation. The adjusted ORs (95 % CIs) for each 10 score increment in personal stigma and perceived stigma were 1.49 (1.18, 1.89) and 1.46 (1.20, 1.77) for the likelihood of suicidal ideation, respectively. The adjusted β coefficients (95 % CIs) for each 10 score increment in personal stigma and perceived stigma were 0.222 (0.121, 0.322) and 0.202 (0.123, 0.281) for suicidal ideation scores, respectively.

LIMITATIONS

Information on sigma, suicidal ideation, and potential covariates was self-reported, so reporting bias was inevitable.

CONCLUSIONS

In this longitudinal study in patients with MDD, more severe personal stigma and perceived stigma were associated with a higher likelihood of suicidal ideation and more severe suicidal ideation. These findings suggest that reducing personal stigma and perceived stigma may help prevent suicidal behavior among patients with MDD.

Transition of nighttime sleep duration and sleep quality with incident cardiovascular disease among middle-aged and older adults: results from a national cohort study

BACKGROUND

Sleep health has recently been incorporated into the Life's Essential 8 of the American Heart Association. Little is known about the associations between changes in nighttime sleep behavior and healthy outcomes, especially for the elderly. This study explores associations between transition of nighttime sleep duration and sleep quality and cardiovascular diseases (CVD) among middle-aged and older adults in China.

METHODS

Data were derived from the China Health and Retirement Longitudinal Study from 2011 to 2018, and a total of 7,905 participants age ≥ 45 years were included. Participants were classified according to nighttime sleep duration (6-8, < 6 or > 8 h) and sleep quality assessed by the number of restless sleep days in the past week (< 3, 3-7 days). Four groups of the changing patterns in nighttime sleep duration and sleep quality between 2011 and 2015 were identified. CVD including heart disease and stroke was defined based on medical diagnosis. Robust Poisson regression and the restricted cubic spline were employed to evaluate the association between the transition of nighttime sleep behavior and the risk of CVD.

RESULTS

Compared to participants with consistently optimal nighttime sleep duration, those with consistently non-optimal (incidence rate ratio [IRR]: 1.36, 95% confidence interval [CI]: 1.15-1.61, P < 0.001), optimal to non-optimal (IRR: 1.20, 95% CI: 1.02-1.43, P = 0.032), or non-optimal to optimal (IRR: 1.23, 95% CI: 1.02-1.48, P = 0.026) transition in nighttime sleep duration had higher risks of CVD. Additionally, those with a good to poor (IRR: 1.42, 95% CI: 1.20-1.68, P < 0.001) or a consistently poor (IRR: 1.55, 95% CI: 1.32-1.83, P < 0.001) changing pattern in nighttime sleep quality were associated with an increased risk of CVD compared to those with a consistently good changing pattern. There was a U-shaped association between changes in nighttime sleep duration and the incidence of CVD in sleep-deprived people. Changes in sleep quality and the risk of CVD exhibited a linear association.

CONCLUSIONS

Persistent non-optimal nighttime sleep duration and poor sleep quality are associated with an increased risk of CVD in middle-aged and older adults. These findings highlight the importance of considering transitions in sleep behavior in CVD risk assessment for middle-aged and older adults, and emphasize the significance of long-term exposure to poor sleep behavior on their cardiovascular health.

Preventive Administration of Quercetin Promotes Survival and Reduces Adverse Ventricular Remodeling after myocardial infarction through facilitating M2-like macrophage polarization

Myocardial infarction (MI) remains a leading cause of global health burden, and adverse cardiac remodeling after MI seriously affects patient recovery. Macrophages play an important role in the cardiac remodeling post-MI. Quercitrin (Que), a bioflavonoid commonly found in fruits, vegetables, and various Chinese medicines, possesses a therapeutic effect in MI, but whether it has a role in the prevention of MI is unclear. This study investigated the potential preventive value and mechanism of Que against MI. In this study, we treated adult male C57BL/6 mice with Que for 2 weeks and then constructed the MI model. We found that pre-treatment with Que improved cardiac fractional shortening and ejection fraction, and elevated the survival of mice after MI. In addition, pre-administration of Que attenuated cardiac hypertrophy and diminished the infarct size of the heart post-MI. Picrosirius red staining of heart sections and detection of fibrosis markers' levels by real-time polymerase chain reaction and western blot analyses revealed that Que repressed cardiac fibrosis after MI. Que pre-administration inhibited the levels of inflammatory factors and the infiltration of inflammatory cells, and increased the proportion of M2-like macrophages in the infarcted area of the heart. Furthermore, we found that Que pre-treatment polarized macrophage from M1-like to M2-like, which promoted the proliferation, migration, and activation of cardiac fibroblasts in vitro. Collectively, these data demonstrated that pre-administration Que promoted survival and reduced adverse ventricular remodeling after MI partially through modifying macrophage polarization. This provides an experimental basis for the future application of Que in cardiovascular diseases including MI.

Association of cardiovascular health with COPD (NHANES 2007-2020): mediating potential of lean body mass

Background

Chronic Obstructive Pulmonary Disease (COPD) is a major global health concern, with lifestyle factors playing a crucial role in its prevention. This study aims to explore the relationship between Life's Crucial 9 (lc9) scores and COPD odds, and to assess the mediating potential of lean body mass (LBM) in this association.

Methods

This study used cross-sectional study to assess the association between lc9 score and COPD using data from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2020. Weighted multivariate regression analyses were performed to examine lc9 score on the odds of COPD after adjusting for confounders. The models were adjusted for age, gender, race/ethnicity, Marital status, education level, Family income-to-poverty ratio, LBM and Alcohol consumption status. The discrimination ability of lc9 on COPD odds was evaluated using (ROC) curve. Mediation analysis was used to investigate the mediating potential of LBM between lc9 and COPD odds. Subgroup analyses and interaction assessments were also performed.

Results

In Model 2, the results showed that for every 10-point change in the lc9 score, the odds of developing COPD decreased. The OR (95% CI) in the Moderate and High groups were OR = 0.37; 95% CI: 0.23, 0.59 and OR = 0.16; 95% CI: 0.09, 0.27 (P for trend < 0.001), respectively. In addition, the results for quartile subgroups were Q3, OR = 0.58; 95% CI: 0.42, 0.81), Q4, OR = 0.24; 95% CI: 0.16, 0.36) and P for trend < 0.001. This relationship was consistent across the total population, subgroup analyses, and sensitivity analyses. There was a nonlinear relationship between lc9 score and odds of COPD (P for Nonlinear = 0.022). The lc9 reduced the odds of COPD by increasing LBM. The lc9 is an suggestive predictor of COPD odds association.

Conclusions

Higher LC9 scores, particularly when accompanied by increased LBM levels, showed significant associations with reduced COPD risk in cross-sectional analyses.

Modifiable risk factors for stroke, dementia and late-life depression: a systematic review and DALY-weighted risk factors for a composite outcome

BACKGROUND

At least 60% of stroke, 40% of dementia and 35% of late-life depression (LLD) are attributable to modifiable risk factors, with great overlap due to shared pathophysiology. This study aims to systematically identify overlapping risk factors for these diseases and calculate their relative impact on a composite outcome.

METHODS

A systematic literature review was performed in PubMed, Embase and PsycInfo, between January 2000 and September 2023. We included meta-analyses reporting effect sizes of modifiable risk factors on the incidence of stroke, dementia and/or LLD. The most relevant meta-analyses were selected, and disability-adjusted life year (DALY) weighted beta (β)-coefficients were calculated for a composite outcome. The β-coefficients were normalised to assess relative impact.

