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

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.

Race/ethnicity-specific association between the American Heart Association's new Life's Essential 8 and stroke in US adults with nonalcoholic fatty liver disease: Evidence from NHANES 2005-2018

BACKGROUND

The Life's Essential 8 (LE8) is a recently introduced assessment of cardiovascular health (CVH) by the American Heart Association (AHA). Nonalcoholic fatty liver disease (NAFLD) is currently the most common chronic liver disease and is associated with an increased risk of stroke. We aimed to explore the association of LE8 with stroke in NAFLD using a national cross-sectional study.

METHODS

Eligible participants with NAFLD aged 20-85 years in NHANES 2005-2018 were included. LE8 was assessed according to AHA criteria and categorized into metabolic and behavioral factors. US Fatty Liver Index (USFLI) ≥ 30 and exclusion of other chronic liver diseases suggested NAFLD. Stroke was diagnosed according to self-report on standardized questionnaires.

RESULTS

After adjusting for all confounders, each point increase in LE8, LE8 metabolic factors, and LE8 behavioral factors was associated with a 4.4 %, 1.8 %, and 2.5 % reduction in stroke prevalence in NAFLD, respectively. Both moderate and high CVH assessed by LE8 and LE8 behavioral factors were associated with reduced odds of stroke compared with low CVH. Stroke prevalence declined progressively with increasing number of ideal LE8 components, with the lowest odds of stroke at 3 + ideal LE8 components for both LE8 metabolic and behavioral factors. Restricted cubic spline suggested dose-response associations. Race/ethnicity was a significant effect modifier, and this association was present only among non-Hispanic white population and other Hispanic population. FLI as a diagnostic indicator of NAFLD yielded generally consistent results.

CONCLUSIONS

Higher LE8 score, especially LE8 behavioral factors, was associated with reduced prevalence of stroke in NAFLD, especially among non-Hispanic white population and other Hispanic population. The odds of stroke declined progressively with increased ideal LE8 component number. These findings underscore the preventive value of adherence to high CVH for stroke prevention in NAFLD.

Association between life's essential 8 and Parkinson's disease: a case-control study

OBJECTIVES

Life's essential 8 (LE8) is an emerging approach for accessing and quantifying cardiovascular health (CVH), but the effect on Parkinson's disease (PD) is still unclear. This study aimed to elucidate the association between LE8 metrics and PD in the US adults.

METHODS

Data of 26,975 participants were extracted from the last 7 National Health and Nutrition Examination Survey (NHANES) cycles (2005-2018). The LE8 metrics were calculated according to the American Heart Association criterion, and participants were divided into 3 groups using tertile range. Multivariate logistic regression models were constructed to explore the association between LE8 metrics and PD. Sensitivity analysis was conducted to verify robustness. A nonlinear linkage was evaluated via restricted cubic spline (RCS). The stability of this effect was validated by subgroup analysis and interaction test.

RESULTS

A total of 26,975 eligible participants (including 271 PD cases and 26,704 non-PD cases) were included in this study. The multivariate logistic regression models revealed a reverse association of continuous LE8 metrics with PD with ORs of 0.97 (unadjusted model [95% CI: 0.96-0.98, P < 0.01], partially adjusted model [95% CI: 0.97-0.98, P < 0.01], fully adjusted model [95% CI: 0.95-0.98, P < 0.01]). Compared to those of low group, the ORs for high group were 0.37 (95% CI: 0.27-0.50, P < 0.01) in unadjusted model, 0.51 (95% CI: 0.36-0.72, P < 0.01) in partially adjusted model, and 0.51 (95% CI: 0.32-0.81, P < 0.01) in fully adjusted model. The sensitivity analysis ensured the robustness of the observed LE8-PD association. A nonlinear relationship (P nonlinearity < 0.01) was observed via RCS analysis. The subgroup analysis showed that participants'gender might impact the strength of LE8 metrics-PD association (P interaction = 0.029).

CONCLUSIONS

CVH, as delineated by LE8 metrics, was reversely associated with PD in the dose-response pattern, more pronounced in female compared to male. These findings highlight the potential of the LE8 metrics to guide targeted strategies for addressing gender-based CVH disparities, offering beneficial insights for the tertiary prevention of PD.

Comparing Life's Simple Seven between newly diagnosed, ART-naive people living with HIV and HIV-uninfected adults in Tanzania: clues for cardiovascular disease prevention

Cardiovascular disease (CVD) represents a major cause of premature mortality in people living with HIV (PLWH). There is a need to characterize the cardiovascular health profiles of PLWH to appropriately guide primary prevention efforts, particularly in settings like Sub-Saharan Africa, where there is a high burden of HIV and limited resources. A cross-sectional analysis was conducted on a cohort of newly diagnosed PLWH and HIV-uninfected adults recruited from three HIV clinics in Mwanza, Tanzania. Modified Life's Simple 7 definitions were applied to the cohort to compare cardiovascular health profiles between the two study groups using Poisson regressions. Pooled cohort equation (PCE) scores were also calculated to compare the distribution of CVD risk between the two groups. Our study included 995 study participants (492 PLWH, 503 HIV-uninfected). PLWH had a higher prevalence of ideal body mass index (75%), ideal blood pressure (56%), and ideal total cholesterol but a lower prevalence of ideal smoking (84%) and ideal physical activity (39%) than HIV-uninfected counterparts. PCE scores were low throughout the study population (76.5%), regardless of HIV status. Primary prevention of CVD in newly diagnosed people living with HIV in Africa may need to focus on smoking cessation and optimization of physical activity levels.

Association between the Life's essential 8 health behaviors score and all-cause mortality in patients with metabolic dysfunction-associated steatotic liver disease

BACKGROUND

The association between Life's Essential 8 (LE8) score and all-cause mortality in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) remains unknown.

METHODS

This population-based prospective cohort study analyzed data of participants aged 20-79 years in the National Health and Nutrition Examination Survey from 2005 to 2018, with linked mortality information until 2019. Multivariable Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for the association between different cardiovascular health (CVH) scores and all-cause mortality in participants with MASLD.

RESULTS

Among 11,988 participants, 4109 (34.3 %) were diagnosed with MASLD. During the median 7.8 years of follow-up, 912 deaths were recorded. Unexpectedly, the total LE8 CVH score was not associated with all-cause mortality in patients with MASLD (all P > .05). However, individuals with MASLD with moderate and poor LE8 health behaviors scores exhibited an increased risk of all-cause mortality (moderate: HR, 1.51; 95 % CI, 1.05-2.17; poor: HR, 2.32; 95 % CI, 1.64-3.30), particularly among patients with advanced fibrosis (moderate: HR, 1.77; 95 % CI, 1.07-2.92; poor: HR, 2.43; 95 % CI, 1.23-4.78). Population-attributable fraction estimates suggest that 35.0 % of all-cause mortality attributed to poor or moderate health behaviors scores could be avoided if ideal CVH metrics were achieved in all patients with MASLD.

CONCLUSION

These findings demonstrate a significant association between the LE8 health behaviors score and all-cause mortality in patients with MASLD, highlighting the usefulness of this score in optimizing risk management strategies for MASLD in future clinical practice.

Association of life's essential 8 and asthma: mediating effect of inflammation and oxidative stress

BACKGROUND

The association of cardiovascular health (CVH) with asthma risk in U.S. adults remains unclear. This study aimed to explore the association of Life's Essential 8 (LE8), a measurement of CVH, with asthma and investigate the potential mediating effect of inflammation and oxidative stress.

METHODS

The data was obtained from the National Health and Nutrition Examination Survey (NHANES) in 2005-2018. LE8 score (range 0 ∼ 100) was measured and categorized as low (<50), moderate (50 ∼ <80), and high (≥80) CVH. Survey-weighted logistic regression and restricted cubic spline model were employed to explore the association between LE8 score and asthma. Mediation analyses were conducted to identify the mediating effects of inflammation and oxidative stress biomarkers.

RESULTS

This study included 10,932 participants aged ≥ 20 years, among whom 890 (8.14%) reported prevalent asthma. After adjusting for all covariates, the odd ratios (OR) for asthma were 0.67 (95% confidence interval (CI): 0.48, 0.94) in the moderate CVH group and 0.52 (95% CI: 0.34, 0.79) in the high CVH group compared with the low CVH group, respectively. The OR for asthma was 0.85 (95% CI: 0.78, 0.93) for every 10 score increase in LE8 score, and linear dose-response relationship was observed (p = 0.0642). Mediation analyses showed that inflammation and oxidative stress mediated 15.97% and 11.50% of the association between LE8 score and asthma, respectively (all p < 0.05).

CONCLUSIONS

LE8 score was negatively associated with asthma, and inflammation and oxidative stress partially mediated this association. It is recommended that maintaining optimal CVH may prevent asthma.

Cardiovascular Disease Mortality Trends, 2010-2022: An Update with Final Data

INTRODUCTION

Age-adjusted mortality rates (AAMR) for cardiovascular diseases (CVD) increased in 2020 and 2021, and provisional data indicated an increase in 2022, resulting in substantial excess CVD deaths during the COVID-19 pandemic. Updated estimates using final data for 2022 are needed.

METHODS

The National Vital Statistics System's final Multiple Cause of Death files were analyzed in 2024 to calculate AAMR from 2010 to 2022 and excess deaths from 2020 to 2022 for U.S. adults aged ≥35 years, with CVD as the underlying cause of death.

RESULTS

The CVD AAMR among adults aged ≥35 years in 2022 was 434.6 deaths per 100,000 (95% CI=433.8, 435.5), which was lower than in 2021 (451.8 deaths per 100,000; 95% CI=450.9, 452.7). The most recent year with a similarly high CVD AAMR as in 2022 was 2012 (434.7 deaths per 100,000 population, 95% CI=433.8, 435.7). The CVD AAMR for 2022 calculated using provisional data overestimated the AAMR calculated using final data by 4.6% (95% CI=4.3%, 4.9%) or 19.9 (95% CI=18.6, 21.2) deaths per 100,000 population. From 2020 to 2022, an estimated 190,661 (95% CI=158,139, 223,325) excess CVD deaths occurred.

CONCLUSIONS

In 2022, the CVD AAMR among adults aged ≥35 years did not increase, but rather declined from a peak in 2021, signaling improvements in adverse mortality trends that began in 2020, amid the COVID-19 pandemic. However, the 2022 CVD AAMR remains higher than observed before the COVID-19 pandemic, indicating an ongoing need for CVD prevention, detection, and management.

