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 polysocial risk score and CVH among women of reproductive age in the SAFE HEART study: An American Heart Association Research Goes Red Initiative

BACKGROUND

To assess the association between polysocial risk factors and cardiovascular health (CVH) among women of reproductive age.

METHODS

Our cross-sectional analysis included women of reproductive age (18-44 years) from community settings and the American Heart Association's Research Goes Red (RGR) registry. Polysocial risk scores (0-14) reflected social disadvantage across domains including socioeconomic stability (education, employment, income, insurance, financial strain), living situation (housing stability, housing quality, marital status, home ownership), food security, transportation, utilities, and interpersonal safety. Suboptimal CVH was defined as having ≥2 risk factors from Life's Essential 8 metrics: physical activity, diet, body mass index, sleep, smoking, blood pressure, blood sugar, and cholesterol. Associations between polysocial risk and suboptimal CVH were analyzed using linear regression models RESULTS: Suboptimal CVH increased with higher polysocial risk, from 77.0 % in the lowest quartile to 95.2 % in the highest. Participants in quartile 3 had the highest odds of suboptimal CVH (aOR 9.52, 95 % CI 2.63-34.46), while quartile 4 showed decreased but significant odds (aOR 3.86, 95 % CI 1.03-14.40) compared to quartile 1. Hypertension (aOR 10.23, 95 % CI 3.61-29.01), diabetes (aOR 8.87, 95 % CI 3.12-25.24), hyperlipidemia (aOR 7.48, 95 % CI 2.72-20.55), and smoking (aOR 9.46, 95 % CI 3.25-27.56) were strongly associated with higher polysocial risk in community-enrolled participants, whereas trends were less consistent in RGR-enrolled participants.

CONCLUSIONS

Women with higher social risks face greater odds of suboptimal CVH. Screening for social determinants and tailored public health interventions are essential for mitigating CVH risks in this population.

Association Between Life's Essential 8 and Diabetic Kidney Disease in Patients With Diabetes Mellitus: Evidence From National Health and Nutrition Examination Survey 2005-2018

BACKGROUND

Diabetic kidney disease (DKD) is often connected with an elevated cardiovascular disease risk. A novel index, the Life's Essential 8 (LE8), was developed with the American Heart Association to ascertain cardiovascular health. In people with diabetes mellitus, we aimed to estimate if LE8 possessed a connection with DKD risk.

METHODS

We implemented data from the National Health and Nutrition Examination Survey from 2005 to 2018. The correlation between LE8 and DKD was evaluated with weighted multivariate logistic regression models and restricted cubic spline models with covariate adjustments. In addition, we performed subgroup analyses and interaction tests.

RESULTS

After taking into account relevant confounding factors, the findings indicated that higher levels of LE8 was linked to a decreased probability of developing DKD (per 10-point increase in LE8, OR = 0.75, 95%CI = 0.68-0.84, P < .001). The subscales of the LE8 similarly demonstrated negative associations with DKD risk. After grouping the LE8 scores, it was found that individuals with high LE8 were significantly less likely to develop DKD compared to those with low LE8 (OR = 0.32, 95%CI = 0.15-0.70, P = .005). The association between LE8 and DKD was consistent across different subgroups.

CONCLUSION

LE8 scores were shown to have a significantly negative association with the risk of DKD in people with diabetes mellitus. By concentrating on the state of cardiovascular health, it may be possible to lessen the impact of DKD.

WMH Contributions to Cognitive Impairment: Rationale and Design of the Diverse VCID Study

As awareness of dementia increases, more individuals with minor cognitive complaints are requesting clinical assessment. Neuroimaging studies frequently identify incidental white matter hyperintensities, raising patient concerns about their brain health and future risk for dementia. Moreover, current US demographics indicate that ≈50% of these individuals will be from diverse backgrounds by 2060. Racial and ethnic minority populations bear a disproportionate burden of vascular risk factors magnifying dementia risk. Despite established associations between white matter hyperintensities and cognitive impairment, including dementia, no study has comprehensively and prospectively examined the impact of individual and combined magnetic resonance imaging measures of white matter injury, their risk factors, and comorbidities on cognitive performance among a diverse, nondemented, stroke-free population with cognitive complaints over an extended period of observation. The Diverse VCID (Diverse Vascular Cognitive Impairment and Dementia) study is designed to fill this knowledge gap through 3 assessments of clinical, behavioral, and risk factors; neurocognitive and magnetic resonance imaging measures; fluid biomarkers of Alzheimer disease, vascular inflammation, angiogenesis, and endothelial dysfunction; and measures of genetic risk collected prospectively over a minimum of 3 years in a cohort of 2250 individuals evenly distributed among Americans of Black/African, Latino/Hispanic, and non-Hispanic White backgrounds. The goal of this study is to investigate the basic mechanisms of small vessel cerebrovascular injury, emphasizing clinically relevant assessment tools and developing a risk score that will accurately identify at-risk individuals for possible treatment or clinical therapeutic trials, particularly individuals of diverse backgrounds where vascular risk factors and disease are more prevalent.

Association between life's crucial 9 and severe abdominal aortic calcification in U.S. Adults: the mediating role of the systemic inflammatory response index

Background

Life's Crucial 9 (LC9) is an emerging cardiovascular health scoring system that incorporates Life's Essential 8 (LE8) alongside mental health factors. However, its relationship with severe abdominal aortic calcification (SAAC) remains poorly understood.

Objectives

The objective of this study is to investigate the relationship between LC9 scores and the incidence of SAAC in the US population.

Methods

Data from 2,323 participants were analyzed, originating from the 2013-2014 National Health and Nutrition Examination Survey (NHANES) cycle. In exploring the dynamics of LC9, its constituents, and their relationship with SAAC, we employed advanced statistical methodologies, specifically multivariable logistic regression and weighted quantile sum regression. Subgroup interaction analyses were conducted to reinforce the conclusions, and mediation analysis was employed to investigate how the systemic inflammatory response index (SIRI) influences the connection between LC9 and SAAC.

Results

In fully adjusted models, an increase of 10 points in LC9 scores was associated with a 26% reduction in the prevalence of SAAC, achieving statistical significance (P < 0.001). As LC9 scores increased, a significant decline in SAAC prevalence was noted (P < 0.05). The WQS analysis pinpointed strong links between the occurrence of SAAC and variables including exposure to tobacco, blood pressure levels, blood glucose concentrations, and mental health status, the odds ratio stood at 0.244, with the 95% CI extending from 0.119 to 0.495. SIRI was positively correlated with SAAC (P < 0.05) and decreased with rising LC9 scores (β = -0.09, P < 0.001). Mediation analysis revealed that the SIRI significantly influenced the linkage between LC9 and SAAC, accounting for 5.8% of the mediation effect, with a statistically significant p-value (P < 0.001).

Conclusion

This research highlights a robust inverse relationship between elevated LC9 scores and reduced SAAC incidence, suggesting the significant role of LC9 as a key factor in diminishing the frequency of SAAC. Furthermore, SIRI mediates this relationship.

Association between the American Heart Association's new "Life's Essential 8" metrics and urinary incontinence: a cross-sectional study of NHANES data from 2011 to 2018

Background

Urinary incontinence (UI), as one of the five major global diseases, has seen a continuous rise in incidence, resulting in significant medical costs and societal burden. The American Heart Association (AHA) established the criteria of ideal cardiovascular health (CVH). and established the Life's Essential 8 (LE8) score to reduce the risk of cardiovascular mortality. UI shares several common risk factors with cardiovascular diseases (CVDs). This study aimed to investigate the association between LE8 score and the incidence of UI, extending the impact of CVH.

Methods

We examined data from the National Health and Nutrition Examination Survey (NHANES) 2011-2018, which included 17,269 US adults over the age of 20. The LE8 score classified CVH into three categories: poor, intermediate, and perfect. Logistic regression was performed to investigate the relationship between CVH status and the incidence of UI. Bayesian kernel machine regression (BKMR) and weighted quantile sum (WQS) regression were utilised to figure out which essential aspects from LE8 infect the UI the most.

Results

The participants in this study had an average age of 49.21 years, with 50.28% being female. The number of participants with poor, intermediate, and perfect CVH was 1,797, 11,721, and 3,751, respectively. After adjusting for related confounding factors, optimal CVH was associated with a decreased incidence of UI compared to bad CVH (adjusted odds ratio: 0.495, 95% confidence interval: 0.432-0.567, P<0.001). Moreover, the body mass index (BMI) score and physical activity score among the CVH metrics were significantly and positively associated with UI prevention, while the effects of the other metrics were not evident.

Conclusions

In the current study, ideal CVH was associated with a lower incidence of UI, which can be an indicator of a healthy lifestyle. Better BMI and activity status are two key preventing factors for UI.

The role of cardiovascular health in the associations between insulin resistance, future cardiovascular disease, and all-cause mortality

BACKGROUND

Whether cardiovascular health (CVH) modifies the associations between insulin resistance (IR) and prognosis remains unclear. This study aims to evaluate the varying relationships between IR, future cardiovascular disease (CVD), and all-cause mortality across different CVH statuses.

METHODS

This was a nationwide cohort study using data from the China Health and Nutrition Survey. The CVH was assessed using the Life's Essential 8 (LE8) metrics, and IR was determined by the homeostasis model assessment of insulin resistance (HOMA-IR) index and the triglyceride-glucose (TyG) index. The study outcomes included incident CVD and all-cause mortality.