RESULTS

Our search yielded 182 meta-analyses meeting the inclusion criteria, of which 59 were selected to calculate DALY-weighted risk factors for a composite outcome. Identified risk factors included alcohol (normalised β-coefficient highest category: -34), blood pressure (130), body mass index (70), fasting plasma glucose (94), total cholesterol (22), leisure time cognitive activity (-91), depressive symptoms (57), diet (51), hearing loss (60), kidney function (101), pain (42), physical activity (-56), purpose in life (-50), sleep (76), smoking (91), social engagement (53) and stress (55).

CONCLUSIONS

This study identified overlapping modifiable risk factors and calculated the relative impact of these factors on the risk of a composite outcome of stroke, dementia and LLD. These findings could guide preventative strategies and serve as an empirical foundation for future development of tools that can empower people to reduce their risk of these diseases.

PROSPERO REGISTRATION NUMBER

CRD42023476939.

The Global Burden of Cardiovascular Disease in Adults: A Mapping Review

BACKGROUND

Cardiovascular diseases (CVDs) persist as formidable contributors to global mortality and pose substantial challenges to public health. Most mortality estimates have been attributed to heart attack and stroke. Despite increased public awareness, the burden of CVDs continues to increase.

OBJECTIVE

This review describes the burden of CVDs and risk factors in adults, according to the World Health Organization's (WHO) defined regions.

METHODS

A mapping review methodology was used. PubMed, Scopus, Wiley, the WHO Global Health Observatory data repository, American Heart Association, National Forum for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, European Commission, Eurostat, European Society of Cardiology, World Heart Federation, and Google Scholar were searched using free text search terms: cardiovascular diseases/CVDs, burden, incidence, prevalence, prevention, and risk factor.

RESULTS

Ischemic heart disease predominated in the Americas, Europe, and Eastern Mediterranean, whereas stroke was more common in Africa, Southeast Asia, and the Western Pacific. Premature deaths occur in populations with low socioeconomic status. Several well-known risk factors are preventable, including hypertension, dyslipidemia, diabetes, air pollution, obesity, smoking, lack of physical activity, and unhealthy dietary intake. Emerging risk factors include excessive or lack of sleep, depression, social isolation, air/noise pollution, and exposure to extreme sunshine, arsenic, lead, cadmium, and copper.

CONCLUSIONS

The burden of CVDs and its risk factors vary greatly according to demographics and geographical region. Addressing CVDs requires multifaceted strategies, including region-specific interventions, addressing socioeconomic inequalities, adopting life-course risk management, strengthening the healthcare workforce, and improving health literacy.

Estimated glucose disposal rate mediates the association between Life's Crucial 9 and congestive heart failure: a population-based study

Background

Life's Crucial 9 (LC9) is the latest indicator of cardiovascular health (CVH), and the estimated glucose disposal rate (eGDR) is a non-invasive indicator of insulin resistance (IR). However, the relationships between LC9 and eGDR and congestive heart failure (CHF) remain unknown.

Methods

In this cross-sectional study, participants aged ≥20 years in the NHANES database from 2005 to 2018 were analyzed. Weighted linear regression, logistic regression, subgroup analysis, and restricted cubic spline (RCS) analysis were employed to analyze the associations among LC9, eGDR, and CHF. Mediation analysis was used to explore the mediating role of eGDR in the association between LC9 and CHF.

Results

A total of 22,699 adult participants were included, among whom 661 suffered from CHF. The mean age of the participants was 47.52 (0.26) years old, with 11186 (48.68%) males and 11513 (51.32%) females. The average value of LC9 was 71.16 (0.22), and that of eGDR was 7.91 (0.04). After adjusting for confounding factors, linear regression showed that LC9 was independently and positively associated with eGDR (β: 1.11, 95%CI: 1.07 - 1.14, P < 0.0001). Logistic regression indicated that both LC9 (OR: 0.76, 95%CI: 0.65 - 0.88, P < 0.001) and eGDR (OR: 0.81, 95%CI: 0.76 - 0.86, P < 0.0001) were independently and negatively associated with the prevalence of CHF. Mediation analysis revealed that the association between LC9 and CHF was mainly mediated by eGDR, with a proportion of 66%.

Conclusion

This study suggests that higher LC9 scores and eGDR values imply a lower prevalence of CHF. Meanwhile, eGDR is the main intermediate factor in the association between LC9 and CHF, indicating that good CVH may reduce the prevalence of CHF by improving IR.

An ecological analysis of sleep health across five African-origin populations spanning the epidemiologic transition

BACKGROUND

Sleep health is emerging as a public health priority due to its strong associations with several key domains of health. However, most of the existing literature are from studies located in high income settings and may not be representative of low-middle income settings. Leveraging the Modeling the Epidemiologic Transition Study, a study of cardiometabolic disease risk in five diverse African-origin populations, we explored differences in objectively measured sleep behavior across cohorts from Ghana, South Africa, Jamaica, Seychelles, and the United States.

METHODS

Data from 809 participants (35-55 years old, 63% women) from the 5 Modeling the Epidemiologic Transition Study research sites were included. Objectively-measured sleep, using actigraphy, was scored according to the criteria of Patel and colleagues. For those with at least 5 nights of valid data, ecological mean sleep onset time, wake-up time, sleep duration, wake after sleep onset, and sleep efficiency were examined.

FINDINGS

Adjusted models indicate that sleep onset was earlier in all sites when compared to US (p<.005). Sleep efficiency varied by locations, being lower in participants from Ghana, South Africa, and Jamaica when compared to United States (Ghana β: -3.7, South Africa: -5.8, Jamaica: -1.3, p<.05 for all) and higher in Seychelles when compared to United States (Seychelles β: 1.6; p=.02). Women presented with shorter sleep duration but with higher sleep efficiency.

INTERPRETATION

Sleep duration, timing (wake time, midsleep time and sleep onset), and efficiency differ by country and sex, likely driven by socio-economic settings. Understanding sleep patterns in different contexts is needed to make informed and culturally appropriate health recommendations.

Life's Essential 8 and the risk of cardiovascular disease: a systematic review and meta-analysis

AIMS

The benefits of achieving optimal cardiovascular health (CVH) through Life's Simple 7 (LS7) are well-documented across diverse populations. In this study, we assess the updated metrics, Life's Essential 8 (LE8), and its association with long-term cardiovascular disease (CVD) outcomes and mortality.

METHODS AND RESULTS

We conducted a comprehensive systematic review, searching PubMed, Google Scholar, Cochrane Library, and ScienceDirect from January 2022 until June 2024, focusing on studies that specifically assessed the impact of LE8 on CVH. The statistical analysis used RevMan 5.4 and applied a random effects model to synthesize hazard ratios (HRs) for primary and secondary outcomes. This study is registered in PROSPERO (CRD42024558493). Our final analysis comprised 34 observational studies, encompassing 1 786 664 participants aged 18-80 years, with an average follow-up of approximately 11.6 years. Pooled analysis revealed a statistically significant decrease in the risk of CVD among individuals with higher LE8 scores compared with those with lower scores, with an HR of 0.47 (95% CI: 0.39-0.56, P < 0.00001). Higher LE8 scores were also associated with significant reductions in both all-cause mortality (HR: 0.54, 95% CI: 0.43-0.69, P < 0.00001) and CVD-related mortality (HR: 0.37, 95% CI: 0.26-0.52, P < 0.00001. Moreover, individuals with high LE8 scores have a 56% lower risk of coronary heart disease and a 48% lower risk of stroke.