Poor sleep quality is associated with probable sarcopenia in community-dwelling older adults: Results from the longevity check-up (lookup) 8

BACKGROUND

Poor sleep quality may contribute to sarcopenia, but evidence remains sparse. This retrospective cross-sectional study investigated the association between subjective sleep quality and probable sarcopenia in a cohort of community-dwelling older adults enrolled in the Longevity Check-Up 8+ study.

METHODS

Participants were asked about their sleep quality over the past month, with four possible options ("very good", "quite good", "quite bad", very bad"). For the analysis, participants were grouped into good or bad sleep quality categories. Probable sarcopenia was operationalized according to handgrip strength values < 27 kg for men and < 16 kg for women. Logistic regression models were used to explore the relationship between sleep quality and probable sarcopenia.

RESULTS

1971 participants were included in the analysis (mean age 73.4 ± 6.2 years, 50.0 % women). Bad sleep quality was reported by 28.3 % of participants and was more prevalent among women, physically inactive individuals, and those with dyslipidemia. Probable sarcopenia was more prevalent in participants with bad sleep quality (23.8 % vs. 18.7 %, p = 0.012). Logistic regression revealed that bad sleep quality was significantly associated with increased odds of probable sarcopenia in both unadjusted (odds ratio [OR] 1.36, 95 % confidence interval [CI] 1.07-1.72, p = 0.010) and fully adjusted models (OR 1.40, 95 % CI 1.08-1.81, p = 0.011).

CONCLUSIONS

Poor sleep quality is associated with increased likelihood of probable sarcopenia in older adults. This finding highlights the importance of addressing sleep quality in interventions aimed at preventing sarcopenia and promoting healthy aging.

Association of depressive symptoms and cardiovascular health with mortality among U.S. adults

BACKGROUND

Depression and cardiovascular health (CVH) are interconnected, and both are independently associated with mortality. However, the joint effects of depressive symptoms and CVH on mortality remain unclear.

METHODS

By utilizing the National Health and Nutrition Examination Survey (NHANES) 2007-2018, we included 18,679 adults aged ≥20 years without cardiovascular diseases (CVD). The definition of elevated depressive symptoms was based on the Patient Health Questionnaire-9 (PHQ-9) scores≥10. CVH was evaluated by Life's Essential 8 (LE8) and categorized into low (<50), moderate (50-80), or high (≥80). The joint association of depressive symptoms and CVH with mortality was examined utilizing multivariate Cox proportional hazard models.

RESULTS

Elevated depressive symptoms were associated with higher mortality risks, and CVH could explain 12.7 % and 13.7 % of the associations between depression and all-cause and non-CVD mortality, respectively. No significant interactions were found between CVH and depressive symptoms on mortality. High CVH attenuated the all-cause mortality risk in patients with elevated depressive symptoms (HR, 0.20; 95 % CI: 0.05-0.89). Compared to participants with elevated depressive symptoms and low CVH, those with no elevated depressive symptoms and high CVH had lower risks of all-cause (HR, 0.26; 95 % CI: 0.16-0.43), CVD (HR, 0.20; 95 % CI: 0.07-0.52), non-CVD mortality (HR, 0.28; 95 % CI 0.16-0.50).

CONCLUSION

Adults with low CVH and elevated depressive symptoms had significantly higher risks of all-cause, CVD, and non-CVD mortality. The finding suggests considering depressive symptoms and CVH jointly in developing targeted strategies to improve survival.

The Associations Between Life's Essential 8 and Diarrhea and Constipation: Results From the 2005-2010 National Health and Nutrition Examination Survey

INTRODUCTION

Few studies have investigated the association between Life's Essential 8 (LE8) and abnormal bowel health. We aimed to investigate the relationship between LE8 and diarrhea and constipation in the adult population of the United States.

METHODS

This cross-sectional study, based on population data, used information from the National Health and Nutrition Examination Survey conducted between 2005 and 2010. Diarrhea and constipation were classified based on Bristol Stool Form Scale and stool frequency. LE8 score is composed of 4 health behaviors (diet, physical activity, nicotine exposure, and sleep health) and 4 health factors (body mass index, blood lipids, blood glucose, and blood pressure) and is classified into low (0-49), moderate (50-79), and high (80-100) cardiovascular health groups. Weighted logistic regression and restricted cubic splines were used to analyze the relationship between the LE8 score and abnormal bowel health.

RESULTS

The study comprised 12,369 participants aged 20 years or older, among whom 1,279 (9.7%) had constipation and 1,097 (7.6%) had diarrhea. After adjusting for potential confounders, we observed negative associations between LE8 scores and diarrhea (odds ratio: 0.60, 95% confidence interval: 0.39-0.93), whereas the association between LE8 scores and constipation was not statistically significant (odds ratio: 0.82, 95% confidence interval: 0.59-1.13). In addition, health behavior scores and health factor scores were associated with constipation.

DISCUSSION

Higher LE8 levels are associated with a lower incidence of diarrhea, but not constipation.

Sleep as a possible mediator in the association of mental health parameters with cardiovascular health indices in women: exploratory analyses from the Heart SCORE Study

OBJECTIVE

This exploratory study aimed to determine the possible role of sleep in the relationships of depression and anxiety, with early surrogate markers of subclinical atherosclerosis, such as brachial artery (BA) diameter and carotid intima media thickness (CIMT) in women.

METHODS

We included 1,075 self-reported postmenopausal women, 45 to 75 years from the Heart Strategies Concentrating on Risk Evaluation Study. Exposure variables were depression and anxiety assessed using the Center for Epidemiologic Studies Depression Scale and the State-Trait Anxiety Inventory, respectively. Outcome variables were BA diameter and CIMT measured using ultrasonography. The mediator, sleep, was assessed with the Pittsburgh Sleep Symptom Questionnaire-Insomnia. Ordinary least squares regression was used for mediation analyses.

RESULTS

Of the 1,075 participants, 56.3% were White and 43.7% were Black. Our analyses revealed significant associations of depression and anxiety with sleep ( P < 0.001 for all). After adjusting for confounders, depression was associated with max CIMT (R 2 = 0.15, P = 0.004), but not BA diameter (R 2 = 0.09, P = 0.083). Although the mediating role of sleep in the association between anxiety and BA diameter was not statistically significant [proportion mediated (CI); 0.41 (-2.77, 4.06); P = 0.219], we observed differential results within each racial group. Sleep appeared to partially mediate the association of anxiety with BA diameter in White [0.21 (0.54, 0.80); P = 0.044] women only.

CONCLUSIONS

We found preliminary indications that sleep might mediate the association of anxiety with BA diameter in White women but does not appear to serve as a mediator in all the other relationships we examined.

Plasma proteomic biomarkers as mediators or moderators for the association between poor cardiovascular health and white matter microstructural integrity: The UK Biobank study

INTRODUCTION

The plasma proteome's mediating or moderating roles in the association between poor cardiovascular health (CVH) and brain white matter (WM) microstructural integrity are largely unknown.

METHODS

Data from 3953 UK Biobank participants were used (40-70 years, 2006-2010), with a neuroimaging visit between 2014 and 2021. Poor CVH was determined using Life's Essential 8 (LE8) and reversing standardized z-scores (LE8z _rev). The plasma proteome was examined as a potential mediator or moderator of LE8z _rev's effects on quantitative diffusion-weighted magnetic resonance imaging (dMRI) metrics.

RESULTS

LE8z_rev was significantly associated with deteriorated WM microstructural integrity, as reflected by lower tract-averaged fractional anisotropy (dMRI-FAmean), (β ± standared error (SE): -0.00152 ± 0.0003, p < 0.001) and higher tract-averaged orientation dispersion (dMRI-ODmean), (β ± SE:+0.00081 ± 0.00017, p < 0.001). Ten strongly mediating plasma proteins of 1463 were identified, with leptin as the principal driver.

DISCUSSION

Poor CVH is linked to poor WM microstructural integrity measures (lower FAmean and higher ODmean), mostly mediated through leptin.

HIGHLIGHTS

Up to 3953 UK Biobank participants were selected for this study. Poor cardiovascular health (CVH) was determined using Life's Essential 8. The plasma proteome was examined as a potential mediator or moderator of poor CVH's effect on dMRI metrics. Ten plasma proteins were identified with strong mediating effects, with leptin being the principal driver.

The impact of cardiovascular health on mortality in US adults with cardiometabolic disease: A prospective nationwide cohort study

BACKGROUND AND AIMS

Individuals with cardiometabolic disease (CMD) face high risks of adverse outcomes. However, there is little evidence of the effectiveness of comprehensive risk assessment using the Life's Essential 8 (LE8) score in CMD. This study aimed to examine the associations between LE8 and all-cause and cardiovascular mortality rates in individuals with CMD.

METHODS AND RESULTS

This study included 11,198 NHANES participants, categorized into low, moderate, and high CVH groups according to LE8 scores. The LE8 score consists of eight components: diet, physical activity, nicotine exposure, sleep health, BMI, blood lipids, blood glucose, and blood pressure. A higher LE8 score indicates better cardiovascular health. Multivariable Cox proportional hazard regression and restricted cubic splines were employed to estimate the associations. Subgroup analyses considered age, sex, race and ethnicity, income, marital status, and education. During a median follow-up of 91 months, 1079 deaths were recorded, 325 of which were cardiovascular. The multivariable adjusted hazard ratio (HR) per 10-point increase in LE8 was 0.79 (95% confidence interval (CI), 0.75-0.84) for all-cause mortality and 0.71 (95% CI, 0.64-0.79) for cardiovascular mortality. Participants with moderate and high LE8 levels showed similar inverse associations. Those under 60 exhibited more pronounced associations (P for interaction <0.05). After adjusting for multiple variables, a linear relationship was observed between LE8 and all-cause and cardiovascular mortality in the CMD population.

CONCLUSIONS

The newly introduced LE8 showed a significant negative association with all-cause and cardiovascular mortality risk among CMD individuals, highlighting its potential for CMD tertiary prevention.