RESULTS

47.0% of the included participants (n = 8635) were men, and the mean age (SD) was 49.7 (15.8) years, with 37.5%, 51.6%, and 10.9% having poor, intermediate, and ideal CVH. During a 6-year follow-up, 482 (5.6%) participants had incident CVD, and 435 individuals died (incidence rate: 7.9 (95% CI: 7.2, 8.7) 1000 person-years). HOMA-IR and the TyG index were positively associated with increased risks of CVD and mortality among participants with intermediate or poor CVH, while no significant associations were found between IR indexes with CVD and death in those with ideal CVH (P for interaction < .05). 13.0% and 16.8% of the associations between CVH and CVD were mediated by HOMA-IR and the TyG index. Similar significant indirect effects of HOMA-IR and the TyG index on the relationship between CVH and all-cause mortality were observed.

CONCLUSIONS

CVH significantly modified the associations between two IR surrogates and long-term CVD and all-cause mortality. Increased risk probabilities of future CVD and mortality were observed among individuals with intermediate or poor CVH. IR mediated a substantial proportion of the associations between CVH and CVD and all-cause mortality, emphasizing the importance of maintaining healthy behaviors and factors to reduce the burden of CVD and mitigate the detrimental impact of IR. Key message What is already known on this subject  The global prevalence of insulin resistance (IR) and diabetes mellitus (DM) is extremely high and their associated disease burden is heavy. Ideal cardiovascular health (CVH) is significant associated with a lower risk of IR and better prognosis. What this study adds  Only 10.9% of the participants maintained ideal CVH in this large Chinese cohort, while more than one-third had poor CVH. CVH significantly modified the associations between two IR surrogates and long-term CVD and all-cause mortality. Increased risk probabilities of future CVD and mortality were observed among individuals with intermediate or poor CVH. IR mediated a substantial proportion of the associations between CVH and CVD and all-cause mortality. How this study might affect research, practice, or policy  Our study indicated that a large number of Chinese citizens still have suboptimal CVH, emphasizing the urgent need for efforts to mitigate the heavy burden of CVDs at the population level. Maintaining optimal CVH could help slow down IR and reduce the risks of future CVD and premature death, as well as mitigate the negative effects of IR on prognosis.

Association of Life's Essential 8 and Life's Simple 7 with metabolic-associated fatty liver disease in the United States

BACKGROUND

Cardiovascular health (CVH) plays a crucial role in overall health, but its association with metabolic-associated fatty liver disease (MAFLD) remains unclear.

AIM

To investigate the relationship between CVH, measured using Life's Essential 8 (LE8) and Life's Simple 7 (LS7), and the prevalence of MAFLD.

METHODS

This cross-sectional study had a sample of 2234 individuals, representing approximately 120 million individuals in the United States. Baseline parameters were compared between the LE8 and LS7 groups. Logistic regression models were used to evaluate the relationship between LE8, LS7, and MAFLD, while taking into account confounding factors. The investigation employed restricted cubic splines to investigate non-linear associations. Subgroup analyses and sensitivity studies were performed to evaluate the strength and reliability of the results.

RESULTS

Higher LE8 and LS7 scores were significantly associated with a decreased risk of MAFLD, even after controlling for demographic, socioeconomic, and clinical variables. This association demonstrated a non-linear pattern, with the most dramatic risk reduction observed at higher CVH levels. Individual CVH components, notably healthy behaviors and factors, exhibited strong relationships with MAFLD. Subgroup analyses indicated consistent relationships across several demographics. Sensitivity tests utilizing other MAFLD definitions validated the robustness of the findings.

CONCLUSION

Higher adherence to CVH criteria, as indicated by LE8 and LS7 scores, is associated with a significantly lower risk of MAFLD. These results emphasize the need to advance CVH to control and avoid MAFLD.

AHA "Life's Essential 8" metrics and prognosis in patients with renal insufficiency: Results from the National Health and Nutrition Examination Survey, 2007-2018

BACKGROUND

The benefits of ideal cardiovascular-health metrics (ICVHMs) in patients with renal insufficiency remain unclear. This study aimed to investigate ICVHM associations with prognosis in a renal insufficiency population.

METHODS

The trial enrolled 29,682 participants from the US National Health and Nutrition Examination Survey (NHANES), 2007-2018, with mortality follow-up through December 31, 2019. Participants were divided into three groups based on estimated glomerular filtration rates. Cardiovascular health was assessed using new "Life's Essential 8" metrics. Cox regression analyses based on NHANES data were used to determine the associations between ICVHMs and cardiovascular mortality in patients with renal insufficiency.

RESULTS

During a mean follow-up of 6.58 years, ideal cardiovascular health (hazard ratio [HR] = 0.42; 95% confidence interval [CI]; 0.25-0.70) and ideal health behavior (HR = 0.53; 95% CI; 0.39-0.73) reduced cardiovascular mortality in participants with renal insufficiency. For each one ICVHM increment, a 25% reduction in cardiovascular mortality was recorded (95% CI; 0.69-0.82). When compared with participants with normal renal function, for those with mild renal insufficiency, the HR for cardiovascular mortality gradually decreased from 1.47 (95% CI; 0.85-2.52) in those who had ≤1 ICVHMs to 0.30 (95% CI; 0.12-0.77) in participants who had >6 ICVHMs.

CONCLUSIONS

From an ICVHM perspective, enhanced cardiovascular benefits were observed in individuals with renal insufficiency, coupled with a reduced risk of all-cause mortality. Furthermore, when compared with individuals with normal renal function, increased ICVHMs can mitigate adverse risks associated with renal impairment.

2025 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

BACKGROUND

The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2025 AHA Statistical Update is the product of a full year's worth of effort in 2024 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. This year's edition includes a continued focus on health equity across several key domains and enhanced global data that reflect improved methods and incorporation of ≈3000 new data sources since last year's Statistical Update.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Association of magnesium depletion score with increased stroke incidence and mortality risks in a comprehensive analysis

Stroke is a leading cause of morbidity and mortality worldwide, with modifiable risk factors being crucial for prevention efforts. Magnesium, an essential mineral involved in numerous physiological processes, is linked to cardiovascular health. However, the relationship between magnesium status, assessed through the Magnesium Depletion Score (MDS), and stroke risk remains underexplored. This study aims to investigate the association between MDS and stroke incidence, as well as the potential correlation between MDS and all-cause and cardiovascular disease (CVD) mortality among US adults. Furthermore, we explore the mediation role of Life's Essential 8 (LE8) in the relationship between MDS and stroke. Utilizing data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018, we conducted a cross-sectional analysis of 44,588 participants. Participants were divided into three groups based on their MDS levels: none to low (MDS = 0-1), middle (MDS = 2), and high (MDS = 3-5). Multivariable logistic regression models were employed to assess the relationship between MDS and stroke risk, adjusting for multiple confounders. Additionally, Cox regression models and Kaplan-Meier survival curves were used to evaluate the association between MDS and mortality outcomes. Subgroup and mediation analyses were performed to explore the role of LE8 in MDS associations with the risk of stroke. Higher MDS was significantly associated with increased stroke risk in a dose-dependent manner. Participants with high MDS scores (3-5) had an odds ratio (OR) of 1.96 (95% CI 1.55-2.49) for stroke compared to those with low MDS scores (0-1). For all-cause mortality, high MDS was associated with a hazard ratio (HR) of 1.73 (95% CI 1.41-2.09), and for CVD mortality, the HR was 2.01 (95% CI 1.49-2.71). Kaplan-Meier analyses revealed lower survival probabilities with increasing MDS levels. Subgroup analyses revealed that higher MDS was associated with increased stroke risk across age and gender groups, with stronger effects observed in older individuals, males, and those with higher cardiovascular risk factors, while LE8 mediated 26.5% of this relationship. Our findings provide strong evidence that higher MDS is significantly associated with increased stroke risk and higher all-cause and CVD mortality among stroke patients. LE8 plays a significant mediating role in this association.

Reappraisal of statin primary prevention trials: implications for identification of the statin-eligible primary prevention patient

BACKGROUND AND AIMS

Identification of patients eligible for primary prevention statin therapy is complex, often relying upon risk algorithms that diverge internationally. Our goal was to develop a simpler global definition of statin-eligible primary prevention patients.

METHODS

Randomized clinical trials (RCTs) cited in North American and European dyslipidemia guidelines justifying primary prevention statins for cardiovascular risk reduction were critically reappraised according to eligibility criteria and characteristics of actual enrollees. Statin-eligibility based on meeting minimal enrolment criteria versus risks calculated using either the Framingham Risk Score, the Pooled Cohort Equation and the Systematic Coronary Risk Estimate 2 were contrasted.

RESULTS

Patient scenarios meeting minimal RCT eligibility criteria seldom attained high enough 10 year risk of events according to the algorithms tested and thus would not be eligible for statin therapy. Overall, enrollees were 63.9 ± 8.9 years (mean ± SD) with low density lipoprotein-cholesterol (LDL-C) 3.53 ± 0.91 mmol/L. Enrollees in trials studying the lowest LDL-C levels were generally older and had additional risk factors.

CONCLUSIONS

Results of primary prevention RCTs justify treatment of more subjects and lower risk subjects than current risk algorithm-based guidelines. Based on a synthesis of RCT inclusion/exclusion criteria and the characteristics of enrollees, we propose that a statin-indicated primary prevention subject is one who is 40 to 70 years with a low density lipoprotein-cholesterol (LDL-C) ≥ 3.0 mmol/L or is 55 to 80 years with LDL-C ≥ 1.8 mmol/L and additional risk factors.