CONCLUSION

LE8 has a strong inverse association with CVD risk and mortality, with higher LE8 scores corresponding to significantly lower risk levels.

Relationship between life's essential 8, vitamin D, and cardiometabolic outcomes

AIMS

To assess the association between cardiovascular health (CVH) and cardiometabolic outcomes and the impact of vitamin D on the relationship. Additionally, we seek to analyze the predictive ability of CVH metrics for cardiometabolic outcomes.

METHODS

This cross-sectional study included 21,913 adult participants of the National Health and Nutrition Examination Survey (2007-2018). Logistic regression models and restricted cubic spline curves were employed to evaluate the association between CVH and cardiometabolic outcomes and analyze the influence of vitamin D on the relationship. Receiver operating characteristic curves were used to assess the predictive ability of CVH metrics for cardiometabolic outcomes.

RESULTS

The study included 21,913 participants, among whom 6193 (28.3%) were classified as having low CVH, 14,080 (64.3%) as having moderate CVH, and 1640 (7.5%) as having high CVH. CVH scores were significantly negatively correlated with cardiometabolic outcomes. Among the CVH metrics, blood glucose and blood pressure had higher predictive values for cardiovascular disease, chronic kidney disease, hypertension, and diabetes. Additionally, there was a significant interaction between CVH and vitamin D.

CONCLUSION

These findings underscore that higher CVH scores, assessed by Life's Essential 8, are associated with lower risks of cardiometabolic outcomes. Improving CVH contributes to reducing the burden of disease and promoting human health.

Sources of well-being and cardiovascular health: A mixed methods investigation from the MIDUS study

OBJECTIVE

Using mixed methods, we investigated whether different sources of well-being were associated with better cardiovascular health.

METHODS

Data came from adults (55% women; 19% Black, 75% White) with biomarker data from the Midlife in the United States (MIDUS) Study. At the second wave and in a refresher cohort, participants answered the question "What do you do to make your life go well?" Judges evaluated each response for the presence of 12 sources of well-being (e.g., positive relationships, faith, health maintenance). Participants were also assessed on 8 components of cardiovascular health at two waves, an average of 12 years apart. Concurrent (N = 2036) and longitudinal (N = 650) linear regressions examined the association between each well-being source in unadjusted models and models adjusted for sociodemographic factors and word count.

RESULTS

Adults who wrote about positive relationships, positive attitudes, enjoyment, coping, health maintenance, and planning tended to have better cardiovascular health in unadjusted models concurrently and longitudinally. In fully adjusted models, health maintenance (p < .001) and planning and organization (p = .004) were associated with better cardiovascular health concurrently. Additionally, health maintenance (p = .03) and work (p = .04) were associated with better cardiovascular health longitudinally.

CONCLUSIONS

Individuals who endorsed maintaining their health as central to well-being showed healthier cardiovascular outcomes 12 years later. Combining qualitative assessments of sources of well-being with clinically assessed measures of cardiovascular health highlights unique contributors of well-being that are relevant for health and may not be evident with conventional self-report measures.

Life's Essential 8, Genetic Susceptibility, and the Risk of Age-Related Macular Degeneration: A Prospective Cohort Study

Purpose

We determined the association between Life's Essential 8 (LE8) scores and AMD incidence and ascertained whether genetic susceptibility modifies it.

Methods

This prospective cohort study included 268,634 UK Biobank study participants with high, moderate, or low cardiovascular health based on LE8 scores. High and low cardiovascular health corresponded to the lowest and highest cardiovascular disease risks, respectively. The hazard ratios (HRs) and 95% confidence intervals (CIs) for AMD were estimated using Cox proportional hazards models. The dose-response relationships were evaluated using restricted cubic spline analysis. Stratified analyses using the AMD-polygenic risk score categories were used to assess potential modification. A composite variable combined LE8 and AMD-polygenic risk to examine their joint effects.

Results

Over an average of 13.76 years, 5253 participants developed AMD. Compared with the lowest cardiovascular health, moderate and high cardiovascular health had adjusted HRs of 0.86 (95% CI, 0.76, 0.97) and 0.79 (0.69, 0.91), respectively. Each standard deviation increase in the LE8 score corresponded to an HR of 0.93 (0.91, 0.96). The LE8 behavior (HR = 0.94 [0.91, 0.96]) and biological (HR = 0.97 [0.95, 1.00]) subscale scores were inversely associated with AMD, whereas the blood lipids component was positively associated (HR = 1.07 [1.04, 1.10]). The AMD-polygenic risk and LE8 scores showed no significant interaction. The HR for having low AMD-polygenic risk and high cardiovascular health relative to having high AMD-polygenic risk and low cardiovascular health was 0.47 (0.37, 0.58).

Conclusions

Maintaining good cardiovascular health can reduce AMD incidence regardless of genetic background.

Association Between Heavy Metals Mixtures and Life's Essential 8 Score in General US Adults

Heavy metals were toxic environmental pollutants capable of entering the human body, posing significant risks to human health. Life's Essential 8 (LE8) score is a new comprehensive index constructed for quantifying cardiovascular health (CVH). However, the association between heavy metals mixtures and LE8 appears ambiguous. To investigated the association between heavy metals and cardiovascular health in US population. Urinary heavy metals concentrations (barium, cadmium, cobalt, manganese, molybdenum, lead, antimony, strontium, thallium, tin, tungsten, uranium, cesium) were Ln-transformed and LE8 was consisted of eight metrics. Single and multivariate linear regression, weighted quantile sum (WQS) and Bayesian kernel machine regression models (BKMR) were utilized to assess the association between single and mixed exposure of thirteen heavy metals concentrations and LE8. In 4339 participants from National Health and Nutrition Examination Survey 2007-2018, single urinary heavy metals barium, cadmium, cobalt, lead, antimony, strontium, tin, tungsten, uranium and cesium showed a significant negative association with LE8. WQS models showed heavy metals mixture was negatively associated with LE8 (β = - 2.720, 95% CI - 3.660, - 1.790). BKMR analysis also demonstrated a downward trend of heavy metals mixture and LE8. Both WQS analyzed weights and the conditional posterior inclusion probabilities (condPIP) of BKMR showed that cadmium (37.78%, condPIP = 1.000), barium (24.56%, condPIP = 0.537) and uranium (14.71%, condPIP = 0.646) contributed most for these negative associations. Single and mixed heavy metals, especially cadmium, barium and uranium were negatively associated with LE8 score, a new comprehensive CVH index, predicting an increasing risk of cardiovascular diseases.

