Association of the American Heart Association's new "Life's Essential 8" with all-cause and cardiovascular disease-specific mortality: prospective cohort study

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

Background

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

Methods

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

Results

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

Conclusions

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

Comparative effectiveness of various exercise interventions on cardiorespiratory fitness in adults living with overweight or obesity: A systematic review and Bayesian network meta-analysis

This study evaluated how different exercise interventions affect maximal oxygen uptake (VO2max) in adults with overweight or obesity. We systematically searched five databases from inception to February 2025 to identify relevant randomized controlled trials (RCTs). We used the Cochrane risk of bias tool. A Bayesian network meta-analysis with a random-effects model was conducted. A total of 93 RCTs involving 4,446 participants were included. The network meta-analysis showed high-intensity interval training (HIIT) ranked highest (Surface Under the Cumulative Ranking Curve [SUCRA]: 82.5%; Standardized Mean Difference [SMD]: 4.85; 95%Credible Interval [CrI]: 3.90, 5.80), followed by high-intensity aerobic training (HAT) (SUCRA: 76.7%; SMD: 4.72; 95%CrI: 3.78, 5.68), and combined aerobic and resistance training (CT) (SUCRA: 69.1%; SMD: 4.52; 95%CrI: 3.48, 5.60), with resistance training (RT) least effective (SUCRA: 18.3%; SMD: 2.57; 95%CrI: 1.32, 3.86). All six interventions effectively improved VO2max in overweight or obese adults. Among them, HIIT was most beneficial. Coaches and fitness professionals should consider these findings to help adults with overweight or obesity achieve optimal outcomes.

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

BACKGROUND

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSION

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

Life's Essential 8 cardiovascular health, cardiovascular-kidney-metabolic syndrome stages, and incident cardiovascular events: a nationwide 10-year prospective cohort study in China

BACKGROUND

Definition and staging rationale of cardiovascular-kidney-metabolic syndrome were developed. The utility of cardiovascular-kidney-metabolic construct in risk stratification and target strategies of health and behavior modifications needs to be addressed. The study aims to investigate the individual and combined associations of cardiovascular-kidney-metabolic stage and cardiovascular health (CVH) by Life's Essential 8 (LE 8) with incident cardiovascular events (CVD), and determine the distribution and contribution of domain-specific CVH across cardiovascular-kidney-metabolic stages.

METHODS

The study included 100,727 individuals in the China Cardiovascular Disease and Cancer Cohort with complete data on cardiovascular-kidney-metabolic factors and LE 8 metrics, with a median follow-up of 10.1 years. Cardiovascular-kidney-metabolic stages and CVH metrics (nicotine exposure, diet, physical activity, sleep, body mass index, blood lipids, blood pressure, blood glucose) were defined according to Presidential Advisory from the American Heart Association. Incident CVD events including cardiovascular death, myocardial infarction, and stroke were validated. The Fine-Gray hazard model was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of CKM stages or CVH status associated with CVD.

RESULTS

Compared with cardiovascular-kidney-metabolic stage 0, the adjusted competing HRs and 95% CIs of CVD events were 1.20 (0.95-1.51), 2.45 (1.97-3.04), 4.43 (3.53-5.58), and 5.95 (4.75-7.45) from stage 1 to stage 4, respectively. Optimal CVH status and each optimal CVH metric presented a significantly decreased risk of CVD events. Variation was observed in the association between cardiovascular-kidney-metabolic stage and CVD events with different CVH status or numbers of optimal CVH metrics. Compared with those in stage 0, Participants in stage 1 or 2 with optimal CVH no longer had elevated risks for incident CVD events. Suboptimal health factor contributed larger population attributable fractions to CVD events in cardiovascular-kidney-metabolic stage 0-2 (51.2%) than in stage 3-4 (25.2%), whereas suboptimal health behavior exhibited larger contribution in advanced stages (13.1% in stage 0-2 and 18.2% in stage 3-4).