Chinese consensus report on the assessment and management of obstructive sleep apnea in patients with cardiovascular disease: 2024 edition

As cardiovascular disease (CVD) incidence and mortality rates continue to rise in China, the importance of identifying and managing CVD risk factors grows. Obstructive sleep apnea (OSA) is a prevalent sleep-related breathing disorder, affecting an estimated 936 million individuals aged 30-69 worldwide, with China leading globally with about 176 million affected. Increasing research indicates a close association between OSA and the onset and progression of various CVD, significantly affecting outcomes. However, OSA has long been underrecognized and undertreated in CVD clinical practice. To address this gap, a multidisciplinary expert panel developed evidence-based recommendations using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology and the Delphi process. This consensus provides 17 recommendations on core clinical issues such as screening, diagnosis, treatment, and follow-up of CVD patients with OSA, aiming to standardize care and improve patient outcomes. The recommendations were informed by current evidence-based research and extensive expert consensus discussions. This approach seeks to support clinical decision-making, improve the quality of care, and address the unique challenges of managing OSA in Chinese CVD patients.

Prevalence of chronic kidney disease among Chinese adults with diabetes: a nationwide population-based cross-sectional study

Background

To date, comprehensive data on the distribution of chronic kidney disease (CKD), the most prevalent comorbidity in diabetes, among Chinese adults with diabetes is lacking. Additionally, research gaps exist in understanding the association between CKD and cardiovascular health (CVH), an integrated indicator of lifestyle and metabolic control, within a nationwide sample of Chinese adults with diabetes.

Methods

A nationally community-based cross-sectional survey was conducted in 2018-2020. 58,560 residents diagnosed with diabetes aged 18-74 years nationwide were invited to participate, and 52,000 participants with complete CKD data were included in this study. CKD was identified by the presence of albuminuria (urine albumin-to-creatinine ratio ≥30 mg/g) and/or decreased estimated glomerular filtration rate (eGFR, <60 mL/min/1.73 m2). The latter was calculated using the CKD-EPI equation incorporating serum cystatin C and creatinine. CVH was evaluated using the "life's essential 8" (LE8) score, which ranged from 0 to 100 and included 8 components: diet, sleep duration, physical activity, nicotine exposure, hemoglobin A1c, blood pressure, non-high-density lipoprotein cholesterol, and body mass index. The total LE8 scores were categorized into low (0-49), middle (50-79), and high (80-100) according to the American Heart Association. The associations of albuminuria and decreased eGFR with potential associated factors, including CVH, socioeconomic status, clinical characteristics, sub-regional divisions, comorbidities, treatments, and metabolic controls, were evaluated using survey logistic regression.

Findings

The weighted prevalence rates (95% CI) of CKD, albuminuria, and decreased eGFR were 32.6% (31.3%-33.8%), 30.8% (29.6%-32.1%), and 5.5% (5.1%-5.9%), respectively. Among those with CKD, 25.7% had diabetic retinopathy (DR) and 22.3% had cardiovascular disease (CVD). The weighted prevalence rates of albuminuria and decreased eGFR were consistently higher among southern residents, rural residents, and individuals with more severe DR and a history of CVD than their counterparts (all p < 0.05). After adjustment for age, sex, sub-regional division, setting, educational level, annual household income, family history of diabetes, diabetes duration, glucose-lowering treatment, any DR, CVD, and drinking status, the logistic models showed that the odds ratios (ORs) (95% CI) for albuminuria and decreased eGFR were 0.46 (0.42-0.51) and 0.61 (0.55-0.67) for the participants with moderate scores, and 0.14 (0.10-0.21) and 0.28 (0.19-0.41) for those with high scores, compared with those with low total LE8 scores. Furthermore, the restricted cubic spline curves depicted that the disparities in the odds of having albuminuria or decreased eGFR among subpopulations grouped by sex, age, setting, and geographical region, significantly decreased and even disappeared in some cases as the LE8 scores increased.

Interpretation

Chinese adults with diabetes are heavily burdened by CKD. Optimized CVH is central to reducing CKD risk across different subpopulations.

Funding

National Key Clinical Specialty, the Chinese Academy of Engineering.

Brief Mindfulness-Based Cognitive Therapy in Women With Myocardial Infarction: Results of a Multicenter Randomized Controlled Trial

Background

Elevated perceived stress is associated with adverse outcomes following myocardial infarction (MI) and may account for poorer recovery among women vs men.

Objectives

This randomized controlled trial tested effects of a mindfulness-based intervention on stress levels among women with MI.

Methods

Women with elevated stress (Perceived Stress Scale [PSS-4]≥6) at least 2 months after MI were enrolled from 12 hospitals in the United States and Canada and via community advertising. Participants were randomized to a remotely delivered mindfulness intervention (MBCT-Brief) or heart disease education, both 8 weeks long. Follow-up was 6 months. Changes in stress (PSS-10; primary outcome) and secondary outcomes (depressive symptoms, anxiety, quality of life, disease-specific health status, actigraphy-assessed sleep) were compared between groups.

Results

The sample included 130 women with MI (mean age 59.8 ± 12.8 years, 34% racial/ethnic minorities). In intention-to-treat analysis, PSS-10 scores declined in the MBCT-Brief arm (-0.52 [95% CI: -0.77 to -0.28]) but not the heart disease education arm (-0.19 [95% CI: -0.45 to 0.06]; group×time interaction P = 0.070). The effect was stronger in per-protocol analysis of participants who completed ≥4 intervention sessions (P = 0.049). There were no significant differences in secondary outcomes in intention-to-treat or per-protocol analyses. Within the MBCT-Brief arm, more frequent mindfulness practice was associated with greater reductions in stress (P = 0.007), depressive symptoms (P = 0.017), and anxiety (P = 0.036).

Conclusions

MBCT-Brief was associated with greater 6-month reductions in stress than an active control among adherent participants. More frequent mindfulness practice was associated with greater improvements in psychological outcomes. Strategies to engage women with MI in mindfulness training and support regular home practice may enhance these effects.

Caregiving and Hypertension in Younger Black Women: The Jackson Heart Study

BACKGROUND

Caregiving has been associated with high blood pressure in middle-aged and older women, but this relationship is understudied among younger Black women, a population at high risk for hypertension. We examined the associations of caregiving stress and caregiving for high-needs dependents with incident hypertension among reproductive-age women in the JHS (Jackson Heart Study), a cohort of community-dwelling Black adults.

METHODS

We included 453 participants, aged 21 to 44 years, with blood pressure <140/90 mm Hg, and not taking antihypertensive medication at baseline (2000-2004). Caregiving stress over the past 12 months was assessed via a single item in the global perceived stress scale. Caregiving for a high-needs dependent status was assessed via a question on hours per week spent caregiving for children (≤5 years or disabled) or older adults. Incident hypertension was defined as systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or self-report of taking antihypertensive medication at follow-up exams in 2005 to 2008 and 2009 to 2013.

RESULTS

Over a median follow-up of 7.4 years, 43.5% of participants developed hypertension. Participants with moderate/high versus no/low caregiving stress had a higher incidence of hypertension (51.7% versus 40.6%). Higher caregiving stress was associated with incident hypertension after adjustment for sociodemographic and clinical factors, health behaviors, and depressive symptoms (hazard ratio, 1.39 [95% CI, 1.01-1.94]). Being a caregiver for a high-needs dependent was not associated with incident hypertension (adjusted hazard ratio, 0.88 [95% CI, 0.64-1.21]).

CONCLUSIONS

Higher caregiving stress among reproductive-age Black women was associated with incident hypertension. Hypertension prevention approaches for this high-risk population may include caregiving stress management strategies.

Association of Novel EEG Biomarkers of Sleep Depth and Cortical Arousability with Cardiac Autonomic Modulation in Adolescents

STUDY OBJECTIVES

To examine the developmental association of the odds ratio product (ORP), an electroencephalographic measure of sleep depth, during non-rapid eye movement (NREM) sleep with 24-hour heart rate variability (HRV), an electrocardiographic measure of cardiac autonomic modulation (CAM), in the transition to adolescence.

METHODS

Leveraging data from the Penn State Child Cohort, we performed longitudinal analyses on 313 children (median [Md] age 9 years) followed-up after Md=7.4y and cross-sectional analyses on 344 adolescents (Md=16y). We extracted ORP during NREM sleep and in the 9 seconds following cortical arousals (ORP-9) from 9-hour, in-lab polysomnography, and frequency- and time-domain HRV indices from 24-h Holter ECG monitoring. Longitudinal and cross-sectional, multivariable-adjusted, regression models examined the association between ORP and ORP-9 with adolescent 24-h HRV indices.

RESULTS

Longitudinally, a greater increase in ORP-9 since childhood was associated with lower daytime Log-LF, SDNN, RMSSD and higher HR in adolescence (p<0.05). A greater increase in ORP since childhood was associated with lower nighttime Log-LF and SDNN (p<0.05). Cross-sectionally, higher ORP and ORP-9 were associated with lower daytime and nighttime Log-LF, SDNN or RMSSD and higher HR within adolescence (p<0.05).

CONCLUSIONS

A greater increase in cortical arousability since childhood is a strong developmental predictor of daytime cardiac autonomic imbalance in adolescence. Shallower sleep depth additionally arises as a proximal determinant of both daytime and nighttime cardiac autonomic imbalance within adolescence. These data suggest a coupling between fine-grained spectral measures of the sleeping brain and those of CAM, which may inform sleep-related cardiovascular risk early in life.

Life's Essential 8 and cardiovascular disease in women with a history of adverse pregnancy outcomes

AIMS

To assess whether better cardiovascular health is associated with a lower long-term risk of CVD in women with a history of adverse pregnancy outcomes (APOs).

METHODS

Using data from the UK Biobank prospective cohort, we included 2,263 participants with prior APOs and 107,260 participants without prior APOs. Life's Essential 8 (LE8) score was assessed at baseline. Multivariable-adjusted Cox models were used to estimate the associations between LE8 score and CVD events.

RESULTS

Over a median 13.5 years of follow-up, 11,134 incident CVD events were documented. Among women with prior APOs, the incidence of total CVD was significantly lower in the top tertile compared to the bottom tertile, with a HR (95% CI) of 0.43 (0.29, 0.65). A similar trend was observed in women without APOs, with an HR (95% CI) of 0.55 (0.53, 0.58). With respect to the individual CVD outcomes, among women with APOs, only the associations with coronary heart disease, HR (95% CI) for T3 vs T1: 0.30 (0.17, 0.55) and atrial fibrillation, 0.47 (0.24, 0.91), achieved statistical significance. Women with high LE8 score and prior APOs had a similar long-term cardiovascular risk compared to women with high LE8 score and no prior APOs, 0.95 (0.63, 1.44).