Accelerated biological aging, healthy behaviors, and genetic susceptibility with incidence of stroke and its subtypes: A prospective cohort study

Stroke risk increases with chronological age, but the relationship with biological age (BA) acceleration is poorly understood. We aimed to examine the association between BA acceleration and incident stroke and its subtypes, explore the modifying effects on genetic susceptibility, and assess how BA acceleration mediates the effect of behavior score. We studied 253,932 UK Biobank participants and computed two BA measures (Klemera-Doubal Method [KDM], Phenotypic Age [PhenoAge]), with BA acceleration calculated by regressing BA on chronological age. The polygenic risk score (PRS) was derived from 87 genetic loci. The behaviors score was based on diet, physical activity, tobacco/nicotine, sleep, and BMI. During a median follow-up of 13.6 years, 5460 strokes, 4337 ischemic stroke (IS), 951 intracerebral hemorrhage (ICH), and 553 subarachnoid hemorrhage (SAH) cases were documented. Adjusting for confounding factors, each standard deviation increase in BA acceleration was associated with higher stroke risk: for KDM-BA acceleration, stroke (HR = 1.28, 95% CI = 1.25-1.32), IS (1.32, 1.28-1.36), ICH (1.15, 1.08-1.23), and SAH (1.16, 1.07-1.27); for PhenoAge acceleration, stroke (1.22, 1.19-1.25), IS (1.26, 1.22-1.29), ICH (1.08, 1.02-1.16), and SAH (1.08, 1.00-1.18). Compared to participants with the lowest PRS and BA acceleration, those with the highest PRS and BA acceleration had the highest stroke risk (KDM-BA acceleration: 2.19, 1.85-2.59; PhenoAge acceleration: 2.03, 1.69-2.42). Additionally, there was an additive interaction between KDM-BA acceleration and PRS. The mediation proportion of BA acceleration in associations of behaviors score with incident stroke and its subtypes ranged from 15.84% to 33.08%. BA acceleration may raise stroke risk, especially in those with high genetic risk. Maintaining healthy behaviors may help mitigate this risk.

Associations of combined accelerated biological aging and genetic susceptibility with incidence of heart failure in a population-based cohort study

The global aging population raises concerns about heart failure (HF), yet its association with accelerated biological age (BA) remains inadequately understood. We aimed to examine the longitudinal association between BA acceleration and incident HF risk, assess its modifying effect on genetic susceptibility, and how much BA acceleration mediates the impact of modifiable health behaviors on incident HF. We analyzed 274,608 UK Biobank participants without HF at baseline. Two BA accelerations (Biological Age Acceleration [BioAgeAccel] and Phenotypic Age Acceleration [PhenoAgeAccel]) were calculated by regressing clinical biomarker-based BA on chronological age, with higher values indicating accelerated aging. Health behavior scores were computed based on diet, physical activity, tobacco/nicotine, sleep, and BMI. Genetic risk scores (GRS) were calculated by 12 HF-associated loci. During a median follow-up of 13.5 years, 8915 HF cases were documented. Each standard deviation increase in BioAgeAccel and PhenoAgeAccel was associated with an increased incident HF risk, yielding HRs of 1.45 (95% CI, 1.42-1.48) and 1.42 (95% CI, 1.40-1.45), respectively. Participants with high GRS and highest quartile of BioAgeAccel had an HR of 2.69 (95% CI, 2.42-2.99), and for PhenoAgeAccel, an HR of 2.83 (95% CI, 2.52-3.18), compared to those with low GRS, and lowest quartile. Additive interactions were observed between GRS and BA accelerations. Health behaviors reduced HF risk, with 21.1% (95% CI, 19.5%-22.8%) mediated by decreased BioAgeAccel and 20.9% (95% CI, 19.5%-22.6%) by decreased PhenoAgeAccel. Accelerated BA is associated with an increased incident HF risk, with an additive effect when combined with genetic susceptibility. Maintaining health behaviors may help mitigate BA aging and reduce HF risk.

Life's Essential 8, Cardiovascular Health, and CKD Progression among Hispanic/Latino Adults: The Hispanic Community Health Study/Study of Latinos Study

Key Points

In US Hispanic/Latino adults with CKD, better cardiovascular health is associated with slower eGFR declines and improvements in albumin-to-creatinine ratio over 6 years. These findings support the implementation of a heart healthy lifestyle to delay CKD progression among US Hispanic/Latino adults.

Background

The primary cause of death in CKD is cardiovascular disease. Life's essential 8 (LE8) is an established measure of cardiovascular health (CVH). Our objective was to examine the relationship between CVH (LE8 score) and CKD progression among Hispanic/Latino adults, an understudied but growing population.

Methods

The Hispanic Community Health Study/Study of Latinos is a longitudinal cohort of Hispanic/Latino adults aged 18–74 years from four cities in the United States, examined at visit 1 (V1, 2008–2011) and visit 2 (2014–2017). At V1, participants underwent a comprehensive assessment of health behaviors (diet, physical activity, nicotine exposure, and sleep health) and clinical measurements (body mass index, blood lipids, blood glucose, and BP) used to estimate an LE8 score (range: 0–100). We included 1284 participants with CKD at V1, defined as eGFR <60 ml/min per 1.73 m2 and/or urine albumin-to-creatinine ratio (ACR) ≥30 mg/g. Change in eGFR and log(ACR) was defined as the difference in each measure between V1 and visit 2. To estimate the association between LE8 score with change in eGFR and log(ACR), we used linear regression models adjusted for follow-up time and demographic, socioeconomic, and clinical factors. All analyses accounted for Hispanic Community Health Study/Study of Latinos complex survey design.

Results

Among 1284 Hispanic/Latino participants with CKD at V1, the mean age was 48.6 years (SEM: 0.8), 57.2% were women, and the mean LE8 score was 61.1 (SEM: 0.7). Over an average of 6 years of follow-up, eGFR declined by 5.8 ml/min per 1.73 m2 and log(ACR) declined by 0.60. From multivariable adjusted models, for each 10-unit higher LE8 score, eGFR was lower by 0.97 ml/min per 1.73 m2 less (95% confidence interval, −1.93 to −0.02) and log(ACR) was lower by an additional 0.15 (95% confidence interval, 0.05 to 0.25).

Conclusions

Among diverse US Hispanic/Latino adults with CKD, higher LE8 score (better CVH) was associated with a slower decline in eGFR and lower albuminuria over 6 years.

Cardiometabolic risk factors in women: what's sauce for the goose is not sauce for the gander

PURPOSE OF REVIEW

The aim of this review was to discuss cardiometabolic risk factors that affect women.

RECENT FINDINGS

Recent calls to action to address cardiometabolic risk factors specific to women relate to increasing evidence of sex-specific differences in patient-related, drug-related, and socio-demographic factors leading to sub-optimal care of women.

SUMMARY

Certain aspects of common modifiable cardiovascular risk factors (e.g. smoking, hypertension, dyslipidaemia and diabetes) affect female individuals more adversely. Additionally, there are risk factors or enhancers that particularly affect cardiometabolic health in women [e.g. premature menopause, polycystic ovarian syndrome (PCOS), familial partial lipodystrophy, socio-cultural factors]. Understanding these risk factors may provide insight on how to improve cardiometabolic outcomes in women.

Overall Sleep Quality Is Associated With Advanced Stages in Patients With Cardiovascular-Kidney-Metabolic Syndrome

BACKGROUND

In 2023, the American Heart Association defined the concept of cardiovascular-kidney-metabolic (CKM) syndrome as a health disorder ascribed to connections among obesity, diabetes, chronic kidney disease, and cardiovascular disease. We aim to examine the association between overall sleep quality and advanced CKM syndrome.