Combined Chronotherapy for Poor Sleep Following Acute Coronary Syndrome: A Pilot Randomized Trial

Sleep disturbance is common following acute coronary syndrome (ACS) and may contribute to a worse prognosis. We describe the rationale, design, and findings of a pilot and feasibility randomized clinical trial (RCT) of an intervention to improve post-ACS sleep. Fifteen post-ACS patients with insomnia and/or short sleep were randomized (2:1 allocation) to combined chronotherapy (CC) plus sleep hygiene education (SHE) or SHE control. CC was bright light therapy (BLT) delivered by a wearable light visor for 30 minutes after awakening and short-wavelength light avoidance using blue-light blocking (BLB) glasses in the evening from 8:00pm to bedtime daily for 4 weeks. Primary outcomes were feasibility, acceptability, appropriateness, usability, and adherence. Secondary outcomes were insomnia symptoms, sleep quality, and sleep duration. Two patients in the CC intervention group dropped before initiating study procedures. Completion of study procedures in remaining patients was high in the CC and control groups (88% and 100%, respectively). Self-reported adherence to CC (i.e., using BLT and BLB on ≥50% of days) was high (88% and 100%, respectively). The proportion of CC patients who perceived the intervention as feasible (71%) and usable (100%) was high, though fewer CC patients rated the intervention as acceptable (57%) and appropriate to improve sleep (29%). Improvements in insomnia symptoms and self-reported sleep quality and duration were seen in response to the CC intervention (71%). Post-ACS patients with sleep disturbance had high adherence to this chronotherapeutic intervention, and most viewed it as feasible and usable. This intervention should be tested in a larger RCT to determine efficacy to improve sleep.

Trial Registration

ClinicalTrials.gov number NCT05299723.

Date of registration

March 29, 2022.

URL of trial registry record

https://classic.clinicaltrials.gov/ct2/show/NCT05299723.

Association between METS-IR index and obstructive sleep apnea: evidence from NHANES

Insulin resistance (IR) is strongly associated with obstructive sleep apnea (OSA). Whereas, few studies have focused on the potential association between the Metabolic Score for Insulin Resistance (METS-IR), a novel non-insulin-dependent IR index, and OSA. Subjects from the National Health and Nutrition Examination Survey (NHANES) spanning 2005-2008 and 2015-2018 were recruited. The potential relationship between METS-IR and other IR indices with OSA was explored through three logistic regression analysis models and restricted cubic spline (RCS) curves. Receiver operating characteristic (ROC) curves were used to assess the diagnostic value of these indicators for OSA. On the basis of age, sex, race, body mass index (BMI), hypertension, diabetes， and cardiovascular disease (CVD), subgroup analyses were conducted to test the robustness of the METS-IR and OSA relationship. A total of 8,306 participants were enrolled, with an OSA prevalence of 30.69%. After adjusting for potential confounders, METS-IR, the triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio, the triglyceride glucose Index (TyG), and the homeostatic model assessment of insulin resistance (HOMA-IR) showed positive associations with OSA prevalence. In the highest tertile of METS-IR, TG/HDL-C, TyG index, and HOMA-IR, OSA prevalence was 2.96-fold, 1.42-fold, 1.29-fold, and 1.41-fold higher, respectively, compared to the lowest tertile (METS-IR: OR = 2.96, 95% CI: 2.50, 3.52, P < 0.0001; TG/HDL-C: OR = 1.42, 95% CI: 1.17, 1.73, P < 0.001; TyG index: OR = 1.29, 95% CI: 1.07, 1.55, P = 0.008; HOMA-IR: OR = 1.41, 95% CI: 1.18, 1.69, P < 0.001). ROC analysis revealed that METS-IR had the highest diagnostic accuracy for OSA (AUC = 0.652). The positive associations between these four IR indices and OSA remain stable across most cases (P for interaction > 0.05); however, all of them show significant interactions with diabetes (P for interaction < 0.05). The METS-IR index is positively associated with the prevalence of OSA and shows superior diagnostic accuracy compared to HOMA-IR, TG/HDL-C, and TyG index.

Digital Transformation in Cardiology - Mobile Health

The World Health Organization recognizes digital health as a key driver for sustainable health systems. Digital health is broad concept that refers to the use of digital technologies to improve health and healthcare. Mobile health is part of digital health and refers to the use of mobile devices such as smartphones, tablets, and wearable gadgets to deliver health-related services. By proactively utilizing personal health records from mHealth, in conjunction with electronic health records, advanced medical practices can be achieved. This integration facilitates app-based patient education and encouragement, lifestyle modification, and efficient sharing of medical information between hospitals. Beyond emergency care, information sharing enables patients to visit multiple healthcare facilities without redundant tests or unnecessary referrals, reducing the burden on both patients and healthcare providers.

Association between psoriasis and Life's Essential 8 among adults in the United States

This study aimed to investigate the association between psoriasis and Life's Essential 8 (LE8), which has demonstrated an inverse relationship with various chronic diseases, though its link to psoriasis remains unexplored. In this cross-sectional study, we analyzed data from the National Health and Nutrition Examination Survey (NHANES) conducted during 2005 to 2006 and 2009 to 2014 that included participants who were 20 years or older. The LE8 score was calculated based on the American Heart Association's recommendations and categorized into three levels: low (0-49), moderate (50-79), and high (80-100). Psoriasis was identified using self-reported questionnaires. Weighted multivariable logistic regression and restricted cubic splines were applied to evaluate the relationship between LE8 scores and psoriasis. The study included 12,744 participants with an average age of 46.2 years (95% CI: 45.53-46.87 years); 6,289 (50.96%) were female, and 374 (2.9%) reported having psoriasis. The weighted mean LE8 score was 68.50 (95% CI: 67.94-69.07). After complete adjustment, a linear negative association was observed between psoriasis and the LE8 score (OR per 1 SD increase: 0.86, 95% CI: 0.75-0.99). Among the subscales, the health factors score showed a linear relationship with psoriasis, while a nonlinear relationship was found between psoriasis and the health behaviors score. Additionally, BMI, an LE8 component, demonstrated a significant association with psoriasis (OR per 1 SD increase: 0.84, 95% CI: 0.72-0.98) in multivariable logistic regression models. Subgroup and sensitivity analyses confirmed the robustness of these findings. We identified a linear negative relationship between psoriasis and LE8, demonstrating that improving LE8 management could serve as a potential strategy for preventing and managing psoriasis.

Life's Essential 8 and mortality among adults with early-onset cardiovascular diseases : A prospective community-based study

BACKGROUND

Information regarding the association between cardiovascular health (CVH) as assessed using Life's Essential 8 (LE8) approach and all-cause mortality in adults with early-onset cardiovascular diseases (CVDs) is limited.

OBJECTIVE

In this study, we aimed to assess the association between CVH constructed by the LE8 metrics and all-cause mortality in Chinese individuals with early-onset CVDs, including myocardial infarction, heart failure, atrial fibrillation, ischemic stroke, and hemorrhagic stroke as well as in those who had undergone coronary artery bypass surgery or coronary intervention.

METHODS

Data of 3454 participants who were first diagnosed with early-onset CVDs (men aged < 55 years and women aged < 65 years with CVDs) in the Kailuan study from 1 January 2006 to 31 December 2020 were analyzed. Assessment of CVH (score ranging from 0 to 100 points) was made using the LE8 metrics (including diet, physical activity, nicotine exposure, sleep duration, body mass index [BMI], lipid, blood glucose, and blood pressure). All-cause mortality information was collected from provincial vital statistics offices. Cox proportional hazard regression models and restricted cubic splines were utilized to examine associations between the CVH scores and all-cause mortality in adults with early-onset CVDs.

RESULTS

During a mean follow-up of 6.78 years (interquartile range [IQR]: 3.36-10.5 years), 460 deaths were documented. After controlling for demographic variables, lifestyles, and major clinical factors, higher CVH scores were associated with lower risks of all-cause mortality among participants with early-onset CVDs. The corresponding hazard ratios (HRs) with 95% confidence intervals (CIs) were 0.64 (0.49, 0.82) comparing two extreme quartiles of CVH scores and 0.85 (0.77, 0.82) for each 10-point increment in CVH score (p trend = 0.001). Specifically, significant inverse associations were observed among participants with hemorrhagic stroke (HR Q4 vs. Q1 = 0.46, 0.23-0.93) and heart disease (HR Q4 vs. Q1 = 0.59, 0.41-0.87).

CONCLUSION

Our findings supported the beneficial role of higher CVH scores in all-cause mortality among adults with early-onset CVD.

Sensitization to common foods and early vascular aging: associations and the mitigating effects of health behaviors

BACKGROUND

Sensitization to common foods is typically considered clinically irrelevant in individuals without symptomatic food allergies. However, recent studies found an association between IgE specific to the mammalian oligosaccharide galactose-α-1,3-galactose and cardiovascular disease (CVD). The aims of this study are to determine whether common food sensitization is associated with early vascular aging (EVA) and to examine whether healthier lifestyle behaviors modifies the association in individuals without CVD.

METHODS

This was a cross-sectional, population-based study of 2788 American participants aged 30 years or older without cardiovascular disease. Total and specific IgE levels for common foods were measured. EVA was defined based on the 10th percentile of the difference between chronological age (CA) and vascular age (VA). Logistic regression models were employed to assess the associations between food sensitization and EVA, and whether healthy lifestyle modified the association. Poisson regression models, ordinal logistic regression models, and linear regressions were performed as sensitivity analysis.

RESULTS

Sensitization to at least one food allergen associated with an increased risk of EVA (odds ratio [OR] 1.91 [95% confidence interval (CI), 1.1 to 3.3]). Milk sensitization demonstrated the most robust association (OR 7.18, [95% CI, 2.5 to 20.62]). Additionally, moderate to vigorous activities (MVA) (OR 0.33 [95% CI, 0.11 to 0.97]) and sufficient sleep duration (OR, 0.21 [95% CI, 0.07 to 0.65]) mitigate the association between food sensitization and EVA. Similar results were presented in Poisson regression models, ordinal logistic regression models, and linear regressions.

CONCLUSIONS

The findings that common foods sensitization is independently associated with EVA, and that MVA and adequate sleep duration mitigate the association, have significant public health implications. Further research is needed to elucidate the mechanisms.