CONCLUSIONS

The study indicated that cardiovascular-kidney-metabolic stage was associated with cardiovascular events, and optimal cardiovascular health could attenuate this risk. Health factor contributed predominantly at the early-stage, whereas health behavior exhibited consistent and slightly increased contribution along the spectrum. These findings support the utility of cardiovascular-kidney-metabolic construct and highlight the importance of target health improvement based on LE 8 framework.

Gender differences in the association between Life's essential 8 and cardiovascular disease: a U.S.-based cross-sectional analysis

BACKGROUND

This research aims to elucidate the gender differences in the association between cardiovascular disease (CVD) prevalence and Life's Essential 8 (LE8), a recently updated measure of cardiovascular health (CVH).

METHODS

This study included participants from the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2018.The scores of LE8, health behavior, health factor and each metric based on diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipid, blood glucose, and blood pressure were classified as low (0-49 points), moderate (50-79 points), and high (80-100 points). The scores of LE8, health behavior and health factor as continuous variables were also used for dose-response analysis. The main outcomes included the prevalence of CVD. The definition of CVD based on self-reported history of coronary heart disease or stroke.

RESULTS

A total of 23,307 individuals were included in this analysis. Participants with CVD had significantly lower LE8 scores compared to those without CVD, and females demonstrated higher CVH levels compared to males including total LE8 scores and the scores of diet, nicotine exposure, blood lipid, blood glucose, and blood pressure (P < 0.05). Moreover, the LE8 score demonstrated a non-linear association with CVD in both males and females (all P-values for non-linearity were < 0.001). Furthermore, compared to the low LE8 level, a high LE8 level was associated with a 78% decreased risk of CVD in males (HR: 0.22, 95% CI: 0.16-0.31) and an 83% decreased risk in females (HR: 0.17, 95% CI: 0.11-0.26). Consistently, compared to low levels of health behaviors and health factors, higher levels were significantly associated with a decreased risk of CVD in both males and females (All P < 0.001). Additionally, the area under the curve (AUC) for the total LE8 score in CVD discrimination was significantly higher in females than in males (P < 0.001).

CONCLUSION

Higher CVH scores were associated with a lower risk of CVD, especially in females. These findings highlight the need for gender-specific preventive strategies in CVH promotion, with a particular focus on improving LE8 scores in high-risk populations.

Oxidative stress and inflammation mediate the association between Life's Crucial 9 and biological ageing: A secondary analysis of two observational studies

BACKGROUND

Life's Essential 8 (LE8) is known to have a negative correlation with biological aging, while the relationship between the Life's Crucial 9 (LC9) score, which includes mental health, and biological aging remains to be further investigated.

METHODS

We obtained data from two national cohorts, the UK Biobank and National Health and Nutrition Examination Survey (NHANES), to analyze the association between LC9 and biological aging. Biological aging was assessed using PhenoAge and KDMAge, with gender, race, and other indicators included as covariates. We applied linear regression models and restricted cubic splines (RCS) to analyze and describe the relationship. Furthermore, we explored the mediating role of oxidative stress and inflammation in the association between LC9 and biological aging. Subgroup analyses were conducted using multiple linear regression models, and differences between subgroups were assessed through interaction p-value tests. Sensitivity analyses were subsequently performed, followed by an exploration of the underlying mechanisms.

RESULTS

In this study, the UK Biobank cohort included 46,599 participants, with 44,973 participants having complete data for all covariates, LC9, and the necessary calculations for PhenoAge and KDMage. In the NHANES cohort, these numbers were 11,726 and 5,936, respectively. In the UK Biobank cohort, a significant association was found between the LC9 score and PhenoAge (β = -2.484, p < 0.001), with similar results observed for KDMage (β = -7.987, p < 0.001). Similar findings were observed in the NHANES cohort, with significant associations between the LC9 score and both PhenoAge (β = -5.327, p < 0.001) and KDMAge (β = 11.826, p < 0.001). These findings align with previous research suggesting that higher LC9 scores are associated with slower biological aging. After multivariable adjustment, an "inverse L-shaped" relationship was observed (non-linear P < 0.001). In the mediation analysis, oxidative stress and inflammation showed significant mediating effects between LC9 and both PhenoAge and KDMage (p < 0.001 for both). In the subgroup analysis, the LC9 score showed broad applicability, particularly among male participants aged over 60 years.