METHODS

This cross-sectional study used data on US adults from the National Health and Nutrition Examination Survey 2015 to 2020. Overall sleep quality was evaluated by summarizing 5 sleep behaviors: sleep duration, trouble sleeping, daytime sleepiness, snoring, and nocturia. CKM syndrome was classified into 5 stages: stage 0, no risk factors; stage 1, excess adiposity; stage 2, metabolic risk factors and kidney disease; stage 3, subclinical cardiovascular disease; and stage 4, clinical cardiovascular disease. CKM syndrome stages 3 and 4 are considered advanced. The association between overall sleep quality and advanced CKM syndrome was assessed using a multivariable weighted logistic regression model.

RESULTS

Of the 12 245 adults included in our study, 10 607 participants met the criteria for CKM syndrome (stage ≥1), and 8930 were categorized into nonadvanced CKM syndrome, while 1677 were categorized into advanced CKM syndrome. Compared with patients with CKM syndrome in the low-sleep-quality group, the adjusted odds ratios for advanced CKM syndrome were 0.68 (95% CI, 0.54-0.87) for those in the moderate sleep quality group and 0.55 (95% CI, 0.40-0.75) for those in the high-sleep-quality group, respectively.

CONCLUSIONS

Patients with CKM syndrome with higher overall sleep quality had a lower likelihood of being in advanced stages.

Lifestyle behaviours and physical, psychological, and cognitive multimorbidity among older hypertensive population in remote areas of China

OBJECTIVES

With the intensification of aging, the proportion of people affected by multimorbidity is steadily increasing worldwide. In remote areas of China, where economic development is lagging and healthcare resources are limited, the older hypertensive population may experience a higher burden of multimorbidity. However, comprehensive evidence is still lacking on how specific combinations of lifestyle behaviours (LBs) impact particular multimorbidity health outcomes in older hypertensive individuals.

STUDY DESIGN

A cross-sectional study was conducted among the older hypertensive population (aged ≥65 years) from 1 July to August 31, 2023 in Jia County, a remote area of China.

METHODS

A total of 40 diseases were categorized into physical, psychological and cognitive disorders. Multivariable-adjusted logistic regression models were used to estimate ORs and 95 % CIs for the associations between LBs and multimorbidity.

RESULTS

Among 17,728 participants, the prevalence of physical, psychological, cognitive, physical-psychological multimorbidity (PPsM), physical-cognitive multimorbidity (PCM), psychological-cognitive multimorbidity (PsCM), and physical-psychological-cognitive multimorbidity (PPsCM) were 63.55 %, 30.12 %, 64.55 %, 22.31 %, 42.03 %, 22.57 %, and 16.74 %, respectively. Compared to participants without any healthy LBs, those with five healthy LBs were associated with a lower risk of physical, psychological, cognitive, PPsM, PCM, PsCM, and PPsCM. Overall, the risk of adverse outcomes decreased with the number of healthy LBs (Ptrend<0.001). However, combinations of healthy LBs of the same quantity but from different categories exhibited varying impacts on the outcomes.

CONCLUSIONS

Multimorbidity involving physical, psychological, and cognitive disorders poses a significant challenge for managing hypertention. Strengthening the capacity of primary healthcare workers to promote healthy lifestyle practices and identifying the optimal LB combinations should be prioritized in the management of hypertensive individuals in remote areas of China.

Prenatal and Perinatal Factors of Life's Essential 8 Cardiovascular Health Trajectories

Importance

The American Heart Association put forth the Life's Essential 8 construct to assess cardiovascular health (CVH) based on 8 biological and behavioral factors. Few studies have identified prenatal and perinatal factors of CVH trajectories across childhood and adolescence, life stages where disease precursors and health behaviors are established.

Objective

To examine associations of prenatal and perinatal factors with child CVH trajectory.

Design, setting, and participants

Data from the Project Viva prebirth cohort from April 1999 to August 2021 were used. Participant inclusion required 3 or more CVH metrics in early childhood (median [range] age, 3.2 [2.8-6.2] years) or 4 or more in midchildhood (median [range] age, 7.7 [6.6-10.9] years), early adolescence (median [range] age, 13.0 [11.9-16.6] years), or late adolescence (median [range] age, 17.5 [15.4-20.1] years). Data were analyzed from April 1 to September 30, 2024.

Exposures

Prenatal and perinatal factors.

Main outcomes and measures

CVH score (0-100 points), calculated as the unweighted average of all available CVH metrics at each life stage.

Results

Among 1333 children included, 680 (51.0%) were male, 78 (5.9%) Hispanic, 181 (13.6%) non-Hispanic Black, and 959 (71.9%) non-Hispanic White. The estimated mean (SD) age of inflection when CVH started to decline was 10.2 (0.7) years for male children and 10.0 (0.6) years for female children. Prepregnancy overweight or obesity (vs healthy or underweight), smoking during pregnancy (vs never), and formula-feeding (vs breastfeeding) in the first 6 months were each associated with lower CVH from childhood to adolescence, but gestational diabetes (vs normal glucose tolerance) was not associated with CVH. Prepregnancy obesity was associated with later inflection (β = 0.1; 95% CI, 0.0 to 0.2 years) and slower CVH decline after inflection (β = 0.2; 95% CI, 0.1 to 0.4 points per year). Gestational hypertension or preeclampsia (vs normal blood pressure) was associated with faster CVH gain before inflection (β = 0.3; 95% CI, 0.1 to 0.5 points per year), earlier inflection (β = -0.1; 95% CI, -0.2 to 0.0 years), and faster CVH decline after inflection (β = -0.3; 95% CI, -0.5 to -0.1 points per year), while smoking during pregnancy was associated with later inflection (β = 0.2; 95% CI, 0.1 to 0.3 years).

Conclusions and Relevance

In this cohort study, prepregnancy overweight or obesity, smoking during pregnancy, and formula-feeding in the first 6 months of life were each associated with adverse CVH trajectories early in life. Future work should examine whether interventions that address these factors would be effective in optimizing CVH in children.

Cardiovascular Effect of Snoring in Asians: What Do Biobank and Genomic Studies Say?

See related article

Association of metabolomic aging acceleration and body mass index phenotypes with mortality and obesity-related morbidities

This study aims to investigate the association between metabolomic aging acceleration and body mass index (BMI) phenotypes with mortality and obesity-related morbidities (ORMs). 85,458 participants were included from the UK Biobank. Metabolomic age was determined using 168 metabolites. The Chronological Age-Adjusted Gap was used to define metabolomically younger (MY) or older (MO) status. BMI categories were defined as normal weight, overweight, and obese. Participants were categorized into MY normal weight (MY-NW, reference), MY overweight (MY-OW), MY obesity (MY-OB), MO normal weight (MO-NW), MO overweight (MO-OW), and MO obesity (MO-OB). Mortality and 43 ORMs were identified through death registries and hospitalization records. Compared with MY-NW phenotype, MO-OB phenotype yielded increased risk of mortality and 32 ORMs, followed by MO-OW with mortality and 27 ORMs, MY-OB with mortality and 26 ORMs, MY-OW with 21 ORMs, and MO-NW with mortality and 14 ORMs. Consistently, MO-OB phenotype showed the highest risk of developing obesity-related multimorbidities, followed by MY-OB phenotype, MO-OW phenotype, MY-OW phenotype, and MO-NW phenotype. Additive interactions were found between metabolomic aging acceleration and obesity on CVD-specific mortality and 10 ORMs. Additionally, individuals with metabolomic aging acceleration had higher mortality and cardiovascular risk, even within the same BMI category. These findings suggest that metabolomic aging acceleration could help stratify mortality and ORMs risk across different BMI categories. Weight management should also be extended to individuals with overweight or obesity even in the absence of accelerated metabolomic aging, as they face increased healthy risk compared with MY-NW individuals. Additionally, delaying metabolic aging acceleration is needed for all metabolomically older groups, including those with normal weight.