Association of Life's Essential 8 and Incident Cardiac Conduction Disorder: a prospective cohort study

AIMS

To evaluate the effect of Life's Essential 8 (LE8), a comprehensive cardiovascular health (CVH) metric from the American Heart Association, on the risk of cardiac conduction disorders (CCD).

METHODS AND RESULTS

We conducted a prospective cohort study of 112,160 adults from the UK Biobank, free of cardiovascular disease at baseline, to examine the association between LE8 scores and the risk of CCD. LE8 scores were categorized into low (0-49), moderate (50-79), and high (80-100) CVH groups. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for CCD incidence during a median follow-up of 11.6 years. A total of 2,760 CCD cases were identified. After adjustment for confounders, the high CVH group exhibited a significantly lower risk of CCD compared to the low CVH group (HR: 0.48, 95% CI: 0.40-0.56). Further analyses showed reduced risks for both severe conduction block (HR: 0.63, 95% CI: 0.52-0.78) and left bundle branch or fascicular block (HR: 0.35, 95% CI: 0.25-0.49) in the high CVH group. Restricted cubic spline regression revealed an L-shaped association between LE8 score and CCD risk. Among individual LE8 metrics, WQS analysis revealed that BMI and sleep health were the major contributors to reduced CCD risk.

CONCLUSIONS

Higher LE8 scores were associated with a lower risk of CCD, including severe conduction block requiring pacemaker implantation and left bundle branch or fascicular block. Comprehensive strategies targeting optimal CVH, especially BMI and sleep health, may be beneficial for preventing CCD.

Associations of the Life's Essential 8 with Parkinson's disease: a population-based study

Background

Parkinson's disease (PD) is a progressive neurodegenerative disorder with increasing global prevalence. This study investigated the association between the American Heart Association's Life's Essential 8 (LE8) and PD prevalence using a large, nationally representative database.

Methods

We analyzed data from 18,277 participants aged 40 years and older from the National Health and Nutrition Examination Survey (NHANES) 2005-2018. LE8 scores were calculated based on diet, physical activity, nicotine exposure, sleep, body mass index, blood lipids, blood glucose, and blood pressure. PD cases were identified through self-reported anti-PD medication use. Multivariate logistic regression models were employed to examine the association between LE8 and PD prevalence, adjusting for various demographic and clinical factors. In addition, we performed restricted cubic splines (RCS), subgroup analyses, and weighted quantile sum (WQS) regression to verify the robustness of the study results.

Results

The prevalence of PD was 1.3% in the study population. After full adjustment, individuals with moderate (50-79) and high (80-100) LE8 scores showed lower odds of PD compared to those with low (0-49) scores (OR 0.53, 95% CI 0.29-0.97 and OR 0.43, 95% CI 0.17-1.04, respectively; p for trend <0.05). A dose-response relationship was observed between LE8 scores and PD prevalence. WQS regression identified dietary factors and glycemic health as the main contributors to the inverse association between LE8 and PD.

Conclusion

Our findings suggest a significant inverse association between Life's Essential 8 (LE8) and PD prevalence, with dietary factors and glycemic health emerging as the most influential components.

Association between Life's Essential 8 and Atherogenic Index of Plasma in adults: insights from NHANES 2007-2018

Introduction

Cardiovascular Disease (CVD) has become a significant global public health challenge, contributing to rising mortality rates. This study aims to investigate the relationship between Life's Essential 8 (LE8) and the Atherogenic Index of Plasma (AIP), providing insights into the assessment and improvement of Cardiovascular Health (CVH).

Methods

We conducted an analysis of data from 8,215 U.S. adults aged 20 years and older, utilizing the National Health and Nutrition Examination Survey (NHANES) data from 2007 to 2018. Based on the LE8 score, CVH was classified into three levels-low, moderate, and high-while AIP was classified into four risk levels: extremely low (AIP<-0.3), low (-0.3≤AIP<0.1), medium (0.1≤AIP<0.24), and high (AIP≥0.24). Weighted ordinal logistic regression analysis was utilized to examine the association between the LE8 score and the AIP risk level, adjusting for potential confounding variables.

Results

A significant negative correlation exists between the LE8 score and the AIP risk level (OR=0.51, 95%CI: 0.49-0.54, P<0.001). Higher CVH were associated with lower AIP risk levels, while lower CVH corresponded to elevated AIP risk levels. Notably, improvements in specific LE8 components-such as body mass index and blood lipids-exhibited a strong relationship with reductions in the AIP risk level.

Discussion

This study suggests that the LE8 may serve as a preventive factor for CVD risk and implies that individuals can actively regulate their metabolic characteristics by optimizing their lifestyle.

Sex Differences in "Life's Essential 8" Cardiovascular Health and Type 2 Diabetes Mellitus Risk Across Menopause Stages

CONTEXT

Existing guidelines often lack sex-specific prevention strategies for type 2 diabetes mellitus (T2DM). Life's Essential 8 (LE8) highlights the role of health behaviors in influencing cardiovascular health (CVH). Due to inherent sex differences, the impact of CVH on T2DM risk may vary between men and women, especially across menopausal stages.

OBJECTIVE

The purpose of this paper is to explore sex-based differences in CVH and the incidence of T2DM among women at different menopausal stages and men.

METHODS

A prospective cohort study was conducted, involving 126 818 participants without preexisting T2DM from the UK Biobank. CVH was assessed using the LE8. Absolute risks (ARs) and hazard ratios (HRs) were separately employed to assess the association between increased CVH and T2DM risk. The accelerated failure time model assessed the effect of CVH on the time to T2DM onset.

RESULTS

Over a mean follow-up of 168 months, 4315 cases of T2DM were documented. In men, each 1-point increase in CVH was associated with a 0.268% decrease in AR and a 6.4% decrease in HR for T2DM. In premenopausal, perimenopausal, and postmenopausal women, each unit increase in CVH resulted in a 0.105%, 0.180%, and 0.166% decrease in AR and a 7.7%, 5.2%, and 6.4% decrease in HR of T2DM. The adjusted median time to T2DM onset was delayed by 12.46, 9.83, 11.5, and 21.43 months in the highest quintile of men, premenopausal, perimenopausal, and postmenopausal women, respectively, compared with the lowest CVH quintile.

CONCLUSION

As CVH improved, the reduction in AR for T2DM was more prominent in men than in women. HR trends for CVH and T2DM were similar in men and postmenopausal women. Increased CVH delayed the onset of T2MD both in men and women, with the most significant delay observed in postmenopausal women.

Adaptation of a digital health intervention for rural adults: application of the Framework for Reporting Adaptations and Modifications-Enhanced

Introduction

Adaptation is a key aspect of implementation science; interventions frequently need adaptation to better fit their delivery contexts and intended users and recipients. As digital health interventions are rapidly developed and expanded, it is important to understand how such interventions are modified. This paper details the process of engaging end-users in adapting the PREVENT digital health intervention for rural adults and systematically reporting adaptations using the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME). The secondary objective was to tailor FRAME for digital health interventions and to document potential implications for equity.

Methods

PREVENT's adaptations were informed by two pilot feasibility trials and a planning grant which included advisory boards, direct clinic observations, and qualitative interviews with patients, caregivers, and healthcare team members. Adaptations were catalogued in an Excel tracker, including a brief description of the change. Pilot coding was conducted on a subset of adaptations to revise the FRAME codebook and generate consensus. We used a directed content analysis approach and conducted a secondary data analysis to apply the revised FRAME to all adaptations made to PREVENT (n = 20).

Results

All but one adaptation was planned, most were reactive (versus proactive), and all adaptations preserved fidelity to PREVENT. Adaptations were made to content and features of the PREVENT tool and may have positive implications for equity that will be tested in future trials.

Conclusion

Engaging rural partners to adapt our digital health tool prior to implementation with rural adults was critical to meet the unique needs of rural, low-income adult patients, fit the rural clinical care settings, and increase the likelihood of generating the intended impact among this patient population. The digital health expansion of FRAME can be applied prospectively or retrospectively by researchers and practitioners to plan, understand, and characterize digital health adaptations. This can aid intervention design, scale up, and evaluation in the rapidly expanding area of digital health.

Association of dietary intake of saturated fatty acids with obstructive sleep apnea: mediating effects of Life's Crucial 9

Introduction

Obstructive sleep apnea (OSA) is a global public health issue. Life's Crucial 9 (LC9) is recognized as a powerful tool for assessing cardiovascular health. Although the etiology of OSA remains unclear, saturated fatty acids (SFAs) and cardiovascular health are increasingly regarded as a non-negligible element. This study aims to assess the association between dietary intake of SFAs and the risk of OSA, and the mediating effect of LC9.

Methods

Based on the National Health and Nutrition Examination Survey (NHANES), dietary questionnaires of participant were collected, and the average values of 24-h dietary recall data over 2 days were obtained. A continuous cross-sectional analysis with dietary energy adjustment was employed. Weighted multivariable logistic regression models were used to estimate the weighted odds ratios (ORs) and their 95% confidence intervals (CIs) for SFAs and OSA. Evaluate the mediating role of LC9 in the relationship between SFAs and OSA.

Results

A total of 13,563 participants aged 20 years and above were included in this study. The intakes of Sfa 4.0 and LC9 among participants with OSA were significantly lower than those in the normal population. After adjusting for confounding factors, total SFAs could increase the risk of OSA [Model 1, Q3, 0.03, 1.49 (1.03, 2.15); Model 2, Q3, 0.04, 1.47 (1.01, 2.13)]. It was emphasized that dietary intake of Sfa 12.0, Sfa 14.0, and Sfa 16.0 were protective factors for OSA, especially among participants aged 45-64 years and white individuals. Moreover, Sfa 12.0 exhibited a better protective effect in female participants [Q3, 0.04, 0.66 (0.45, 0.99)]. In addition, the cardiovascular health score - LC9 had a mediating effect in Sfa4.0 on OSA [Proportion of mediation: -0.035, 95% CI: (-0.058, -0.01); p= 0.002]. There was a nonlinear relationship between dietary intake of Sfa 12.0, Sfa 16.0, and Sfa 18.0 and OSA (P-Nonlinear = 0.013).