CONCLUSION

This cohort study suggests that higher LC9 scores are associated with slower biological aging. In addition to emphasizing diet and lifestyle habits, the role of mental health in biological aging should not be overlooked.

Psychosocial factors and associations with preventive cardiovascular screening among U.S adults: Findings from the National Health Interview Survey, 2023

OBJECTIVE

Structural and COVID-related factors have been linked with the decline in preventive health screenings among adults. However, associations between psychosocial factors and undergoing preventive cardiovascular screening are not fully known. The current study examined associations between psychosocial factors and preventive cardiovascular screening among U.S. adults.

METHODS

We used data from the 2023 National Health Interview Survey (N = 23,428). Data were collected from January to December from adults living in U.S. Preventive cardiovascular (CV) screening (i.e., blood pressure, cholesterol, or blood sugar level) was defined as no screening, and undergoing screening for any CV risk within the past year. Psychosocial factors were defined as discrimination, life satisfaction, and depression. Multivariable logistic regression models examined the associations between psychosocial factors and preventive cardiovascular screening, adjusted for sociodemographic characteristics.

RESULTS

Adults with diagnosis of depression (OR: 1.93, 95 % CI: 1.65-2.25) had higher odds of undergoing screening for any CV risk. Adults who experienced discrimination had lower odds of undergoing screening for cholesterol (OR: 0.77, 95 % CI: 0.71-0.84) and blood sugar level specifically (OR: 0.78, 95 % CI: 0.72-0.85), while life dissatisfaction was associated with lower odds of screening for blood pressure (OR: 0.76, 95 % CI: 0.58-0.99) and blood sugar level specifically (OR: 0.80, 95 % CI: 0.65-0.97).

CONCLUSIONS

Discrimination and life dissatisfaction were associated with decreased odds of undergoing specific preventive cardiovascular screening, and depression is associated with increased odds of undergoing any preventive cardiovascular screening. Equitable health care policies focused on addressing psychosocial factors are needed to increase preventive cardiovascular screening among U.S. adults.

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

OBJECTIVES

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

STUDY DESIGN

Prospective cohort study.

METHODS

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

RESULTS

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

CONCLUSIONS

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

Association of polysocial risk score, cardiovascular health status, and the risk of premature mortality: Findings from the UK Biobank

BACKGROUND

Evidence of the cumulative effects of social risk factors on premature mortality is quite limited. We aimed to examine the association between cumulative social risk factors and premature mortality by constructing a polysocial risk score, and to explore the influence of cardiovascular health on this association.

METHODS

A polysocial risk score was constructed by summing 11 social determinants of health. A cardiovascular health (CVH) score was calculated following the algorithm of "Life's Essential 8". Premature mortality was defined as death at an age younger than 75. Cox proportional hazards model was conducted.

RESULTS

A total of 314,039 participants in the UK Biobank were included (median age 56.0 years, 53.1% women). During a median of 12.7 years of follow-up, 13,888 premature deaths were reported. Compared with participants who had a low polysocial risk score (≤3), participants with a high polysocial risk score (≥7) were more than twice as likely to die prematurely in the follow-up period (HR 2.18, 95% CI 2.06-2.30). Compared with participants with ideal CVH and low polysocial risk score, those with poor CVH and high polysocial risk score had the highest risk of premature mortality (HR 5.25, 95% CI 4.48-6.14). A significant interaction was found between CVH status and polysocial risk score on premature mortality risk (P for interaction <0.001).