CONCLUSIONS

Among women with a history of APOs, better cardiovascular health as assessed using LE8 was associated with a significantly lower incidence of CVD, particularly coronary heart disease and atrial fibrillation. The excess risk associated with APOs appears to be attenuated among those with a high LE8 score.

Obesity Phenotypes, Lifestyle Medicine, and Population Health: Precision Needed Everywhere!

The worldwide prevalence of obesity is a key factor involved in the epidemic proportions reached by chronic societal diseases. A revolution in the study of obesity has been the development of imaging techniques for the measurement of its regional distribution. These imaging studies have consistently reported that individuals with an excess of visceral adipose tissue (VAT) were those characterized by the highest cardiometabolic risk. Excess VAT has also been found to be accompanied by ectopic fat deposition. It is proposed that subcutaneous versus visceral obesity can be considered as two extremes of a continuum of adiposity phenotypes with cardiometabolic risk ranging from low to high. The heterogeneity of obesity phenotypes represents a clinical challenge to the evaluation of cardiometabolic risk associated with a given body mass index (BMI). Simple tools can be used to better appreciate its heterogeneity. Measuring waist circumference is a relevant step to characterize fat distribution. Another important modulator of cardiometabolic risk is cardiorespiratory fitness. Individuals with a high level of cardiorespiratory fitness are characterized by a lower accumulation of VAT compared to those with poor fitness. Diet quality and level of physical activity are also key behaviors that substantially modulate cardiometabolic risk. It is proposed that it is no longer acceptable to assess the health risk of obesity using the BMI alone. In the context of personalized medicine, precision lifestyle medicine should be applied to the field of obesity, which should rather be referred to as 'obesities.'

Association between cardiovascular health and osteoporotic fractures: a national population-based study

Osteoporotic fractures are a major public health concern, particularly among the aging population, as they significantly contribute to morbidity, mortality, and reduced quality of life. While cardiovascular health (CVH) has traditionally been linked to cardiovascular disease outcomes, emerging evidence suggests it may also influence bone health. This study investigates the association between CVH, as measured by the Life's Essential 8 (LE8) score, and the prevalence of osteoporotic fractures in U.S. adults. This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018. A total of 17,606 adults aged 20 and above were included in the analysis after excluding participants with missing data on CVH or osteoporotic fractures. CVH was assessed using the LE8 score, which incorporates eight modifiable cardiovascular health metrics: diet, physical activity, tobacco use, sleep, body mass index (BMI), lipid levels, blood glucose, and blood pressure. The primary outcome, osteoporotic fractures, was identified through self-reported data confirmed by a physician. Weighted multivariate logistic regression models were used to estimate the association between CVH and the prevalence of osteoporotic fractures, adjusting for demographic and health-related covariates. Participants with higher CVH scores had a lower prevalence of osteoporotic fractures. In the fully adjusted model, each 1-point increase in the LE8 score was associated with a 1% reduction in the odds of osteoporotic fractures (OR = 0.99, 95% CI: 0.98-0.99). Compared to participants with low CVH levels, those with moderate CVH had a 22% lower odds of osteoporotic fractures (OR = 0.78, 95% CI 0.70-0.87), and those with high CVH had a 34% lower odds (OR = 0.66, 95% CI 0.56-0.79). A significant linear trend was observed across different CVH levels (P for trend < 0.001). Subgroup analyses revealed that the inverse relationship between CVH and osteoporotic fractures was consistent across different demographic and health-related subgroups. This study highlights a significant inverse association between cardiovascular health and osteoporotic fractures in U.S. adults. These findings suggest that maintaining a high level of cardiovascular health, as measured by the LE8 score, may be important in reducing the risk of osteoporotic fractures. Public health strategies that integrate cardiovascular and bone health interventions may enhance overall health outcomes and reduce the societal burden of both cardiovascular diseases and osteoporosis.

Higher Life's Crucial 9 protects against infertility among U.S. women aged 18-45 years

Objective

Infertility is not only a reproductive issue but is also closely linked to cardiovascular health and other factors. Life's Crucial 9 (LC9) is a set of lifestyle guidelines aimed at improving cardiovascular health, yet its potential association with infertility remains underexplored. This study aims to investigate the relationship between LC9 and infertility, providing new insights and strategies for the prevention and management of infertility.

Methods

This study utilized data from the National Health and Nutrition Examination Survey (NHANES) from 2013 to 2018. Multivariate logistic regression and weighted quantile sum (WQS) regressions were employed to investigate the association between LC9 and infertility. Restricted cubic spline (RCS) analysis explored the linear or non-linear relationship between LC9 and infertility. Interaction analyses were conducted on subgroups to validate the findings.

Results

There was a significant negative association between LC9 and infertility. After adjusting for covariates, for every 10-point increase in LC9, there was a 35% decrease in the prevalence of infertility (P < 0.001). This negative correlation persisted when LC9 was divided into quartiles. Moreover, as LC9 increased, there was a trend towards lower infertility prevalence (P for trend < 0.001). WQS analyses showed consistent associations (OR=0.27, 95%CI: 0.14, 0.53), with sleep health score, psychological health score, and Body mass index score as significant factors. The dose-response curve indicated a linear association between LC9 and infertility, with higher LC9 associated with lower infertility risk.

Conclusion

The results of this study show a strong negative correlation between LC9 and the prevalence of infertility. Clinically, these findings offer hope for infertility patients, suggesting that adherence to a higher LC9 score significantly reduces the risk of infertility. This will provide a new avenue for infertility prevention and management, offering hope and potential relief to infertile patients.

Medically Tailored Grocery Deliveries to Improve Food Security and Hypertension in Underserved Groups: A Student-Run Pilot Randomized Controlled Trial

BACKGROUND/OBJECTIVES

Randomized controlled trials (RCTs) are needed to evaluate the impact of food is medicine (FIM) programs, such as medically tailored groceries (MTGs) to treat hypertension among diverse populations. Partnerships between academic centers' student-run organizations (SROs) and community-based organizations (CBOs) offer critical safety nets for historically underserved groups, positioning these organizations to effectively undertake FIM programs among populations disproportionately affected by hypertension. We conducted an unblinded pilot RCT whose objectives were to assess the feasibility and acceptability of an SRO-coordinated, CBO-partnered MTGs intervention targeting blood pressure (BP) and food insecurity (FI) in underserved groups.

METHODS

Adult Black/African American and Hispanic/Latinx patients in Durham, North Carolina, where essential hypertension and FI were randomized (parallel arm, computerized 1:1 ratio) to 12 weeks of home-delivered, hypertension-focused MTGs plus in-person nutrition education sessions with compensation (intervention) versus data collection sessions with compensation (control). We offered transportation, childcare, and home visits to facilitate session attendance. The primary outcomes were the eligibility, enrollment, and retention rates (feasibility), and the survey feedback from the participants and CBO partners (acceptability). The secondary outcomes included the changes in the mean BP and median FI score with associated 95% confidence intervals.

RESULTS

Medical record screening identified 1577 eligible participants. Of the 94 reached to confirm eligibility, 77 met the enrollment criteria, and 50 were randomized (82% post-screen eligibility, 65% enrollment). A conventional content analysis of 15 participant surveys and CBO partner feedback affirmed the acceptability, noting intervention components that enhanced the retention (e.g., home delivery, transportation support, home visits). Pre-post analyses of secondary outcomes for 13/25 intervention and 15/25 control participants completing ≥2 sessions ≥2 months apart were performed. The intervention was associated with an average change in systolic BP of -14.2 mmHg (-27.5, -4.5) versus -3.5 mmHg (-11.7, 5.9) in the control group. The FI scores improved by -2 (-2.2, -0.5) in the intervention group and -1 (-1.3, -0.2) in the control group. No adverse events were reported.

CONCLUSIONS

SRO-CBO partnerships could be feasible and acceptable avenues for conducting FIM trials among underserved populations. This multi-component FIM approach enhanced the study equity by addressing the participants' disease-related social needs and warrants expansion into a powered RCT.

Association of life's essential 8 and inflammatory biomarkers with nutritional anemia in UK adults

Several modifiable health factors in Life's Essential 8 (LE8) are linked to nutritional anemia and can assess overall cardiovascular health (CVH). This study explored the associations of CVH measured by LE8 score with nutritional anemia and iron deficiency anemia (IDA), including the mediating role of inflammatory biomarkers. This prospective cohort study included 181,069 participants from UK Biobank. CVH was categorized into low (0-49), medium (50-79), and high (80-100) based on the LE8 score. Weibull regression models were used to quantify the association between CVH and nutritional anemia and IDA. During a median follow-up of 8.6 years, 6749 cases of nutritional anemia occurred, including 92% (6223/6749) IDA cases. After adjusting for covariates, participants with moderate CVH and high CVH had a 44% and 54% lower risk of nutritional anemia (Moderate: hazard ratio [HR] 0.56; 95% confidence interval [CI], 0.51-0.60; High: HR 0.46; 95% CI, 0.41-0.51), and a 46% and 54% lower risk of IDA (Moderate: HR 0.54; 95% CI, 0.50-0.59; High: HR 0.46; 95% CI, 0.41-0.51), respectively, compared to those with low CVH. An L-shaped association was observed between CVH score and both types of anemia. Inflammatory biomarkers explained 22.1% and 21.6% of the associations between CVH and nutritional anemia and IDA, respectively. Higher CVH scores were associated with lower risk of nutritional anemia and IDA, and these associations may be partially mediated by inflammatory biomarkers. These findings emphasize the importance of CVH and inflammation in preventing nutritional anemia.

Dose-response relationship between Life's Essential 8 score and COPD risk: the NHANES cohort study 2007-2018

Objective

This study aims to discuss the dose-response relationship between the Life's Essential 8 (LE8) score and chronic obstructive pulmonary disease (COPD).

Methods

We screened data from the National Health and Nutrition Examination Survey (NHANES) database for the years 2007-2018. Logistics regression analysis and subgroup analysis were used to explore the relationship between cardiovascular health (CVH) and COPD based on the LE8 score. Additionally, restricted cubic spline (RCS) plots were drawn to visually display the dose-response relationship.