Discussion

These findings suggest that dietary mixtures of saturated fatty acids increase the risk of OSA. Among them, SFA 4:0 can increase the risk of OSA through the level of cardiovascular health. However, contrary to traditional beliefs, long-chain saturated fatty acids can reduce the risk of OSA.

Association between Life's essential 8 and mortality among individuals with hypertension

The "Life's Essential 8" (LE8) score is an assessment of cardiovascular health recently introduced by the American Heart Association. This study aimed to explore the correlation of the total LE8 score and its individual metrics with all-cause and cardiovascular disease (CVD) mortality in patients with hypertension. Data from 10,556 hypertension adults were retrieved from National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018. After a median follow-up of 6.75 years, patients with high LE8 scores (≥ 75 points) showed significantly lower mortality rates from all causes and CVD (P < 0.001). Cox regression analysis indicated that high LE8 scores were associated with a 40% lower risk of all-cause [0.60(0.50-0.73)] and CVD mortality [0.60(0.43-0.83)] compared to low scores. As the total LE8 score increased linearly, the likelihood of all-cause and CVD mortality decreased, with a potential threshold at 60 points. Subgroup analyses revealed that diet, sleep, nicotine exposure, physical activity, and blood glucose control affected both types of mortality. The LE8 score was negatively correlated with the risks of all-cause and CVD mortality in hypertensive patients. Life interventions and management of physical indicators based on the LE8 score may be an effective way to improve mortality in hypertensive patients.

Life's Essential 8 and Cardiovascular Disease in Breast Cancer Survivors

PURPOSE OF REVIEW

To explore the role of optimal cardiovascular health as defined by the Life's Essential 8 in breast cancer survivors.

RECENT FINDINGS

Optimal cardiovascular health may be associated with decreased cancer mortality. Breast cancer survivors may derive additional benefit from obtaining ideal cardiovascular health as defined by the Life's Essential 8. Certain components of the Life's Essential 8 may impact cardiovascular risk but also cancer mortality, and risk for cancer therapy related cardiac dysfunction. Continued physical activity, avoidance of smoking, and control of lipids and blood pressure are beneficial in breast cancer survivors. More study is needed to define the role of anti-hyperglycemic agents, BMI, and sleep on CVD risk in breast cancer survivors. The Life's Essential 8 can be a tool to inform clinicians regarding a breast cancer survivor's disease risk and to identify potential areas of improvement.

Clonal hematopoiesis of indeterminate potential, health indicators, and risk of cardiovascular diseases among patients with diabetes: a prospective cohort study

BACKGROUND

Clonal hematopoiesis of indeterminate potential (CHIP) was associated with diabetes and cardiovascular diseases (CVD). However, the effect of CHIP on CVD have not been evaluated among patients with diabetes, and whether maintaining the healthy indictors could mitigate the adverse influence was also unclear.

METHODS

A total of 22,239 adults from the UK Biobank with diabetes and available whole-exome sequence data, and free of CVD were included. Multivariable-adjusted Cox regressions were used to explore the associations of any CHIP (variant allele fraction ≥ 2%), large CHIP (variant allele fraction ≥ 10%), and the top 10 commonly mutated driver genes for CHIP and with risk of CVD. The joint associations between health indicators (body mass index [BMI], HbA1c, blood pressure [BP], and low-density lipoprotein cholesterol [LDL]) and CHIP were further investigated.

RESULTS

Over a median follow-up of 13.2 years, 5366 participants with diabetes developed CVD events. The hazard ratios (HRs) (95% confidence intervals [CIs]) of any CHIP and large CHIP were (1.21, 1.08-1.36) and (1.25, 1.09-1.43) for incident CVD, respectively. Significant associations between any CHIP and coronary heart disease (HR, 95%CI: 1.18, 1.03-1.36) and heart failure (1.73, 1.46-2.06) were observed, but not for stroke (1.14, 0.89-1.48). Gene-specific analyses suggested that the greatest association were for SF3B1 (HR, 95%CI: 2.50, 1.25-5.01) and TET2 (HR, 95%CI: 1.36, 1.07-1.77) with risk of CVD. There was no significant interaction between the four health indicators and CHIP in relation to incident CVD. Compared to patients without CHIP, those with any CHIP and ideal health indicators still exhibited significantly or nonsignificantly higher HRs (BMI: 1.18, 0.82-1.68; HbA1c: 1.12, 0.96-1.30; BP: 1.24, 1.03-1.49; LDL: 1.29, 1.09-1.53). Similar results were demonstrated using large CHIP.

CONCLUSIONS

CHIP is independently associated with an increased risk of CVD in patients with diabetes, regardless of health indicator levels. Diabetic patients with CHIP but ideal health indicators still exhibited higher CVD risk compared with diabetic patients without CHIP.

Time in the United States and walking for physical activity among Black Californians: Findings from the California Health Interview Survey (2012-2017)

Background

No studies examine associations between acculturation and physical activity (PA) in California's foreign-born Black population, even though rates of PA are lower in Black populations, lower PA rates are a risk for cardiovascular disease, and this population is growing. Further, despite differences in CVD and PA by sex and mental health status; no studies have examined whether these factors modify associations between acculturation and PA.

Methods

We used the California Health Interview Survey (2012-2017) and fully adjusted, survey-weighted regression models to examine associations between time in the US as a proxy for acculturation (i.e., foreign-born <10 years in the US, foreign-born ≥10 years in the US) and walking for PA [leisure time (LTPA) and transportation-related (TRPA)] among Black Californians (n = 5,952). We also tested effect modification by sex and mental health status.

Results

About 7 % in the sample were foreign-born. In the adjusted model of TRPA, the odds of walking for PA were significantly higher in the foreign-born group living <10 years in the US (OR = 8.63; 95 %CI: 2.49, 29.86; p < 0.01) and no different in the foreign-born group living ≥10 years in the US (OR = 1.05; 95 % CI: 0.62, 1.75; p = 0.85), compared to US-born Black Californians. We found no effect modification of the associations by sex or mental health, except by frequency of feeling depressed.

Conclusion

Some foreign-born Black Californians have higher odds of walking for PA related to transportation than their US-born counterparts. Future research is needed to examine the role of mental health status on PA levels of this immigrant group.

Healthy lifestyle factors and combined macrovascular and microvascular events in diabetes patients with high cardiovascular risk: results from ADVANCE

BACKGROUND

To explore whether healthy lifestyle factors (HLFs) predict a lower risk of major macrovascular and microvascular events and death in people with type 2 diabetes (T2D) with a high risk of vascular complications.

METHODS

Post hoc analyses of 11,133 participants with T2D in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial who were assigned a score ranging from 0 to 4 based on the number of baseline HLFs: never smoked, moderate-to-vigorous physical activity, ideal waist/hip ratio, and low-to-moderate alcohol consumption. Multivariable Cox models were used to determine associations of 0, 1, 2, and ≥ 3 HLFs with vascular events and all-cause mortality.

RESULTS

Compared to participants with no HLFs, hazard ratios for participants with 3 or 4 HLFs were 0.68 (95% confidence interval [CI] 0.57-0.81) for the composite of major macrovascular or microvascular events, 0.58 (0.46-0.75) for major macrovascular events, 0.78 (0.61-0.99) for microvascular events, and 0.48 (0.37-0.63) for all-cause mortality during a median follow-up of 5 years. Each increment in HLF score was significantly associated with lower rates of these outcomes. There was no heterogeneity in the effect on any outcome by HLF across randomized intensive blood glucose control and blood pressure lowering treatments.

CONCLUSIONS

HLFs are associated with lower risks of major macrovascular and microvascular events and lower rates of death in high-risk adults with T2D.

Prediction of major adverse cardiovascular events following ST-segment elevation myocardial infarction using cardiac obesity marker-epicardial adipose tissue mass index: a prospective cohort study

Background

Although reperfusion therapy has led to improvements in the acute phase of ST-segment elevation myocardial infarction (STEMI), the incidence of major adverse cardiovascular events (MACE) following STEMI has not significantly decreased. The accumulation of epicardial adipose tissue (EAT) may be associated with poorer STEMI prognosis and could serve as a potential prognostic marker. However, research examining this relationship remains limited.

Methods

This single-center prospective study enrolled 308 STEMI patients. Patients were randomly assigned to training set and validation set in a 7:3 ratio. The primary outcome was MACE one-year post-STEMI. Epicardial adipose tissue mass index (EAMI) was calculated as EAT volume divided by absolute value of the EAT attenuation index, measured using coronary computed tomography angiography (CTA). The relationship between EAMI and MACE was analyzed using Kaplan-Meier curves, Cox regression, and restricted cubic spline (RCS) plots. The predictive performance of EAMI was assessed through receiver operating characteristic (ROC) curves, C-index, net reclassification index (NRI), integrated discriminant improvement (IDI), coefficient of determination (R2), calibration curves, Brier score, and decision curve analysis (DCA) with comparisons to the GRACE score. Subgroup analyses were conducted based on age, gender, body mass index (BMI), left ventricular ejection fraction (LVEF), and culprit artery.

Results

A total of 308 patients were included in the analysis, with 212 in the training set and 96 in the validation set. In the training set, Kaplan-Meier survival analysis revealed that higher EAMI levels were associated with an increased cumulative risk of MACE. Cox multivariate regression analysis indicated that EAMI was independently associated with MACE (HR = 2.349, 95% CI 1.770-3.177, P < 0.001). Restricted cubic spline (RCS) analysis suggested a positive dose-response relationship between EAMI and MACE (P for nonlinearity = 0.87). EAMI showed better discriminative ability, prediction effect, accuracy, and clinical applicability compared to the traditional GRACE score. In the validation set, EAMI also demonstrated good predictive performance for MACE. Subgroup analyses suggested that EAMI's predictive ability was consistent across various demographic and clinical characteristics.