Associations of Cardiovascular Health and New-Onset Age-Related Macular Diseases From UK Biobank

Purpose

This study aimed to investigate the correlation between cardiovascular health (CVH), evaluated through the Life's Essential 8 (LE8) score, and the risk of new-onset age-related macular degeneration (AMD).

Methods

This longitudinal analysis included 271,274 participants who were free of both cardiovascular diseases and AMD at baseline. The LE8 score was classified into three categories: low (<50 points), moderate (50 to <80 points), and high (≥80 points), with higher scores indicating better CVH. Cox proportional hazards models were used to explore the relationships between the CVH and AMD incidence. Furthermore, the population attributable risk (PAR%) was calculated for CVH and each individual metric.

Results

During an average follow-up duration of 10.9 years, a total of 7468 (2.8%) cases of AMD were documented. Individuals with moderate and high CVH levels had a 14% (hazard ratio [HR] = 0.86; 95% confidence interval [CI], 0.78-0.94) and 23% (HR = 0.77; 95% CI, 0.69-0.86) reduced risk of developing AMD, respectively. A linear dose-response relationship was identified between the cumulative LE8 score and the incidence of AMD. Attaining optimal CVH in all individuals could potentially avert 9.4% (95% CI, 3.7%-15.1%) of AMD cases. Among the CVH metrics, ideal blood glucose and blood pressure levels were related to a reduction of 3.3% and 8.7% in AMD cases, respectively.

Conclusions

Enhanced CVH is significantly associated with a reduced risk of developing AMD. Promoting CVH through the LE8 guideline might potentially contribute to the prevention of AMD.

Sleep characteristics and self-reported sleep quality in the oldest-old: Results from a prospective longitudinal cohort study

Little is known about the correlation between subjective perception and objective measures of sleep quality in particular in the oldest-old. The aim of this study was to perform longitudinal home sleep monitoring in this age group, and to correlate results with self-reported sleep quality. This is a prospective longitudinal home sleep-monitoring study in 12 oldest-old persons (age 83-100 years, mean 93 years, 10 females) without serious sleep disorders over 1 month using a contactless piezoelectric bed sensor (EMFIT QS). Participants provided daily information about perceived sleep. Duration in bed: 264-639 min (M = 476 min, SD = 94 min); sleep duration: 239-561 min (M = 418 min, SD = 91 min); sleep efficiency: 83.9%-90.7% (M = 87.4%, SD = 5.0%); rapid eye movement sleep: 21.1%-29.0% (M = 24.9%, SD = 5.5%); deep sleep: 13.3%-19.6% (M = 16.8%, SD = 4.5%). All but one participant showed a weak (r = 0.2-0.39) or very weak (r = 0-0.19) positive or negative correlation between self-rated sleep quality and the sleep score. In conclusion, longitudinal sleep monitoring in the home of elderly people by a contactless piezoelectric sensor system is feasible and well accepted. Subjective perception of sleep quality does not correlate well with objective measures in our study. Our findings may help to develop new approaches to sleep problems in the oldest-old including home monitoring. Further studies are needed to explore the full potential of this approach.

Cardiovascular Health Among Rural and Urban US Adults-Healthcare, Lifestyle, and Social Factors

Importance

Improving cardiovascular health in rural areas is a national priority in the US. However, little is known about the current state of rural cardiovascular health and the underlying drivers of any rural-urban disparities.

Objective

To compare rates of cardiometabolic risk factors and cardiovascular diseases between rural and urban US adults and to evaluate the extent to which health care access, lifestyle factors, and social risk factors contribute to any rural-urban differences.

Design, Setting, and Participants

This nationally representative cross-sectional study analyzed data from US adults aged 20 years or older residing in rural vs urban areas using the 2022 National Health Interview Survey. Data were analyzed between August 2024 and February 2025.

Exposure

County-level rurality.

Main Outcomes and Measures

The primary outcomes were age-standardized rates of cardiometabolic risk factors (hypertension, hyperlipidemia, obesity, and diabetes) and cardiovascular diseases (coronary heart disease [CHD] and stroke).

Results

The study population consisted of 27 172 adults, including 4256 adults (14.0%) residing in rural areas, 14 741 (54.8%) in small or medium metropolitan areas, and 8175 (31.2%) in urban areas. Mean (SD) participant age was 49.1 (17.8) years, and 4399 participants (50.8%) were female. Compared with their urban counterparts, rural adults were more likely to smoke, be insufficiently physically active, and have more social risk factors. Age-standardized rates of cardiometabolic risk factors were significantly higher in rural areas, including hypertension (37.1% vs 30.9%; rate ratio [RR], 1.20; 95% CI, 1.13-1.27), hyperlipidemia (29.3% vs 26.7%; RR, 1.10; 95% CI, 1.03-1.18), obesity (41.1% vs 30.0%; RR, 1.37; 95% CI, 1.27-1.47), and diabetes (11.2% vs 9.8%; RR, 1.15; 95% CI, 1.02-1.29). The same pattern was observed for CHD (6.7% vs 4.3%; RR, 1.58; 95% CI, 1.35-1.85), but no differences were observed for stroke. The magnitude of rural-urban disparities was largest among young adults (aged 20-39 years) for hypertension (RR, 1.44; 95% CI, 1.12-1.86), obesity (RR, 1.54; 95% CI, 1.34-1.77), and diabetes (RR, 2.59; 95% CI, 1.54-4.38). Rural-urban disparities in cardiovascular health were not meaningfully attenuated after adjustment for measures of health care access (insurance coverage, usual source of care, and recent health care utilization) and lifestyle factors (smoking and physical activity). However, accounting for social risk factors (poverty, education level, food insecurity, and home ownership) completely attenuated rural-urban disparities in hypertension (adjusted RR [aRR], 0.99; 95% CI, 0.93-1.06), diabetes (aRR, 1.02; 95% CI, 0.90-1.15), and CHD (aRR, 1.08; 95% CI, 0.91-1.29), but only partially attenuated disparities in obesity (aRR, 1.29; 95% CI, 1.20-1.39).

Conclusions and Relevance

This national cross-sectional study found substantial rural-urban disparities in cardiometabolic risk factors and cardiovascular diseases, which were largest among younger adults and almost entirely explained by social risk factors. These findings suggest that efforts to improve socioeconomic conditions in rural communities may be critical to address the rural-urban gap in cardiovascular health.

Investigating modifiable risk factors associated with ideal cardiovascular health among cancer survivors: a scoping review

BACKGROUND

Cancer survivors are at higher risk of developing cardiovascular diseases and face worse morbidity and mortality outcomes than the general population. The American Heart Association (AHA) introduced the Life's Essential 8 framework, encompassing eight modifiable risk factors and lifestyle behaviors for maintaining ideal cardiovascular health (CVH). Although this framework is well-established for predicting CVH in the general population, studies on its association with cardiovascular outcomes among cancer survivors remain scattered across the literature.

OBJECTIVE

This review maps existing literature surrounding modifiable risk factors, lifestyle behaviors, CVH, and cardiovascular outcomes among cancer survivors to take stock of what is known, identify methodological strengths and weaknesses, and propose promising research directions.