Results

A total of 12,517 participants were included, of which 835 had COPD. After multivariable adjustment, the LE8 score was found to be linearly and inversely associated with the risk of developing COPD. A similar relationship was observed in the scores for health behavior factors, whereas the relationship was weaker for health factors. The RCS plots visually demonstrated the aforementioned dose-response relationship. Moreover, subgroup analyses showed that this relationship remained robust across different groups.

Conclusion

LE8 scores are inversely and linearly associated with the risk of developing COPD. Higher LE8 scores can reduce the risk of developing COPD in individuals over 40 years old, especially concerning health behavior factors.

A Narrative Review of Cardiometabolic Profiles among U.S. Adults: Temporal Trends and Implications

PURPOSE OF REVIEW

To provide a narrative overview of trends and disparities in the cardiometabolic profiles of U.S. adults by synthesizing findings from nationally representative studies conducted between 1999 and 2020.

RECENT FINDINGS

During the study period, the cardiometabolic profiles of U.S. adults displayed a complex mix of trends. While there were notable improvements in specific risk factors, such as reductions in total cholesterol, triglycerides, and low-density lipoprotein cholesterol levels, other aspects of cardiometabolic health worsened. The mean body mass index and hemoglobin A1c levels increased, accompanied by significant rises in the prevalence of obesity, type 2 diabetes, and metabolic syndrome. Despite some progress in blood pressure and lipid profiles, the overall cardiometabolic health of the population declined, with only a small percentage of adults maintaining optimal health by 2018. Furthermore, significant disparities persisted across racial and socioeconomic groups, with non-Hispanic Black participants and those with lower education and income facing higher cardiometabolic risks compared to their counterparts. Despite improvements in certain aspects of cardiometabolic profiles among U.S. adults, significant challenges remain, particularly with the rising rates of obesity, type 2 diabetes, and metabolic syndrome. Persistent disparities in cardiometabolic health across sociodemographic groups emphasize the need for comprehensive public health strategies that address medical care, lifestyle factors, and social determinants of health. Future efforts should prioritize reducing these disparities and enhancing health equity to mitigate the overall burden of cardiometabolic disease.

Association of extreme heat events with sleep and cardiovascular health: a scoping review

BACKGROUND

Extreme heat events (EHEs), driven by anthropogenic climate change, exacerbate the risk of cardiovascular disease (CVD), although the underlying mechanisms are unclear. A possible mechanism leading to heat-related CVD is disturbances in sleep health, which can increase the risk of hypertension, and is associated with ideal cardiovascular health. Thus, our objective was to systematically review the peer-reviewed literature that describes the relationship between EHEs, sleep health, and cardiovascular measures and outcomes and narratively describe methodologies, evidence, and gaps in this area in order to develop a future research agenda linking sleep health, EHEs, and CVD.

METHODS

A comprehensive literature search was performed in the following databases from inception-June 2023: Ovid MEDLINE, Ovid Embase, CINAHL, Web of Science, and the Cochrane Library. Studies retrieved were then screened for eligibility against predefined inclusion/exclusion criteria. Then studies were described qualitatively in relation to study design, findings, and the evidence linking the relationship between sleep health, EHEs, and CVD.

RESULTS

Of the 2035 records screened, only three studies met the inclusion criteria. In these three studies, EHE was measured as absolute temperatures (greater than 30 °C) or relative temperatures (i.e., 90th percentile daily maximum temperature within the region). Cardiovascular (CV) measures described included blood pressure (BP), heart rate (HR), and HR variability (no CVD outcomes were described), and objective and subjective measurements of sleep health outcomes included sleep duration, calmness, ease of falling asleep, ease of awakening, freshness after awakening, and sleep satisfaction. Two studies were controlled trials, and one was a cohort study. During EHEs, individuals slept for shorter periods of time and less efficiently, with greater degrees of HR variability in two of the three studies lasting at most 1-2 days; BP (both systolic and diastolic) significantly decreased during EHEs in two of the studies. No formal assessment of a mediating relationship between EHE exposure, sleep outcomes, and CV measures was undertaken.

CONCLUSIONS

Few studies examine the link between CVD, sleep, and extreme heat as a possible mechanism of elevated CVD risk during EHEs, despite a strong physiological rationale. Our findings highlight an important gap in the literature that should be closely examined as EHEs become more frequent and their harmful impacts of health increase.

A Proposed Framework to Aid Primary Care Clinicians in Promoting Cardiovascular Health

Healthy lifestyle behaviors play a significant role in promoting cardiovascular health. Primary care clinicians (PCCs) are tasked with promoting cardiovascular health through the assessment of lifestyle behaviors and the use of behavior change counseling. However, PCCs face several barriers including a lack of training in counseling techniques. We propose a framework to guide the development of a patient-centered digital communication bundle that can aid PCCs in helping their patients create and sustain feasible lifestyle changes. Our framework proposes that this digital communication bundle contains the following features: assess and analyze an individual's cardiovascular health status; communicate personalized information in a health-literacy-friendly, visual format; assess behavioral components of change (e.g., motivation) that can inform the PCC's approach in guiding behavior change; provide PCCs with brief, behavior change counseling prompts that are grounded in motivational interviewing; and assess and address potential structural, socioeconomic, and environmental barriers, thereby fostering resilience in patients' lifestyle change efforts. We highlight the available research to support the need for such a tool and its potential ability to guide PCCs while also promoting behavior change in a patient-centered manner.

Association between life's essential 8 and bone mineral density among adults aged 20-59 years

This study investigates the relationship between Life's Essential 8 (LE8) scores and bone mineral density (BMD) in adults aged 20-59 years. This cross-sectional analysis employed nationally representative data from NHANES 2011-2018. Weighted multiple linear regression models were applied to assess the association between LE8 scores and varying levels of cardiovascular health (CVH) with BMD. Subgroup analyses were performed to evaluate differences in the impact of LE8 scores on BMD across age groups, genders, races, socioeconomic statuses, and BMI categories. The study included 2159 participants. After adjusting for all covariates, LE8 scores demonstrated a significant positive linear association with lumbar spine BMD, thoracic spine BMD, trunk BMD, and total BMD. Individuals in the medium and high CVH groups exhibited higher BMD compared to those in the low CVH group. Subgroup analyses indicated that the association was more evident in participants aged 20-35 years and among those with normal BMI. In females, thoracic spine BMD appeared particularly sensitive to changes in LE8 scores. This study identifies a positive linear relationship between LE8 scores and BMD. Higher CVH scores were linked to greater BMD in adults aged 20-59 years. These findings highlight the importance of adopting comprehensive health strategies, suggesting that improving CVH may contribute to maintaining bone density and supporting skeletal health.

Biological aging traits mediate the association between cardiovascular health levels and all-cause and cardiovascular mortality among adults in the U.S. without cardiovascular disease

The American Heart Association's (AHA) Life's Essential 8 (LE8) metrics provide a framework for assessing cardiovascular health (CVH). This study evaluates the relationship between CVH levels from LE8 and mortality risk, considering biological aging's role. Using data from the NHANES non-CVD adult population, CVH scores were categorized as low (< 50), moderate (50-79), and high (≥ 80) per AHA guidelines. Cox regression model assessed the impact of CVH levels on all-cause and cardiovascular mortality, while examining four aging indicators as mediators. RCS explored the relationships between CVH scores and mortality risk. The model's performance was evaluated using nine machine learning algorithms, with SHAP analysis on the best model to determine CVH score components' importance. Cox regression showed that all-cause mortality rates decreased by 35% for moderate and 54% for high CVH groups compared to low CVH. The high CVH group had a 59% lower cardiovascular mortality rate. Each unit increase in CVH score reduced all-cause and cardiovascular mortality to 0.98 times. RCS analysis revealed a nonlinear trend between CVH scores and mortality risk. Biological aging indicators significantly mediated the CVH-mortality relationship, with PhenoAge (21.57%) and KDM-Age (20.33%) showing the largest effects. The XGBoost model outperformed others, with SHAP analysis ranking CVH components: physical activity, nicotine, blood pressure, BMI, lipids, healthy eating index, blood glucose, and sleep. Higher CVH levels correlate with reduced all-cause and cardiovascular mortality risk, with biological aging mediating these effects. Adhering to AHA's LE8 metrics is recommended to enhance life expectancy in the non-CVD population.

Cross-sectional and longitudinal association of sleep patterns and aneurysmal vulnerability biomarkers on high-resolution magnetic resonance vessel wall imaging

BACKGROUND

Aneurysm wall enhancement (AWE) on vessel wall imaging (VWI) scans is a robust biomarker for aneurysmal vulnerability. This study aimed to explore the association of different sleep patterns with AWE and other vulnerability features.

METHODS

Patients with unruptured intracranial aneurysms were prospectively recruited. Sleep characteristics were collected through a standard questionnaire. Poor sleep quality was defined using the Pittsburgh Sleep Quality Index (PSQI)>5. Cross-sectional multistate predictive models were used to identify various sleep patterns related to aneurysmal vulnerability. In longitudinal observation, core covariates were adjusted with each sleep characteristic to verify cross-sectional results.

RESULTS

A total of 344 aneurysms were enrolled for cross-sectional analyses, while 74 cases (21.5%) that did not receive preventive treatment participated in longitudinal follow-up. In cross-sectional analysis, U-shaped relationships were evident between AWE and nocturnal sleep duration and siesta habit. Improper nocturnal sleep duration, inappropriate siesta habits, insomnia, and snoring were significantly associated with multiple VWI markers of aneurysmal vulnerability (all P<0.05). Notably, all vulnerability indicators were related to poor sleep quality. In longitudinal analysis, short nocturnal sleep duration, snoring, and poor sleep quality were independently associated with aneurysmal progression (all P<0.05).

CONCLUSIONS

Unhealthy sleep patterns were significantly associated with multiple features related to aneurysmal vulnerability. Interventional studies are needed to evaluate the role of improving sleep burden and individual sleep symptoms as potential targets for reducing the risk of aneurysm rupture.