Conclusion

EAMI has high value in predicting MACE in patients 1-year after STEMI, helps identify high-risk patients with poor prognosis in early clinical practice.

Dietary patterns, nutrients, and risk of expiratory airflow limitation in children and adolescents

BACKGROUND

Increasing global pediatric respiratory diseases require understanding modifiable factors affecting lung function. We explored the association between dietary patterns, nutrients and the risk of expiratory airflow limitation (EAL) in children and adolescents.

METHODS

Dietary intake was collected using a validated food frequency questionnaire (FFQ) with 110 food items. Factor analysis was employed to determine dietary patterns. Pulmonary function was measured using a medical-grade pulmonary function analyzer. EAL was defined as the ratio of Forced Expiratory Volume in one second to Forced Vital Capacity (FEV1/FVC) < 0.8.

RESULTS

A total of 611 EAL cases occurred in 3,204 participants, with a prevalence of 19.07%. Four primary dietary patterns were identified (animal, healthy, sweet, and plant foods), which explained 44% of the variance in food consumption. The plant foods pattern (fourth quartile vs. first quartile intake) was associated with a reduced risk of EAL (Odds Ratio [OR] = 0.71, 95% Confidence Interval [CI]: 0.53, 0.94; Pfor trend < 0.02). Higher fruit consumption (high vs. low) in plant foods pattern was associated with lower EAL risk (OR = 0.79, 95% CI: 0.62, 0.99, Pfor trend = 0.04). Every standard deviation increase in foods (Chinese sauerkraut, pickled foods) and nutrients (total dietary fiber, soluble dietary fiber, and pyridoxine) in plant foods was all positively associated with FEV1 /FVC (all P < 0.05).

CONCLUSIONS

Long-term intake of plant foods pattern enriched with dietary fiber and pyridoxine is promising for lung function protection in children and adolescents.

Modifiable factors and 10-year and lifetime cardiovascular disease risk in adults with new-onset hypertension: insights from the Kailuan cohort

BACKGROUND

Preventing cardiovascular disease (CVD) in adults with hypertension is essential, but it remains uncertain whether optimizing modifiable factors can eliminate the excess CVD risk associated with new-onset hypertension.

METHODS

In this prospective cohort study, 29,597 adults with new-onset hypertension and no prior CVD (from 2006-2016 surveys) were each matched by age and sex to a normotensive control. Eight modifiable factors were assessed using the American Heart Association's Life's Essential 8 algorithm. We followed participants for incident CVD until December 2020, estimating 10-year and lifetime (age 25-95) CVD risks using the Fine-Gray competing risks model.

RESULTS

Over a median follow-up of 9.81 years, adults with new-onset hypertension had higher 10-year (8.97% vs. 6.31%) and lifetime CVD risks (45.55% vs. 34.98%) compared to normotensive controls. After adjusting for age, sex, and other unmodifiable factors, each additional favorable factor was associated with a stepwise reduction in CVD risk (P-trend < 0.05). Hypertensive participants with four or more favorable factors had a 17% lower 10-year CVD risk (HR 0.83; 95% CI 0.72-0.97) and a similar lifetime CVD risk (HR 0.90; 95% CI 0.78-1.05) compared to normotensive controls. Notably, the protective effect was weaker among those with early-onset (before age 45) hypertension than those with later-onset (age ≥ 60) hypertension (P-interaction < 0.05).

CONCLUSIONS

In adults with new-onset hypertension, maintaining four or more modifiable factors at favorable levels was associated with a CVD risk comparable to that of normotensive individuals. However, young hypertensive adults may require more aggressive interventions to mitigate CVD risk.

Cumulative Incidence of Mortality Associated with Cardiovascular-Kidney-Metabolic (CKM) Syndrome

Key Points

Background

It is imperative to critically evaluate the prognostic implications of cardiovascular–kidney–metabolic (CKM) syndrome staging to inform clinical practice. The primary aims of this study were to define the risk of mortality associated with each CKM syndrome stage and to determine the corresponding restricted mean survival time over a 15-year period.

Methods

This was a longitudinal study of 50,678 community-dwelling US adults aged 20 years and older with baseline data for CKM stage determination participating in the 1999–2018 National Health and Nutrition Examination Survey. CKM stages were defined according to the American Heart Association presidential advisory. Fifteen-year adjusted cumulative incidences of cardiovascular mortality were calculated for each stage from confounder-adjusted survival curves using the G-formula.

Results

Over a median 9.5-year follow-up, 2564 participants experienced cardiovascular death. The 15-year adjusted cumulative incidences of cardiovascular mortality were stage 0, 5.5% (95% confidence interval [CI], 1.8 to 9.3); stage 1, 5.7% (95% CI, 3.2 to 8.2); stage 2, 7.9% (95% CI, 6.8 to 9.1); stage 3, 8.7% (95% CI, 6.7 to 10.8); and stage 4, 15.2% (95% CI, 13.6 to 16.8). The absolute risk difference between CKM stage 4 and stage 0 at 15 years was 9.6% (95% CI, 5.6 to 13.6). The survival difference between CKM stage 0 and stage 4 at 15 years was 8.1 (95% CI, 8.0 to 8.2) months.

Conclusions

Our findings reveal a graded risk of cardiovascular mortality associated with higher CKM syndrome stage.

Social Determinants of Health, Cardiovascular Health, and Mortality in Sexual Minority Individuals in the United States

BACKGROUND

Despite recent efforts to address health disparities regarding social determinants of health (SDOH), the intersection between SDOH and cardiovascular health (CVH) outcomes in sexual minority (SM) individuals remain largely underexplored.

OBJECTIVES

This study sought to investigate associations between SDOH profile and CVH and mortality outcomes among SM individuals in the United States.

METHODS

All participants aged ≥18 years surveyed in the 2013 to 2017 National Health Interview Survey were included, except those with missing data on SM status, any CVH or SDOH domain, or any other covariate. SM status was self-reported and categorized as lesbian/gay, bisexual, or uncertain. Participants' SDOH profile was quantified using a 6-domain (economic stability, neighborhood/physical environment/social cohesion, community and social context, food, education, and health care system), 38-item score, with higher scores indicating greater social deprivation. CVH was adapted from the American Heart Association's Life's Essential 8 framework. Because detailed dietary data were unavailable, a 7-item (hypertension, diabetes mellitus, hypercholesterolemia, smoking, physical inactivity, inadequate sleep, and obesity) CVH score was used, with higher scores indicating worse CVH. Additionally, cardiovascular mortality was ascertained through the National Death Index using death certificate information.

RESULTS

The study sample consisted of 57,182 participants, representing a population of 82,826,690 persons. A worse composite SDOH score was associated with a worse CVH score in both heterosexual (adjusted rate ratio: 1.14; 95% CI: 1.13-1.15; P < 0.001) and SM individuals (adjusted rate ratio: 1.16; 95% CI: 1.12-1.20; P < 0.001), with associations appearing to be potentially stronger in the latter (Pinteraction = 0.042). Subgroup analysis demonstrated consistent associations among gay/lesbian individuals and bisexual individuals, but not in those with other or uncertain sexual orientations. Further exploratory analysis showed that a worse composite SDOH score was significantly associated with higher risk of cardiovascular mortality in both heterosexual (adjusted HR: 1.17; 95% CI: 1.06-1.28; P = 0.002) and SM individuals (adjusted HR: 2.25; 95% CI: 1.24-4.08; P = 0.008), with associations being significantly stronger in the latter (P interaction = 0.006).

CONCLUSIONS

An unfavorable SDOH profile was associated with worse CVH scores and higher cardiovascular mortality risk among SM individuals in the United States compared to their heterosexual counterparts.

Associations between asthma and Life's Essential 8: a cross-sectional study

Background

Asthma is a serious respiratory disease attributed to multiple factors. The Life's Essential 8 (LE8), introduced by the American Heart Association, aims to improve and maintain cardiovascular health. However, the correlation between LE8 components and asthma remains unclear. We hypothesized that LE8 is a protective factor against asthma.

Materials and methods

Multiple logistic regression analysis, restricted cubic spline (RCS) analysis, and subgroup analysis were used to analyze the data collected from the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2018.

Results

A total of 3,360 participants with asthma were included in the analysis. With all confounders controlled for, LE8 scores were negatively correlated with asthma prevalence (odds ratio (OR) per 10-point increment, 0.85 [95% confidence interval (CI), 0.82-0.88]). Compared to low LE8 scores, moderate and high LE8 scores were associated with reduced asthma risk, with adjusted ORs (95% CIs) of 0.59 (0.51-0.68) and 0.48 (0.39-0.58), respectively. Non-linear correlations were observed between LE8 scores and asthma (p non-linear = 0.01) and between health factor scores and asthma (p non-linear = 0.01). However, a linear dose-response correlation was noted between health behavior scores and asthma (p non-linear = 0.30). Subgroup analysis showed no significant interaction effects (p > 0.05), except in the sex and drinking status subgroups (p for interaction = 0.02).

Conclusion

Asthma is associated with components of LE8, which warrants further attention and may contribute to reducing asthma prevalence.

Red Meat Consumption and Hypertension: An Updated Review

PURPOSE OF REVIEW

Hypertension (HTN) is a major risk factor for cardiovascular diseases (CVD). The global prevalence of HTN and related CVD mortality continues to rise. The development of HTN is influenced by genetic predisposition and modifiable risk factors, including diet. One area of ongoing debate is the relationship between red meat consumption and risk of HTN.