CONCLUSIONS

Polysocial risk score was associated with an increased risk of premature mortality, the association was exacerbated by poor CVH. Our findings indicate that limiting social inequities and encouraging people to achieve an ideal CVH are essential to reducing the burden of premature mortality.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Mediating Effect of Established Risk Factors on Association Between Social Determinants and Cardiovascular Disease Mortality

BACKGROUND

Social determinants of health (SDOH) contribute to increased cardiovascular disease (CVD) mortality.

OBJECTIVES

The authors investigated the mediating effects of behavioral and clinical risk factors in the association between SDOH and CVD mortality.

METHODS

A total of 50,808 National Health and Nutrition Examination Survey participants aged ≥20 years were included in this analysis. Data on social, behavioral, and clinical risk factors were collected in each National Health and Nutrition Examination Survey, and CVD deaths were ascertained through linkage to the National Death Index with follow-up through 2019. Multiple mediation analysis was used to examine the contributions of behavioral and clinical risk factors to the SDOH-CVD mortality association.

RESULTS

The mean age of participants was 47.2 years, and 48.8% were male. A dose-response association between the number of SDOH and CVD mortality was identified. Individuals with a composite SDOH score ≥ median have a 2.13-fold increased risk of CVD mortality (95% CI: 1.91-2.37) compared to those with a score < median. After adjusting for behavioral and clinical risk factors, the HR was reduced to 1.67 (95% CI: 1.50-1.86). Current smoking (relative contribution 11.4%; 95% CI: 8.1%-14.8%), physical inactivity (7.7%; 95% CI: 4.9%-10.6%), chronic kidney disease (5.5%; 95% CI: 3.8%-7.1%), diabetes (2.0%; 95% CI: 1.1%-2.9%), and unhealthy sleep duration (1.8%; 95% CI: 0.3%-3.3%) significantly mediated the association between CVD mortality and unfavorable SDOH. In aggregate, behavioral and clinical risk factors mediated 30.8% (95% CI: 24.2%-37.5%) of the overall CVD mortality attributable to unfavorable SDOH.

CONCLUSIONS

Behavioral and clinical risk factors partially mediate the association between unfavorable SDOH and increased CVD mortality.

Lifestyle changes for cardiometabolic health: Planting the seeds for long-term benefit

With nearly three-quarters of global deaths attributed to lifestyle-associated diseases, effective lifestyle modifications are more urgent than ever. The American Heart Association's framework for cardiovascular health has evolved significantly, transitioning from 'Life's Simple 7' to 'Life's Essential 8' with the incorporation of sleep, and further to 'Life's Essential 9' by adding mental health as a key component. Despite these advancements, recent evidence reveals a persistently low prevalence of ideal cardiovascular and cerebrovascular health behaviors across populations. These findings highlight the critical gap in addressing modifiable lifestyle and psychosocial factors. To reduce the global disease burden, public health strategies must prioritize comprehensive interventions that encompass physical, neurological, and mental well-being.

Cumulative Life's Essential 8 Scores and Cardiovascular Disease Risk

Importance

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

Objective

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

Design, Setting, and Participants

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

Main Outcomes and Measures

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

Results

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

Conclusions and Relevance

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

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

OBJECTIVES

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

DESIGN

A cross-sectional study.