METHODS

A scoping review was conducted to identify studies examining different dimensions of ideal CVH in adult cancer survivors. Measurement methods of ideal CVH metrics, and determinants associated with CVH were examined.

RESULTS

Twenty-two articles met eligibility criteria. Of which, 82% (n = 18) were published in or after 2020. Fourteen studies (about 64%) followed the AHA's framework to conceptualize ideal CVH. Higher scores on ideal CVH are linked to better cardiovascular outcomes among cancer survivors with associations noted for social inequalities and neighborhood environmental factors, underscoring the complexity of CVH determinants in this population.

CONCLUSIONS

Research on ideal CVH among cancer survivors appears to have accelerated in recent years, yet many gaps remain to orient clinical and public health practice. Promising research directions include expanding investigations into pre-diagnosis CVH, addressing disparities in CVH across diverse populations, and conducting longitudinal studies to clarify causal pathways between lifestyle behaviors, cancer treatments, and cardiovascular outcomes.

Stressor-Evoked Brain Activity, Cardiovascular Reactivity, and Subclinical Atherosclerosis in Midlife Adults

BACKGROUND

Cardiovascular responses to psychological stressors have been separately associated with preclinical atherosclerosis and hemodynamic brain activity patterns across different studies and cohorts; however, what has not been established is whether cardiovascular stress responses reliably link indicators of stressor-evoked brain activity and preclinical atherosclerosis that have been measured in the same individuals. Accordingly, the present study used cross-validation and predictive modeling to test for the first time whether stressor-evoked systolic blood pressure responses statistically mediated the association between concurrently measured brain activity and a vascular marker of preclinical atherosclerosis in the carotid arteries.

METHODS AND RESULTS

Six hundred twenty-four midlife adults (aged 28-56 years, 54.97% women) from 2 different cohorts underwent 2 information-conflict functional magnetic resonance imaging tasks, with concurrent systolic blood pressure measures collected. Carotid artery intima-media thickness was measured by ultrasonography. A mediation framework that included harmonization, cross-validation, and penalized principal component regression was then used. Brain areas where functional magnetic resonance imaging activity exhibited reliable direct and indirect effects were identified through bootstrapping. Sensitivity analysis further tested the robustness of findings after accounting for prevailing levels of cardiovascular disease risk and brain imaging data quality. Task-averaged patterns of functional magnetic resonance imaging activity across distributed brain areas exhibited a generalizable association with carotid artery intima-media thickness, which was reliably mediated by an area under the curve measure of aggregate systolic blood pressure reactivity. Importantly, this effect held in sensitivity analyses. Implicated brain areas in this mediation included the ventromedial prefrontal cortex, anterior cingulate cortex, insula, and amygdala.

CONCLUSIONS

These novel findings support a link between stressor-evoked brain activity and preclinical atherosclerosis, which is accounted for by individual differences in corresponding levels of stressor-evoked cardiovascular reactivity.

Addressing cardiovascular risks with a goal to prevent cardiovascular complications in patients undergoing antihormonal therapy for prostate cancer

Over 1 million cases of prostate cancer are reported every year, and it is the second most common cancer in men. Androgen deprivation therapy (ADT) is a hallmark treatment for prostate cancer but is associated with the development or exacerbation of cardiovascular disease. The most common cause of non-cancer death in patients with prostate cancer is cardiovascular disease. Thus, a better understanding of the prevalence of cardiovascular toxicity across all therapies, management of potential cardiovascular complications, and prevention of cardiovascular events is essential as treatments continue to evolve. In this article, the first in a 2-part series, we provide a review of the current landscape of ADT therapy and its association with cardiovascular disease, summarize recent clinical trial data evaluating cardiovascular outcomes, and provide insights on the management of cardiovascular risk factors and adverse events for clinicians managing this high-risk population of men undergoing potentially cardiotoxic treatment for prostate cancer.

Polysomnographic characteristics of patients with heart failure combined with sleep apnea: A systematic review and meta-analysis

AIMS

Objective sleep parameters in patients with HF and their comorbidity with sleep-disordered breathing (SDB) are not fully understood. We aimed to investigate the polysomnography-measured sleep characteristics in HF patients using a systematic review and meta-analysis.

METHODS

PubMed, Embase, and Web of Science databases were searched for studies on PSG in HF patients. Meta-analyses were conducted to compare PSG parameters between HF patients and Non-HF, HF patients with and without SDB, HF patients with different types of SDB, and HF patients before and after SDB treatments.

RESULTS

HF patients showed decreased sleep efficiency (MD = -7.5 %, 95 %CI: [-10.8 %, -4.1 %], P < 0.001) and reduced slow wave sleep (MD = -3.2 %, 95 %CI: [-5.7 %, -0.7 %], P = 0.013) compared with those without HF. With comorbid SDB, HF patients experienced further decreases in sleep efficiency and total sleep time, and disruptions in sleep architecture, including decreased rapid-eye-movement sleep (MD = -3.4 %, 95 %CI: [-6.2 %, -0.5 %], P = 0.020) and SWS (MD = -3.1 %, 95 %CI: [-4.1 %, -2.1 %], P < 0.001).

CONCLUSIONS

HF patients showed poorer sleep continuity and less restorative sleep. Additionally, SDB was associated with poor objective sleep architecture in HF patients, indicated by a decrease in the percentage of deep sleep and an increase in sleep fragmentation. SDB treatments, such as adaptive servo-ventilation (ASV) and continuous positive airway pressure (CPAP), were associated with improved sleep quality and quantity in HF patients with SDB.

Baseline and 10-year change in the number of ideal cardiovascular health metrics and sudden cardiac death in the community

AIMS

Adherence to an ideal cardiovascular health (CVH) might contribute to lower the burden of sudden cardiac death (SCD) in the community. We aimed to examine the association between the number of ideal CVH metrics at baseline and of its change over 10 years with the risk of SCD.

METHODS AND RESULTS

The Copenhagen City Heart Study is a community-based prospective cohort study. The number of ideal CVH metrics (range 0-6; non-smoking and ideal level of body mass index, physical activity, untreated glucose, untreated systolic blood pressure, and untreated total cholesterol levels) at baseline in 1991-94 and its 10-year change thereof between 1981-83 and 1991-94 were evaluated. Definite SCD was defined as a death occurring within 1 h (eye-witnessed case) or within 24 h (non-eye-witnessed) of symptoms onset, with the presence of confirmed ventricular tachycardia and the exclusion of non-cardiac cause at autopsy. Fine and Gray sub-distribution HRs (sHRs) were calculated to account for competing risk. The study population includes 8837 participants (57% women; mean age 57 years, ±15 years) in 1991-94. After a median follow-up of 22.6 years from 1 January 1993 up to 31 December 2016, 56 definite SCD occurred. The risk of definite SCD decreased gradually with the number of ideal metrics in 1991-94 [sHR = 0.58; 95% confidence interval (CI): 0.44-0.75 per additional ideal metric] and with the change (i.e. improvement) in the number of ideal metrics between 1981-83 and 1991-94 (sHR = 0.68; 0.50-0.93 per change in the number of ideal metrics). Effect size was lower for coronary death, all-cause mortality, and coronary heart disease events.

CONCLUSION

Adherence to a higher number of ideal cardiovascular health was related to a substantial lower risk of definite SCD.