RECENT FINDINGS

Processed red meat has become increasingly implicated in the pathogenesis and morbidity of HTN, though randomized control trials comparing HTN-related outcomes associated with red meat subtypes have yielded heterogenous results. This review summarizes the existing relevant literature and highlights the methodological challenges that complicate definitive conclusions, with a focus on processed versus unprocessed red meat consumption and HTN. It explores pathophysiologic mechanisms contributing to this relationship and reviews practical, evidence-based dietary guidelines that address red meat consumption to mitigate the risk of adverse HTN-related CVD outcomes.

The association between life's essential 8 and gallstones: A cross-sectional study

This study investigates the relationship between Life's Essential 8 (LE8), a measure of cardiovascular health (CVH), and the risk of gallstones in adult Americans. We analyzed data from 5,024 participants aged 20 and older, using information from the 2017-2020 National Health and Nutrition Examination Survey. Gallstone presence was determined via a standard questionnaire. LE8 scores, representing four health behaviors (sleep, tobacco/nicotine exposure, physical activity, and diet) and four health factors (body mass index, non-high-density lipoprotein cholesterol, blood glucose, and blood pressure), were categorized into low, moderate, and high CVH groups. Weighted logistic regression, restricted cubic splines (RCS), and stratified analyses were used to assess the association between LE8 and gallstones. Of the 5,024 participants, 543 (11.22%) had gallstones. In fully adjusted models, participants with high CVH (LE8 ≥ 80) had a 59% lower risk of gallstones compared to those with low CVH (LE8 < 50) (OR: 0.41, 95% CI: 0.23-0.72, P = 0.010). RCS analyses suggested a nonlinear relationship between LE8 and gallstones. Stratified analysis showed a stronger association in participants under 65 (OR: 0.26, 95% CI: 0.15-0.44), females (OR: 0.44, 95% CI: 0.24-0.81), those with higher education (OR: 0.39, 95% CI: 0.19-0.78), non-white individuals (OR: 0.28, 95% CI: 0.13-0.60), and married participants (OR: 0.40, 95% CI: 0.20-0.80).Higher CVH, as measured by LE8, is associated with a lower risk of gallstones among adult Americans.

Influence of Experiences of Discrimination and Anticipated Discrimination on Cardiovascular Health Outcomes

PURPOSE OF REVIEW

This review summarizes recent evidence linking experiences of discrimination and anticipated discrimination with cardiovascular health outcomes.

RECENT FINDINGS

Experiences of discrimination were consistently associated with increased risk of nicotine exposure, poor sleep health, obesity, diabetes, hypertension, and subclinical cardiovascular disease. Evidence is mixed for cardiovascular disease diagnoses and cardiovascular mortality. Although research is limited, anticipated discrimination is an independent risk factor for poor sleep health and subclinical cardiovascular disease. Key methodological limitations included the limited use of gold-standard objective measures of health behaviors and well-validated self-report measures, inadequate consideration of intersectionality, and lack of robust examinations of psychological, behavioral, and physiological mechanisms linking discrimination with cardiovascular health outcomes. There is substantial evidence linking experiences of discrimination with cardiovascular outcomes. Yet, before translating these findings into clinical practice, more rigorous studies are needed to address methodological limitations and uncover mechanisms by which discrimination influences cardiovascular health. There is a need for studies to inform the development of evidence-based interventions focused on reducing the influence of discrimination-related stressors on cardiovascular health outcomes. Findings have important implications for future work to advance cardiovascular health equity.

Associations Between Domains and Patterns of Sedentary Behavior with Sleep Quality and Duration in Pregnant Women

Objectives: To assess the associations of sedentary behavior (SB) with sleep quality and duration in pregnant women by trimesters and to consider SB domains and patterns. Methods: This investigation included 935 participants (age = 30.0 ± 5.6 years; first trimester = 24.1%, second trimester = 33.9%, third trimester = 42.0%). The total, domains (leisure, occupational, commuting), and patterns (weekdays, weekends) of SB, as well as sleep quality and duration, were self-reported. Adjusted logistic regression models examined the associations of different SBs with the risk of poor sleep quality, not adhering to sleep duration guidelines (7-9 h/day), or being a short- or long-sleeper. Results: The odds of poor sleep quality were significantly higher by 14.2% and 7.4% for each hour increase in total and leisure SB on weekends, respectively. The odds of not adhering to sleep duration guidelines were significantly higher by 5.5% and 11.4% for each hour increase in total and leisure SB during weekdays, respectively; paradoxically, the odds of not complying with the sleep duration guidelines were significantly lower, ranging between 6.6% and 34.4% for each hour increase in total, leisure, or commuting SB on weekends. Further, when analyzed separately, the likelihood of being a short- or long-sleeper was highly variable across SB domains, with associations being more apparent in the first and third trimesters. Conclusions: The relationship between SB and healthy sleep during pregnancy was complex. These variable findings underscore the importance of considering domains and patterns of SB beyond simple total durations in future research to inform interventions and guidelines to improve sleep health during pregnancy.

Association between Life's Essential 8 and risk of heart failure: findings from the Kailuan study

AIMS

The impact of Life's Essential 8 (LE8) on heart failure (HF) remains poorly understood. We examined the associations between three forms of LE8 measurements and HF.

METHODS AND RESULTS

A total of 35 896 participants without a prior history of HF from the Kailuan community were included. The LE8 status was measured in 2014. A latent mixture model was employed to identify the trajectories of LE8 during 2006 to 2014. The LE8 annual change rate was defined as the slope of the linear regression equation fitted by five LE8 measurements. Cox proportional hazards models were used to assess the risk of HF associated with LE8, after adjusting for potential confounding variables. The predictive performance was quantified and compared using the C-index. Five distinct LE8 trajectories were identified. 461 HF events documented during follow-up. The LE8 trajectories presenting an upward trend in LE8 were associated with a reduced risk of HF, even when the initial LE8 level was low [HR (95% confidence interval) for moderate-increasing vs. moderate-decreasing trajectory was 0.43 (0.34, 0.55)]. The LE8 status was inversely associated with HF risk. A higher LE8 annual increase was associated with a lower risk of HF. The LE8 trajectory was more accurate in predicting the risk of HF compared with LE8 status.

CONCLUSION

LE8 was inversely associated with HF risk. Individuals with initially low LE8 levels experienced a reversal in HF risk upon improvement. Both LE8 trajectories and status are practicable in identifying individuals at high risk of HF, LE8 trajectories may provide added prognostic information.

Association of lung health and cardiovascular health (Life's Essential 8)

Background

Cardiorespiratory health issues often intersect. This study explored the relationship between lung health and the recently updated Cardiovascular Health Measure (Life's Essential 8).

Methods

Data from the 2007-2018 National Health and Nutrition Examination Survey (NHANES) were analyzed. Three cohorts were included: lung disease in the Main cohort (N = 9,772), lung function in the Spirometry sub-cohort (N = 3,896), and respiratory symptoms in the Respiratory Symptoms sub-cohort (Age > 40) (N = 3,449). LE8 scores were used as both continuous and categorical variables (0-49, 50-79, 80-100). Weighted multivariate regression analyses examined the correlations between LE8 and lung health, and weighted restricted cubic spline (RCS) regression analyzed potential non-linear relationships. Subgroup analysis was conducted to verify stability.

Results

Overall lung health was better in the high LE8 group than in the low LE8 group. In the fully adjusted model, the high LE8 group had significantly lower odds of asthma (OR = 0.42; 95% CI = 0.29, 0.59) and chronic bronchitis (OR = 0.27; 95% CI = 0.15, 0.49) compared to the low LE8 group. Regarding lung function, each 10-point increase in LE8 was associated with an increase of 50 ml in FEV1 (Beta = 50; 95% CI = 32, 67) and 56 ml in FVC (Beta = 56; 95% CI = 32, 79). Among middle-aged and older adults (age > 40), the high LE8 group had significantly lower odds of respiratory symptoms, including cough (OR = 0.23; 95% CI = 0.12, 0.46), phlegm (OR = 0.42; 95% CI = 0.19, 0.90), and wheezing (OR = 0.29; 95% CI = 0.15, 0.54). RCS analyses demonstrated a non-linear negative correlation between LE8 and cough, sputum, and wheeze. Subgroup and sensitivity analysis suggested stability.

Conclusion

Life's Essential 8 (LE8) scores are positively associated with lung health in the US population. These findings provide a valuable reference for maintaining overall cardiorespiratory health.

Association of American Heart Association's Life's Essential 8 and mortality among US adults with and without cardiovascular disease

BACKGROUND

Differences in the American Heart Association's Life's Essential 8 (LE8) score and its association with mortality based on the presence of clinically prevalent cardiovascular disease (CVD) has not been assessed previously.

METHODS

Data from the National Health and Nutrition Examination Survey 2009-2018 were utilized to calculate LE8 scores among adult patients, stratified by the presence of existing CVD. Health metrics were further divided into health behaviors and health factors. Scores were also evaluated based on sex, age, race/ethnicity, and socioeconomic status. Cox proportional hazard models were used to evaluate the association between the levels of cardiovascular health (CVH), estimated using LE8 score, and risk of all-cause and cardiovascular mortality.

RESULTS

25,359 patients were included in the analysis, of which 10.2 % had CVD. Individuals with known CVD had lower overall CVH (55.9 vs. 65.8, p < 0.001), health behaviors (60.6 vs. 67.9, p < 0.001), and health factors (51.3 vs. 63.8, p < 0.001) scores. The lower CVH scores in those with prior CVD persisted after stratification by sex, age, race/ethnicity, and socioeconomic status. When assessing the association of CVH metrics with mortality, for every 10-point increase in LE8 score, there was a significant reduction (17 %-27 %) in all-cause and CV mortality in those with and without CVD.