Association between atherogenic index of plasma and future risk of cardiovascular disease in individuals with cardiovascular-kidney-metabolic syndrome stages 0-3: a nationwide prospective cohort study

BACKGROUND

As an emerging concept, Cardiovascular-kidney-metabolic syndrome (CKM) elucidates the intricate interconnection between metabolic disorders(Mets), cardiovascular disease(CVD), and chronic kidney disease(CKD). Within this context, while numerous studies have demonstrated a correlation between the Atherogenic Index of Plasma (AIP) and CVD, the precise relationship between long-term fluctuations in the AIP and the incidence of CVD in patients with CKM syndrome remains unclear.

METHOD

The CKM stages 0-3 population was obtained from the China Health and Retirement Longitudinal Study (CHARLS). The outcome CVD was defined as self-reported heart disease and/or stroke. AIP control level was classified using k-mean cluster analysis. Logistic regression was used to analyse the effect of cumulative AIP (cumAIP) on the incidence of CVD. Restricted cubic spline models (RCS) were used to explore the potential non-linear relationship between cumulative AIP and CVD risk at different CKM syndrome stages.

RESULTS

Of the 3429 CKM stages 0-3 participants, 620 patients developed CVD during the 3-year follow-up period. After adjusting for various confounders, the odds ratio (OR) for the well-controlled class 2 compared with the best AIP control class 1 were 1.37 (1.04, 1.81), the OR for the moderately-controlled class 3 were 1.54 (95% CI, 1.04-2.26), the poorly-controlled class 4 were 1.65 (95% CI, 1.13-2.41), and the worst-controlled class 5 were 2.14 (95% CI, 1.15-3.97). In restricted cubic spline regression analyses, changes in AIP were linearly associated with the occurrence of CVD events. Further weighted quartiles and regression analyses indicated that triglyceride(TG) was a key variable for AIP in predicting CVD events in the CKM stages 0-3 population.

CONCLUSIONS

Poor control level of AIP are associated with an increased risk of CVD events in the population of CKM stages 0-3. Long-term dynamic monitoring of changes in AIP may help in the early identification of patients at high risk of developing CVD in the individuals with CKM stages 0-3.

The association between metabolomic profiles of lifestyle and the latent phase of incident chronic kidney disease in the UK Population

Chronic kidney disease (CKD) is a global health challenge associated with lifestyle factors such as diet, alcohol, BMI, smoking, sleep, and physical activity. Metabolomics, especially nuclear magnetic resonance(NMR), offers insights into metabolic profiles' role in diseases, but more research is needed on its connection to CKD and lifestyle factors. Therefore, we utilized the latest metabolomics data from the UK Biobank to explore the relationship between plasma metabolites and lifestyle factors, as well as to investigate the associations between various factors, including lifestyle-related metabolites, and the latent phase of CKD onset. The study enrolled approximately 500,000 participants from the UK Biobank (UKB) between 2006 and 2010, excluding 447,163 individuals with missing data for any metabolite in the NMR metabolomics, any biomarker in the blood chemistry (including eGFR, albumin, or cystatin C), any factor required for constructing the lifestyle score, or a baseline diagnosis of CKD. Lifestyle scores (LS) were calculated based on several factors, including diet, alcohol consumption, smoking, BMI, physical activity, and sleep. Each healthy lifestyle component contributed to the overall score, which ranged from 0 to 6. A total of 249 biological metabolites covering multiple categories were determined by the NMR Metabolomics Platform. Random forest algorithms and LASSO regression were employed to identify lifestyle-related metabolites. Subsequently, accelerated failure time models(AFT) were used to assess the relationship between multiple factors, including traditional CKD-related biomarkers (such as eGFR, cystatin C, and albumin) and lifestyle-related metabolites, with the latent phase of incident CKD. Finally, we performed Kaplan-Meier survival curve analysis on the significant variables identified in the AFT model. Over a mean follow-up period of 13.86 years, 2,279 incident chronic kidney disease (CKD) cases were diagnosed. Among the 249 metabolites analyzed, 15 were identified as lifestyle-related, primarily lipid metabolites. Notably, among these metabolites, each 1 mmol/L increase in triglycerides in large LDL particles accelerated the onset of CKD by 24%. Diabetes, hypertension, and smoking were associated with a 56.6%, 31.5% and 22.3% faster onset of CKD, respectively. Additionally, each unit increase in age, BMI, TDI, and cystatin C was linked to a 3.2%, 1.4%, 1.6% and 32.3% faster onset of CKD. In contrast, higher levels of albumin and eGFR slowed the onset of CKD, reducing the speed of progression by 3.0% and 3.9% per unit increase, respectively. Nuclear magnetic resonance metabolomics offers new insights into renal health, though further validation studies are needed in the future.

Complex interactions and composite burden of risk factors in vascular cognitive impairment

Vascular cognitive impairment (VCI) stresses the vascular contributions to cognitive decline, ranging from mild to major forms. Except for symptomatic treatment for relevant vascular diseases, the other recommended strategy is to intervene in key vascular risk factors (VRFs) as early as possible. A considerable amount of previous research delineated the association of a specific factor with dementia, involving each risk factor discussed in the present review. However, due to the heterogeneity and complexity of VCI, managing a single factor is insufficient to reduce its incidence and prevalence. Ongoing studies suggest differences in the impact of various combinations of risk factors on dementia. Here in this review, we aimed to provide an updated overview of clinical evidence and implications of complex interactions among various risk factors of VCI, including common VRFs and modifiable dementia-related risk factors. Understating the effect of comorbid risk factors on VCI and underlying mechanisms of them during VCI progression is essential for identifying high-risk population and developing preventive strategies. Furthermore, we summarized common composite risk scores and models used for risk evaluation and prediction of VCI, involving conventional risk scores, subclinical vascular composites, and novel risk models driven by intelligent algorithms. Lastly, we discussed potential gaps and research directions on searching specific clinical risk profiles, constructing effective risk scores, and implementing targeted risk interventions.

Association between glyphosate exposure and cardiovascular health using "Life's Essential 8" metrics in US adults

BACKGROUND

Glyphosate, as one of the most widely used herbicides worldwide, has been reclassified as a potential carcinogen and linked to multiple health problems. Recent data from animal experiments have proved its potential cardiovascular toxicity. However, whether glyphosate exposure influences human cardiovascular health at the population levels remains unknown. This study aims to elucidate the correlation between glyphosate exposure and Cardiovascular Health (CVH) by utilizing comprehensive Life's Essential 8 (LE8) metrics.

METHODS

Data from 2842 participants, approximating 155.24 million U.S. adults, from 2013 to 2018 in National Health and Nutrition Examination Survey were analyzed. The association between natural logarithm (ln)-transformed glyphosate exposure in urine and CVH was examined using weighted linear regression and restricted cubic spline (RCS) models. Mediation analysis was used to determine potential mediators correlated with glyphosate and CVH. Further subgroup analysis and sensitive analysis were conducted to confirm the results.

RESULTS

In fully adjusted models, the total CVH score decreased by 1.33 points for every unit increase in continuous ln-transformed glyphosate [β = -1.33, 95 % confidence interval (CI) (-2.25, -0.41)]. There was a negative correlation between the total CVH score and the lowest quantiles of ln-transformed glyphosate (Q1), Q2, Q3, and Q4 with p for trend < 0.05. A non-linear relationship between glyphosate and total CVH emerged (p for non-linear<0.001, p for overall = 0.003), and no safe threshold of glyphosate was observed. Serum insulin was an important mediator in the adverse effects of glyphosate on CVH with an 18.73 % mediation proportion. Moreover, higher serum insulin levels and higher homeostasis model assessment of insulin resistance were associated with higher glyphosate exposure but negatively correlated with total CVH score.

CONCLUSIONS

Glyphosate exposure may pose a risk to cardiovascular health at the population levels, with elevated serum insulin levels acting as a crucial mediating element. Further studies are required to investigate the safe threshold and underlying mechanism of glyphosate impairment.

Association of blood cadmium and physical activity with mortality: A prospective cohort study

Physical activity (PA) may be considered an alternative method to ameliorate the elevated mortality risks associated with cadmium exposure. In this prospective cohort study, a total of 20,253 participants (weighted mean age, 47.79 years), including 10,247 men (weighted prevalence: 50.1 %), aged 18 years or older, were selected from the National Health and Nutrition Examination Survey from 2007 to 2018. Multivariable Cox proportional hazards regression models were utilized to evaluate the associations between blood cadmium levels, PA, and the risks of mortality. Restricted cubic spline analyses were employed to investigate the nonlinear relationships between blood cadmium and PA levels and mortality risks. During a median follow-up of 7.6 years, a total of 2002 (9.89 %) all-cause deaths occurred, of which 581 (2.87 %) participants were due to cardiovascular disease (CVD) and 498 (2.46 %) died of cancer. J-shaped associations were observed for blood cadmium with risks of mortality (all Poverall < 0.001; all Pnonlinearity < 0.001). Blood cadmium and PA had multiplicative interactions on mortality risk (all Pinteraction < 0.05). Compared with the subgroup with the lowest quartile of blood cadmium and recommended PA, the combination of the highest quartile of blood cadmium and without recommended PA was associated with the highest risks of all-cause and cancer mortality, followed by those meeting recommended PA but in the highest quartile of blood cadmium (hazard ratios, 2.43; 95 % confidence interval, 1.95-3.02). Achieving recommended PA significantly attenuated the detrimental effects of blood cadmium on all-cause, CVD, and cancer mortality risks.

Promotion of Cardiometabolic Health: A Personal Journey

PURPOSE OF REVIEW: Narrative review of the author's main contributions to the field of cardiovascular health spanning four decades, with a focus on findings related to 1- the pathophysiology of obesity, insulin resistance, type 2 diabetes and cardiovascular disease, and 2- the management/prevention of these conditions. Particular attention is given to the importance of regular physical activity. RECENT FINDINGS: Because behaviors and their physiological consequences are still not measured in clinical practice, it is proposed to systematically assess and target "lifestyle vital signs" (waist circumference, cardiorespiratory fitness, food-based diet quality and level of leisure-time physical activity) in primary care. However, cardiometabolic health of the population will not be substantially improved until our living and economic conditions are permissive to the adoption of healthy behaviors. Closing the gap between primary care and public health should be a priority to address the socioeconomic determinants of cardiometabolic health.