Association of cardiovascular health metrics and metabolic associated fatty liver disease: Methodological limitations, and future directions

Metabolic-associated fatty liver disease (MAFLD), formerly known as nonalcoholic fatty liver disease, is an increasing global health challenge with substantial implications for metabolic and cardiovascular health (CVH). A recent study by Fu et al investigated the relationship between CVH metrics, specifically Life's Simple 7 and Life's Essential 8, and the prevalence of MAFLD. While this study offered important insights into the relationship between CVH and MAFLD, several methodological limitations, unaddressed confounding factors, and potential biases that could impact the interpretation of their findings should be considered. The study's cross-sectional nature restricted the ability to draw causal conclusions, and it did not fully account for potential confounding factors such as dietary habits, genetic predispositions, and medication use. Furthermore, relying on transient elastography to diagnose MAFLD introduces certain diagnostic limitations. Longitudinal study designs, advanced statistical modeling techniques, and diverse population groups should be utilized to strengthen future research. Exploring the mechanistic pathways that link CVH metrics to MAFLD through multi-omics approaches and interventional studies will be essential in formulating targeted prevention and treatment strategies. Structural equation modeling and machine learning techniques could provide a more refined analysis of these interrelated factors. Additionally, future research should employ longitudinal study designs and explore genetic and epigenetic influences to enhance our understanding of CVH and MAFLD interactions.

Psychological Distress and Cardiovascular Health in Pregnancy: Findings From the U.S. National Health Interview Survey

BACKGROUND

The relationship between psychological health and cardiovascular health (CVH) during pregnancy is not well characterized.

OBJECTIVES

The purpose of this study was to perform a cross-sectional analysis in order to assess the relationships between psychological distress and CVH among pregnant individuals in the United States.

METHODS

U.S. National Health Interview Survey (2013-2018) data were used for the analyses. The sample included all pregnant participants aged ≥18 years, but excluded those with missing data for the exposure, outcome, or covariates. Psychological health was measured with the 6-item Kessler scale, and severe psychological distress was defined as 6-item Kessler scale ≥13. CVH was quantified using the American Heart Association's Life's Essential 8; as detailed dietary data were unavailable, a 7-item score was used (higher scores indicated worse CVH). Multivariable Poisson regression tested associations between severe psychological distress and CVH, adjusting for potential confounders including age, race/ethnicity, sexual orientation, education level, family income, any known cardiovascular conditions, and insurance.

RESULTS

Among 1,110 pregnant individuals (representing >1.5 million pregnant individuals each year of the survey), 3.5% reported severe psychological distress (95% CI: 2.2%-5.5%), 21.7% reported moderate psychological distress (95% CI: 18.8%-24.9%), and 74.9% reported either mild or no psychological distress (95% CI: 71.4%-78.0%). Individuals reporting moderate psychological distress (adjusted rate ratio: 1.25 [95% CI: 1.13-1.38], P < 0.001) or severe psychological distress (adjusted rate ratio: 1.42 [95% CI: 1.20-1.68], P < 0.001) had lower CVH scores compared to those with mild or no psychological distress. A stepwise relation was observed between the severity of psychological distress and CVH.

CONCLUSIONS

We observed a strong association between psychological distress and suboptimal CVH during pregnancy, highlighting the need to manage psychological health along with CVH in pregnant individuals.

Modifiable risk factors and plasma proteomics in relation to complications of type 2 diabetes

A comprehensive assessment of combined modifiable risk factors with common complications of type 2 diabetes (T2D) is lacking, and the potential role of proteomics remains unclear. Here, we examine the associations of cardiovascular health (CVH) score and degree of risk factor control with common diabetic complications using data from the UK Biobank (n = 14,102). Furthermore, we explore the mediation effects of plasma proteomics in a subset with proteomic data (n = 1287). Over median follow-ups of 12.4-13.4 years, higher CVH score and higher degree of risk factor control are associated with lower risks of 30 and 22 of 45 adverse outcomes among individuals with T2D, respectively. Mediation analyses reveal that mortality and multiple vascular diseases share common mediators, such as uromodulin and pro-adrenomedullin. These findings highlight the importance of risk factors modification in reducing disease burden among people with T2D and facilitate the understanding of mediation effects of plasma proteins underlying these associations.

Cardiovascular Health in the Transition From Adolescence to Emerging Adulthood: A Scientific Statement From the American Heart Association

Cardiovascular disease remains a leading cause of death in the United States, with an alarming rise in the proportion of young adults experiencing cardiovascular events. Many adolescents enter adulthood with significant cardiovascular disease risk factors. This scientific statement addresses the critical need for cardiovascular health promotion during emerging adulthood, a transitional stage between the ages of 18 and 25 or 29 years of age. We discuss the significance of social determinants of health and the interplay between individual-level risk factors and developmental changes, including shifts in substance use, social connections, and emotional well-being. We conclude by outlining strategies for optimizing cardiovascular health promotion and disease prevention, underscoring the importance of primordial prevention, early intervention, and tailored approaches to address the unique needs of emerging adults. Addressing these multifaceted factors is crucial for mitigating the burden of cardiovascular disease risk factors among emerging adults and promoting long-term cardiovascular well-being.

Association Between Self-Perceived Stress and Cryptogenic Ischemic Stroke in Young Adults: A Case-Control Study

BACKGROUND AND OBJECTIVES

Psychosocial stress is a potentially modifiable risk factor of early-onset ischemic stroke, with limited evidence suggesting a stronger association between stress and cryptogenic ischemic stroke (CIS) compared with strokes of known etiology. We aimed to explore the association between self-perceived stress and CIS, with subgroup analyses stratified by sex and age.

METHODS

Young patients aged 18-49 years with a first-ever CIS and sex-matched and age-matched stroke-free controls from 19 European centers were included. Self-perceived stress was assessed using a modified version of the Perceived Stress Scale (PSS). Scores were categorized into low (0-13), moderate (14-26), and high (27-40) perceived stress. Conditional logistic regression-adjusted for age, level of education, traditional risk factors (hypertension, cardiovascular diseases, diabetes mellitus, heavy alcohol consumption, current smoking, obesity, diet, depression, and physical inactivity), and migraine with aura (MA)-was used to assess independent association between self-perceived stress and CIS.

RESULTS

Altogether, 426 patients (median age 41 years; 47.7% women) and 426 controls were included. Patients were more often at least moderately stressed compared with controls (46.2% vs 33.3%, p < 0.001). In the entire study population, higher self-perceived stress as a discrete measure was independently associated with CIS: adjusted odds ratio (OR) 1.04 per point increase; 95% CI 1.01-1.07. Categorical PSS score analysis showed an independent association between moderate stress and CIS (OR 1.47; 95% CI 1.00-2.14), but not with high stress (2.62; 0.81-8.45). In sex-specific analysis, higher stress as a discrete measure was associated with CIS in women (1.06; 1.02-1.11), but not in men (1.02; 0.97-1.07). Moderate stress was associated with CIS in women (1.78; 1.07-2.96), but not in men (1.06; 0.58-1.96). When stratified by age, higher stress as a discrete measure was significantly associated with CIS only in patients aged 18-39 years (1.06; 1.00-1.11).

DISCUSSION

Self-perceived stress was strongly correlated with an increased risk of early-onset CIS, even after robust adjustment for cardiovascular risk factors and MA. These findings highlight the need for further investigation into the mechanisms by which stress may contribute to the risk of CIS. Possibility of recall bias should be considered when interpreting the results.

TRIAL REGISTRATION INFORMATION

Clinical trial registration number: NCT01934725.