CONCLUSIONS

Individuals with known CVD have lower CVH metric scores. Overall, the LE8 score is able to predict future CV outcomes in both individuals with and without CVD and highlights the importance of effective implementation strategies that target health factors and behaviors in primary and secondary prevention populations.

Visceral adiposity: A major mediator of the relationship between epicardial adiposity and cardiorespiratory fitness in adults

BACKGROUND AND AIMS

Epicardial adiposity has been positively associated with visceral adipose tissue (VAT). Few studies have examined the association between cardiorespiratory fitness (CRF) and epicardial adiposity. Furthermore, whether this relationship was independent of VAT remains unexplored. Our purpose was to investigate the contribution of VAT in the relationships between CRF, physical activity (PA) and epicardial adipose tissue (EAT) in asymptomatic women and men.

METHODS AND RESULTS

We examined the associations between EAT and VAT measured by magnetic resonance imaging, CRF measured by cardiopulmonary exercise testing, and PA assessed using pedometers and a 3-day PA journal in 239 apparently healthy adults (43 % women). Participants were compared according to EAT tertiles and CRF level in both sexes. Participants with the highest EAT level presented more VAT (p < 0.001), lower CRF (p < 0.01), and a more deteriorated cardiometabolic health score (p < 0.01) than those with the lowest EAT level. CRF was negatively associated with EAT in both sexes (p < 0.01). No significant relationship was found with PA (p = NS). Stepwise multivariable regression analyses showed that VAT explained most of the variance in EAT in women and men. Mediation analyses confirmed that VAT was a mediator of the association between CRF and EAT in both sexes.

CONCLUSION

In women and men, VAT appears as a major mediator of the association between CRF and EAT thereby suggesting that managing VAT by improving CRF could help in the prevention of cardiometabolic disorders related to excess EAT.

Association between Life's essential 8 and stress urinary incontinence in women from the National Health and nutrition examination survey 2005-2018: A cross-sectional study

OBJECTIVE

Stress urinary incontinence (SUI) may be associated with cardiovascular disease. Life's Essential 8 (LE8), a recently updated measure of cardiovascular health (CVH), has been investigated for its association with SUI in women.

METHODS

The study adopted a cross-sectional design with national scope, incorporating 9332 women aged 20 and above, selected from the National Health and Nutrition Examination Survey dataset from 2005 to 2018. The LE8 metric, which varies from 0 to 100, was evaluated based on the criteria set by the American Heart Association. SUI was determined based on self-report. To evaluate these correlations, we employed models with multivariable logistic variables and a restricted cubic spline.

RESULTS

In the cross-sectional study, a total of 9332 participants were included (weighted average age, 52.23 years), and 4274 had SUI (weighted percentage, 48.64%). Considering potential confounders, it was found that higher LE8 scores were associated with lower odds of SUI (odds ratio [OR] for each 10-point increase was 0.83; 95% confidence interval [CI], 0.80-0.87). Compared to participants with lower LE8 scores, those with higher LE8 scores had a 57% lower probability of developing SUI. There was a statistically significant association between LE8 score and SUI among participants who were middle-aged, non-Hispanic white, had higher levels of education and income, and were living with a partner.

CONCLUSION

According to this study, there was an association between increase in Life's Essential 8 and reduction in SUI risk. Therefore, promoting optimal CVH may associate with reducing SUI in women.

Associations of Life's Essential 8 with low muscle mass mediated by testosterone, inflammation, and nutritional status in United States adults: a cross-sectional study

BACKGROUND

Low muscle mass, defined as appendicular lean mass adjusted for body mass index (BMI), may indicate early skeletal muscle deterioration.

OBJECTIVES

This study aimed to investigate the relationship between Life's Essential 8 (LE8), the updated cardiovascular health (CVH) metrics by the American Heart Association, and low muscle mass, including the impact of related biomarkers on muscle quality.

METHODS

This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) cycles 2011-2014, selected due to their inclusion of the most recent appendicular lean mass measurements available in the NHANES dataset. Participants aged 20-60 y were included. We employed weighted logistic regression models, restrictive cubic splines, and weighted quantile sum (WQS) regression to assess the relationship between LE8 scores and low muscle mass. Four mediation models were constructed to explore whether serum testosterone in males, serum sex hormone-binding globulin (SHBG) in females, serum albumin, and systemic immune-inflammation index (SII) mediated the association between LE8 scores and low muscle mass.

RESULTS

Higher LE8 scores are associated with lower odds of low muscle mass. Compared with participants with low CVH, those with intermediate and high CVH had 49% (odds ratio [OR]: 0.51, 95% confidence interval [CI]: 0.30, 0.87) and 86% (OR 0.14, 95% CI: 0.06, 0.29) lower odds of low muscle mass, respectively. Mediation analysis revealed that testosterone, SHBG, SII, and albumin partially mediated the association between LE8 scores and low muscle mass. The WQS regression model indicated that BMI and physical activity might be important factors influencing low muscle mass within the components of LE8.

CONCLUSIONS

LE8 scores negatively associated with low muscle mass in United States adults. Serum testosterone in males and SHBG in females were negative predictors of low muscle mass, whereas SII was inversely associated. Serum albumin had a beneficial effect on muscle mass.

Long-term trends in the prevalence of cardiovascular-kidney-metabolic syndrome in South Korea, 2011-2021: a representative longitudinal serial study

Background

The American Heart Association recently introduced a new framework, known as cardiovascular-kidney-metabolic (CKM) syndrome, aimed at the early prevention of cardiovascular disease. However, this syndrome has not been studied extensively outside of the United States. Thus, this study aimed to examine the long-term trends in CKM syndrome and its associated demographic features in South Korea.

Methods

This nationwide, cross-sectional study analyzed data from 61,106 Korean adults aged ≥20 years using the Korea National Health and Nutrition Examination Survey from 2011 to 2021. CKM syndrome was defined using the PREVENT equations, categorizing individuals into five stages (0-4). Age-standardized prevalence rates, annual percent changes (APC), and sociodemographic disparities were analyzed using multinomial logistic regression and Joinpoint regression.

Findings

Among the 61,106 participants (50.4% females [95% CI, 50.0-50.8%] and 49.6% males [95% CI, 49.2-50.0%]), stage 2 CKM syndrome was the most prevalent (43.4% [42.9-43.9]), followed by stages 1 (25.4% [25.0-25.8]), 0 (21.1% [20.7-21.6]), 3 (7.3% [7.0-7.5]), and 4 (2.8% [2.6-2.9]). From 2011 to 2021, advanced stages showed significant increases (APC for stage 4: 3.2%; 95% CI, 1.5-5.2), while stage 0 declined (APC: -1.9%; 95% CI, -3.8 to 0.0). Advanced stages were more common among vulnerable subgroups, including males, older adults, rural residents, smokers, drinkers, individuals with obesity, lower education levels, and lower household incomes.

Interpretation

This is the first study to investigate the long-term prevalence of CKM syndrome based on stages at the national level in an Asian population. Our findings emphasize the urgent need for tailored public health strategies targeting metabolic risk factors, particularly in vulnerable subgroups, to prevent progression to advanced CKM stages.

Funding

National Research Foundation of Korea.

Associations of early-onset coronary heart disease and genetic susceptibility with incident dementia and white matter hyperintensity: A prospective cohort study

BACKGROUND

The associations of early-onset coronary heart disease (CHD) and genetic susceptibility with incident dementia and brain white matter hyperintensity (WMH) remain unclear. Elucidation of this problem could promote understanding of the neurocognitive impact of early-onset CHD and provide suggestions for the prevention of dementia.

OBJECTIVES

This study aimed to investigate whether observed and genetically predicted early-onset CHD were related to subsequent dementia and WMH volume.

DESIGN

Prospective cohort study.

SETTING

UK Biobank.

PARTICIPANTS

500 671 individuals without dementia at baseline.

MEASUREMENTS

Early-onset CHD (male ≤55 years; female ≤65 years) was ascertained using hospital inpatient records. Incident dementia including all-cause dementia, Alzheimer's disease, and vascular dementia was ascertained using hospital inpatient records, mortality register data, and self-reported data. WMH volume was measured through brain magnetic resonance imaging (MRI). Cox proportional hazards models and linear regression models were used to analyze the associations of early-onset CHD with incident dementia and WMH. Subsequently, a polygenetic risk score (PRS) analysis was conducted to investigate the associations of genetically predicted early-onset CHD with outcomes.

RESULTS

Among 500 671 individuals (female: 272 669, 54.5%; mean age: 57.0 ± 8.1 years), 9 294 dementia occurred during a median follow-up of 13.8 years. Compared with the non-CHD group, both early-onset (n = 16 133) and late-onset CHD (n = 43 944) groups had higher risks of developing dementia (hazard ratio [HR]: 1.99, 95% confidence interval [CI]: 1.81 to 2.19 for early-onset group; HR: 1.20, 95% CI: 1.14 to 1.27 for late-onset group). Among CHD participants, early-onset CHD was associated with a significantly higher risk of incident dementia, compared with late-onset CHD (HR: 1.56, 95% CI: 1.39 to 1.75). In a subset of 40 290 individuals who completed brain MRI scans during a median follow-up of 9.3 years, participants with early-onset CHD exhibited the largest WMH volume among the three groups (early-onset CHD, late-onset CHD, and non-CHD, Ptrend<0.001). The PRS analysis supported the associations of early-onset CHD with dementia (odds ratio [OR] for the highest quartile: 1.37, 95% CI: 1.28 to 1.46, Ptrend<0.001) and WMH volume (β for the highest quartile: 0.042, 95% CI: 0.017 to 0.068, Ptrend=0.002).

CONCLUSIONS

Early-onset CHD and genetic susceptibility are associated with a higher risk of incident dementia and a larger WMH volume. Additional attention should be paid to the neurocognitive status of individuals with early-onset CHD.