KAT6A acetylation drives metabolic adaptation to mediate cellular growth and mitochondrial metabolism through AMPK interaction

Diets influence metabolism and disease susceptibility, with lysine acetyltransferases (KATs) serving as key regulators through acetyl-CoA. We have previously demonstrated that a ketogenic diet alleviates cardiac pathology, though the underlying mechanisms remain largely unknown. Here we show that KAT6A acetylation is crucial for mitochondrial function and cell growth. Proteomic analysis revealed that KAT6A is acetylated at lysine (K)816 in the hearts of mice fed a ketogenic diet under hypertension, which enhances its interaction with AMPK regulatory subunits. RNA-sequencing analysis demonstrated that the KAT6A acetylation-mimetic mutant stimulates AMPK signaling in cardiomyocytes. Moreover, the acetylation-mimetic mutant mitigated phenylephrine-induced mitochondrial dysfunction and cardiomyocyte hypertrophy via AMPK activation. However, KAT6A-K816R acetylation-resistant knock-in mice unexpectedly exhibited smaller hearts with enhanced AMPK activity, conferring protection against neurohumoral stress-induced cardiac hypertrophy and remodeling. These findings indicate that KAT6A regulates metabolism and cellular growth by interacting with and modulating AMPK activity through K816-acetylation in a cell type-specific manner.

Association between cardiovascular health and metabolic dysfunction-associated steatotic liver disease: a nationwide cross-sectional study

PURPOSE

Evidence concerning the effect of cardiovascular health (CVH) on the risk of metabolic dysfunctional-associated steatotic liver disease (MASLD) is scarce. This study aimed to investigate the association between CVH and MASLD.

METHODS

5680 adults aged ≥ 20 years from the National Health and Nutrition Examination Survey 2017-March 2020 were included. Life's essential 8 (LE8) was applied to assess CVH. Weighted binary logistic regression was employed to calculate the odds ratio (OR) and 95% confidence interval (CI) to investigate the association of CVH with MASLD. Restricted cubic spline (RCS) was conducted to explore the dose-response association between LE8 and its subscales scores with MASLD.

RESULTS

Among 5680 participants, 724, 3901, and 1055 had low, moderate, and high CVH levels, respectively, with a MASLD diagnosis prevalence of 36.83%. In the fully adjusted logistic regression model, ORs for MASLD were 0.50 (95% CI, 0.37-0.69) for participants with moderate CVH and 0.21 (95% CI, 0.13-0.34) for those with high CVH, when compared to those with low CVH (P < 0.001 for trend). OR for MASLD was 0.68 (95% CI, 0.61-0.77) for each 10-point increase in LE8 score. RCS model demonstrated a non-linear dose-response relationship between LE8 score and health factors score with MASLD, while a linear relationship was found between health behaviors score and MASLD. Subgroup analysis showed a consistent negative correlation between LE8 score and MASLD, and sensitivity analysis validated the reliability of these findings.

CONCLUSIONS

Higher LE8 score was associated with a lower risk of MASLD. Encouraging adherence to optimal CVH levels may help mitigate the burden of MASLD.

Association between serum testosterone level and cardiovascular health in US male adults: results from the 2013-2016 NHANES

BACKGROUND

There have been many studies of the association between testosterone and cardiovascular disease (CVD). However, limited research has examined the association between testosterone and Life's Essential 8 (LE8), a recently updated algorithm for assessing cardiovascular health (CVH).

OBJECTIVES

This study aims to investigate the association between serum total testosterone (TT) levels and LE8 scores-where higher LE8 scores indicate better CVH-among adult males in the United States.

METHOD

Data from 3308 adult males were extracted from the National Health and Nutrition Examination Survey conducted between 2013 and 2016. Weighted univariate and multivariate linear regression models [β and 95% confidence intervals (CIs)] and logistic regression models [odds ratios (ORs) and 95% CIs] were used to explore the association between testosterone and LE8 and high CVH risk. Additionally, a smoothed curve fit (penalized spline method) and generalized additive model regression were applied to further explore these relationships.

OUTCOMES

LE8 includes 4 health behaviors (nicotine exposure, diet, physical activity, and sleep duration) and 4 health factors (body mass index, non-high-density lipoprotein cholesterol, blood pressure, and blood glucose).

RESULTS

Serum TT levels were strongly associated with LE8 scores after adjusting for all confounders (continuous: β = 2.75, 95% CI: 1.92, 3.57, P < .0001; quartiles: Q4 vs Q1: β = 3.89, 95% CI: 2.78, 5.01, P < .0001). Similarly, high levels of TT were associated with a significantly lower CVH risk (OR = 0.59, 95% CI: 0.49, 0.73, P < .001). Compared to low TT levels, normal TT levels significantly reduced the risk of CVH (OR = 0.51, 95% CI: 0.38, 0.69, P < .001). Smoothed curve fitting showed a positive linear correlation between TT levels and LE8 scores, as well as a consistent linear negative correlation with CVH risk.

CLINICAL IMPLICATIONS

These findings highlight the importance of endogenous TT levels in promoting CVH and provide new insights into factors influencing CVH.

STRENGTHS AND LIMITATIONS

This study is the first to investigate the association between serum TT level and LE8 scores as well as LE8-assessed CVH among adult males. However, the observational nature of this study precludes any assessment of causality.

CONCLUSIONS

This study demonstrates a robust positive association between serum TT levels and LE8 scores in a nationally representative sample of adult men in the United States.

The associations of cardiovascular health and all-cause mortality among individuals with depression

The association between the recently updated cardiovascular health (CVH) assessment algorithm, the Life's Essential 8 (LE8), and all-cause mortality among adults with depression remains unknown. From the National Health and Nutrition Examination Survey (NHANES) spanning 2005-2018, a cohort of 2,935 individuals diagnosed with depression was identified. Their CVH was evaluated through the LE8 score system. The investigation of mortality status utilized connections with the National Death Index up to December 31, 2019. To assess the impact of CVH on mortality risk, Kaplan-Meier survival analysis and Cox proportional hazards models, adjusting for variables related to demographics and socioeconomic status, were applied. Among 2,935 participants, those with higher CVH levels had significantly lower all-cause mortality compared to those with lower CVH levels. Cox regression analyses demonstrated that each 1-point increase in CVH score was associated with a lower risk of all-cause mortality [HR = 0.97, 95%CI:0.96-0.98]. The inverse association between CVH and mortality persisted across different demographic and socioeconomic subgroups. Higher CVH levels were associated with a significantly lower risk of all-cause mortality in individuals with depression. These findings underscore the importance of comprehensive CVH management as part of healthcare strategies for people with depression, suggesting that improving CVH may contribute to longer life expectancy in this vulnerable population.

Changes in Cardiovascular Health, Genetic Risk, and Cardiometabolic Diseases: Evidence From a Large-Scale Cohort Study

BACKGROUND

Evidence has firmly established the association between superior cardiovascular health (CVH) and reduced susceptibility to cardiometabolic diseases (CMDs). In reality, CVH experiences dynamic fluctuations throughout individuals' lifespans. However, the association between changes in CVH and the impact on CMDs among individuals with different genetic risks remains unclear.

METHODS AND RESULTS

Based on a large-scale community-based cohort, we evaluated the association between baseline CVH (n=289 069), changes in CVH between 2 examinations (n=37 702), and the risk of CMDs and its individual components (ischemic heart disease, type 2 diabetes, and stroke) using Cox proportional hazards models, leveraging detailed repeatedly assessed lifestyle information and genetic data. Estimations were also stratified by age groups (≤65 years, >65 years) and genetic risk groups, defined by the tertiles of the polygenic risk score for CMDs components. Population-attributable fractions and relative risk reduction were calculated to assess the potential benefits of improvement in CVH in preventing CMDs. For participants whose baseline CVH ranged from ideal to poor, an ascending trend was exhibited in the risk of CMDs overall, as well as its individual components. Based on a median of 5.4-year follow-up after the reassessment of CVH, individuals with an enhancement from intermediate to ideal CVH demonstrated a 36% lower risk of CMDs (hazard ratio [HR], 0.64 [95% CI, 0.53-0.77]; P<0.001), compared with those with constantly intermediate CVH, while those deteriorating from intermediate to poor faced a 44% higher risk (HR, 1.44 [95% CI, 1.17-1.78]; P<0.001). Interestingly, changes in CVH exerted a more pronounced impact on CMD risk within younger populations (≤65 years) (Pinteraction=0.006). Notably, among participants with a high genetic risk of ischemic heart disease, those who improved their CVH status from intermediate to ideal exhibited a 50% lower risk of ischemic heart disease (HR, 0.50 [95% CI, 0.34-0.74]; P<0.001), compared with those with constantly intermediate CVH.

CONCLUSIONS

Individuals with better baseline CVH exhibited a lower risk of CMDs. Enhancement in CVH significantly mitigates the risk of CMDs, especially when efforts are made before the age of 65 years and within high genetic risk groups. These findings underscore the importance of interventions aimed at promoting cardiovascular well-being across entire populations, offering valuable insights for targeted preventive strategies and healthcare interventions.

Effects of School-Based Lifestyle Interventions on Cardiovascular Health in Chinese Children and Adolescents: A Post Hoc Analysis of a National Multicenter Study

BACKGROUND

We evaluated the effects of a national school-based lifestyle intervention program against childhood obesity on improving cardiovascular health (CVH), assessed using the recently introduced Life's Essential 8 metric framework.

METHODS AND RESULTS

Our post hoc analysis of the national school-based lifestyle intervention targeting diet and physical activity included 94 schools with eligible students aged 7 to 17 years (intervention group n=30 629; control group n=26 581). We assessed CVH metrics by individual scores for 4 health behaviors (diet, physical activity, nicotine exposure, and body mass index) and 3 health factors (blood lipids, glucose, and pressure). These scores were subsequently combined to calculate the CVH score, health behavior score, and health factor score. The primary outcomes were these 3 composite scores and high CVH (CVH score≥80). All analyses applied a likelihood-based random-effects regression modeling following the intention-to-treat. The school-based lifestyle intervention was associated with a 0.89-point increase in the CVH score (95% CI, 0.03-1.74), 14% greater odds of having high CVH (odds ratio, 1.14 [95% CI, 1.01-1.29]), and a 1.35-point improvement in the health behavior score (95% CI, 0.32-2.38). According to our subgroup analyses, this intervention had stronger favorable effects on CVH and health behavior scores in primary (grades 1-6) and junior (grades 7-9) schools than in senior high (grades 10-12) schools (P<0.001).

CONCLUSIONS

This school-based lifestyle intervention improved CVH behaviors in Chinese children and adolescents. The differences in the intervention effect according to school grade imply critical windows for forming healthy lifestyles at younger ages.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: NCT02343588.

Association Between Sleep Duration and Cardiovascular Disease Among Asian Americans

BACKGROUND

Cardiovascular disease (CVD) prevalence varies widely among Asian American adults. The American Heart Association added healthy sleep to its metrics to define ideal cardiovascular health. Little is known about the association between sleep and CVD prevalence among Asian subgroups. We aim to examine the association between suboptimal sleep duration and CVD risk prevalence among Asian American subgroups.

METHODS AND RESULTS

We used 2012 to 2018 National Health Interview Survey data to examine the association between suboptimal sleep duration and CVD prevalence. We included 6868 self-identifying Asian adults age >40 years (Asian Indian [n=1053], Chinese [n=1415], Filipino [n=1734], and Other Asian [n=2666] adults). Suboptimal sleep was defined as <7 or >9 hours per night. CVD was defined as self-reported stroke, heart attack, coronary artery disease, or angina. Logistic regression was used to calculate odds ratios and 95% CI to estimate the association between suboptimal sleep duration and CVD prevalence. Filipino and Other Asian participants with suboptimal sleep had the highest prevalence of CVD. Aggregated Asian American participants with suboptimal sleep duration had a higher prevalence of CVD (odds ratio [95% CI, 1.35 [1.09-1.68]) compared with those with optimal sleep duration. After stratification by race or ethnicity or both, a significant association persisted for Other Asian participants (1.77 [95% CI, 1.27-2.46]) but not among all other Asian American subgroups.

CONCLUSIONS

Our study highlights the heterogeneity of CVD prevalence associated with suboptimal sleep duration among Asian American adults. Future studies should consider how different measures of sleep duration and quality affect CVD outcomes among disaggregated Asian American subgroups.

Cardiovascular Health Status in US Adults With Chronic Diseases: National Health and Nutrition Examination Survey (NHANES), 2013-2018

BACKGROUND

Cardiovascular health (CVH) assessment may have important benefits for adults with chronic diseases to prevent incident cardiovascular disease and additional chronic conditions. Few studies have compared CVH in adults with chronic diseases and healthy adults without chronic disease using the American Heart Association's (AHA's) Life's Essential 8 (LE8) metrics.

METHODS AND RESULTS

We used National Health and Nutrition Examination Survey data from 2013 to 2018 to identify the presence of 16 chronic diseases by participant self-report of diagnosis. We included adults aged 20 to 79 years. CVH was defined by AHA's LE8 metrics. Overall mean LE8 (range 0-100, higher = better CVH) and individual LE8 metric scores were calculated according to disease status for all participants and stratified by self-identified sex, race, and ethnicity. There were 12 296 adults (51% women; mean age, 46 years) representing >186 million noninstitutionalized US adults. Significantly, and often substantially, lower CVH scores were noted for adults with chronic disease (14 of 16 diseases studied) versus unaffected adults, including all subtypes of cardiovascular disease, lung diseases, chronic kidney disease, liver conditions, cancer, arthritis, cognitive decline, and depression. For example, mean overall LE8 score was 14.0 points lower in those with versus without chronic obstructive pulmonary disease (51.0 versus 65.0, P<0.0001). Men and Black adults consistently had lower LE8 scores.

CONCLUSIONS

CVH is significantly poorer in adults with many chronic diseases compared with unaffected adults. These data suggest the utility of the LE8 score to identify groups for targeted optimization of CVH to enhance primary and secondary prevention efforts for cardiovascular disease and potentially for concomitant chronic diseases of aging.

Cognition and influencing factors of secondary prevention in patients with ischemic stroke 1 year after discharge in Southwest China: a cross-sectional survey

Although the risk of recurrent stroke is very high in patients with ischemic stroke (IS), the implementation of secondary prevention of IS has not received enough attention. Therefore, we aimed to investigate the cognition and compliance status of secondary prevention in patients with IS in southwest China and explore the factors affecting compliance with secondary prevention 1 year after discharge. We conducted a cross-sectional survey of patients with IS 1 year after discharge in southwest China through convenience sampling. Factors affecting the compliance of secondary prevention in patients with IS after discharge were analysed. A total of 1,041 patients were included in our study. Nearly one-third of patients did not follow secondary prevention measures according to the guidelines, and an improvement in lifestyle was even less likely. Living with or without children did not significantly affect patient compliance (odds ratio 1.11; 95% confidence interval 0.83-1.49; p = 0.47). Furthermore, no significant differences were observed in the probability of treatment acceptance between patients experiencing one or two of the following conditions: hypertension, diabetes, and hyperlipidemia, and those with all three conditions. Thus, patients with IS have insufficient compliance with secondary prevention and there is a particular lack of emphasis on lifestyle improvement. Further interventions are needed to improve compliance with secondary prevention in patients with IS, especially patients with all three conditions of hypertension, diabetes, and hyperlipidemia.

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

Background

Life's Essential 8 (LE8) score, developed by the American Heart Association, assesses cardiovascular health using eight components: diet, physical activity, nicotine exposure, sleep health, body mass index, lipids, blood glucose, and blood pressure. Liver function is a critical indicator of overall health, with impairments linked to numerous chronic diseases. While the LE8 score has been extensively studied in relation to cardiovascular outcomes, its association with liver function remains underexplored. Understanding this relationship is crucial for integrating cardiovascular and hepatic health management, particularly given the shared metabolic pathways underlying these systems. This study aims to examine the relationship between LE8 scores and liver function indicators in a large cohort, addressing a critical gap in understanding the interplay between cardiovascular and liver health.

Methods

Data from the 2007-2018 National Health and Nutrition Examination Survey (NHANES) were used in this cross-sectional study. The study included 21,873 participants, stratified into low (0-49), moderate (50-79), and high (80-100) LE8 score categories. The relationship between LE8 scores and liver function markers, including alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), and ALT/AST ratio, was evaluated using multivariable linear regression, smoothed curve fitting, threshold effect analysis, and weighted quantile sum (WQS) regression. Subgroup analyses were performed based on sex and age to assess potential interactions.

Results

Higher LE8 scores were significantly associated with improved liver function, particularly highlighted by two major findings. First, nonlinear associations were observed between LE8 scores and liver function parameters, including ALT and ALT/AST ratio, with stronger effects beyond specific thresholds (ALT: 50.625, ALT/AST: 61.875). Second, subgroup analyses revealed that these associations were more pronounced in younger participants (<60 years), suggesting age-specific differences in the relationship. These age-related differences might be attributed to variations in metabolic function or differences in the severity of cardiovascular and liver-related risk factors between younger and older individuals. WQS regression identified body mass index, blood pressure, blood glucose, and nicotine exposure as the strongest contributors to liver function markers. These findings underscore the potential of LE8 scores as a comprehensive indicator for liver health, particularly in younger populations.

Conclusion

This study suggests that LE8 scores is associated with improved liver function. Clinicians and public health practitioners could consider integrating LE8 scores into routine assessments to help identify individuals at risk for liver dysfunction, particularly among younger populations. Further research should explore whether interventions targeting cardiovascular health could also improve liver function outcomes.

Association between Life's Crucial 9 and overactive bladder: the mediating role of weight-adjusted-waist index

Background

Research suggests a potential connection between cardiovascular health, obesity, and overactive bladder (OAB). However, the mechanisms by which obesity influences the relationship between cardiovascular health and OAB remain unclear. Life's Crucial 9 (LC9) is a recently proposed method for assessing cardiovascular health, while the weight-adjusted waist index (WWI) is a novel and more accurate measure of obesity. This study investigates the relationship between LC9 and OAB and assesses whether WWI moderates this relationship.

Methods

Data for this study came from the National Health and Nutrition Examination Survey (NHANES). We used subgroup analyses, restricted cubic spline curves (RCS), and multivariate logistic regression to explore the relationship between LC9 and OAB. Additionally, mediation analysis was conducted to investigate the potential association between WWI levels and the relationship between LC9 and OAB.

Results

A total of 25,319 participants were included in this study, among which 5,038 reported incidents of OAB. After adjusting for all variables using multivariable logistic regression, an increase of 10 units in LC9 was associated with a 28% reduction in the incidence of OAB (OR = 0.72, 95% CI: 0.69, 0.76), while an increase of one unit in WWI was associated with a 40% increase in the incidence of OAB (OR = 1.40, 95% CI: 1.29, 1.51). Consistent results were also observed when LC9 and WWI were categorized into quartiles, with a P for trend <0.001. The analysis using restricted cubic splines indicated a linear negative correlation between the incidence of OAB and LC9. Mediation analysis revealed that 13.89% of the relationship between LC9 and OAB was mediated by WWI (p = 0.002).

Conclusion

This study found a significant negative correlation between LC9 and OAB, with WWI acting as a partial mediator in this relationship. This study provides new insights for future research into the relationship between LC9 and OAB and the role of WWI as a mediator.

The association between the healthy lifestyle index and MRI-derived body composition measurements in the UK Biobank study

A high healthy lifestyle index (HLI) score, which reflects an adequate amount of sleep, no alcohol consumption, no smoking, a moderate to high physical activity level, a high quality diet, and a normal body mass index (BMI), has been associated with reduced risk of morbidity and mortality. We examined the relationship between the HLI and measurements of adipose and lean tissue volumes measured using magnetic resonance imaging (MRI). We studied 33,002 participants in the UK Biobank study, aged 40-69 years at enrolment. Information on lifestyle components was obtained at the baseline examination (2006-2010), while MRI was performed at a later exam (2014-2020). A multilevel HLI score, constructed by assigning individual scores to each HLI component, was categorized into quartiles in multivariable linear regression analyses. Higher HLI levels were associated with lower levels of body composition parameters (visceral and subcutaneous adipose tissue, total adipose tissue, total lean tissue, muscle fat infiltration, abdominal fat ratio, weight to muscle ratio) in a dose-dependent manner (tests-for-trend p-value < 0.001 for all parameters). When BMI was excluded from the HLI score and included separately in the model, a direct association between HLI score and total lean tissue volume was observed. Higher HLI scores were associated with a better body composition profile.