SETTING AND PARTICIPANTS

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

MEASUREMENTS

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

RESULTS

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

CONCLUSIONS

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

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

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

The Role of Psychological Health in Cardiovascular Health: A Racial Comparison

Purpose: Modifiable health factors influence racial disparities in cardiovascular health (CVH), yet the role of psychological health in these disparities remains understudied. This study examines (1) the association between negative and positive psychological health measures and CVH and (2) the racial differences in these associations among US adults. Methods: Aim 1 included adults aged 34-84 from the MIDUS biomarker substudy (n = 1255). Aim 2 included adults aged 28-84 from the MIDUS parent study (N = 4702). Our outcome was CVH, operationalized as the AHA's Life's Essential 8 (LE8) total score, behavior, and health factor subscores. Negative psychological health was operationalized as depressive symptoms (CES-D), stress reactivity (from the Multidimensional Personality Questionnaire [MPS]), aggression (from the MPS), pessimism (Life Orientation Test), perceived stress (Perceived Stress Scale), and trait anxiety (Spielberger Trait Anxiety Inventory); positive psychological health was operationalized as psychological well-being ("PWB"; Ryff Well-Being Scale [WBS] and MPS), purpose in life (from the WBS), mindfulness (developed by MIDUS), gratitude (developed by MIDUS), and optimism (Life Orientation Test). Results: In covariate-adjusted models, most negative psychological health factors were negatively associated with LE8 total scores and health behavior subscores. Of those, pessimism was the only factor to demonstrate Black-White differences (Black > White, p < 0.001). Positive psychological health factors were less consistently associated with the LE8 total, health behavior, and health factor subscores in covariate-adjusted models. Of these, PWB (Black > White, p < 0.001), gratitude (Black > White, p < 0.001), and optimism (Black > White, p < 0.001) demonstrated significant differences by race. Conclusions: Black-White differences in LE8 are not largely explained by differences in psychological health.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

AIMS

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

METHODS AND RESULTS

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

CONCLUSION

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

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

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

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

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

Association of Life's Essential 8 with incidence of heart failure modified by depressive symptoms: a prospective cohort study from UK Biobank

BACKGROUND

The Life's Essential 8 (LE8) proposed by the American Heart Association for assessing cardiovascular health (CVH) has been demonstrated to be associated with cardiovascular disease, but rarely includes heart failure (HF), and the role of psychological factors has not been considered. We aimed to prospectively investigate the independent, joint, and interactive associations of LE8 and depressive symptoms with HF incidence.

METHODS

A total of 336,939 participants recruited from UK Biobank without HF, coronary heart disease, and stroke were included in the cohort study. The LE8 score consisted of four behavioral (diet, physical activity, nicotine exposure, and sleep) and four biological factors (glucose, blood lipids, blood pressure, and body mass index) and was classified into three levels: low, moderate, and high CVH. Depressive symptoms at baseline were identified by self-report and linkage to medical records. Incident HF cases during follow-up were extracted through primary care, hospital admissions, self-reports, and death registrations. Cox proportional hazard models were conducted to examine the associations of LE8 and depressive symptoms with HF incidence, with findings presented as hazard ratios (HRs) (95% confidence interval, CI).

RESULTS

A total of 9379 (2.8%) participants developed HF during a median follow-up of 13.6 years. Compared with low-CVH individuals, the multivariate-adjusted HRs with 95% CI for incident HF were 0.596 (0.565-0.629) and 0.458 (0.408-0.514) in those with moderate and high CVH, respectively. Per standard deviation increment in LE8 was associated with a 25.5% (HR = 0.745; 95% CI: 0.729-0.762) lower risk of HF. The stratification analysis indicated that the detrimental effect of low CVH on HF was more pronounced in participants with depressive symptoms compared to those without, with a significant multiplicative interaction (P for multiplicative interaction = 0.016). The joint test showed that the lowest risk of HF was observed in participants with high CVH and no depressive symptoms (HR = 0.344; 95% CI: 0.295-0.401), which may be attributed to a significant additive interaction observed.

CONCLUSIONS

The cohort study revealed that LE8-defined CVH not only could predict the incidence of HF, but also mitigate the increased risk of HF attributable to depressive symptoms. Achieving the high LE8 scores recommended by the AHA to improve CVH will be beneficial in reducing the population burden of HF, especially among patients with depressive symptoms.

Insights into associations between Life's essential 8 and lung function from NHANES data

The Life's Essential 8 (LE8) is a novel indicator of cardiovascular health proposed by the American Heart Association. While numerous studies have demonstrated its guiding value in chronic diseases, research on its role in lung function remains limited. This study utilized data from the National Health and Nutrition Examination Surveys (NHANES 2007-2012), which included comprehensive measurements of lung function, diet, physical activity, nicotine exposure, sleep patterns, body mass index (BMI), blood glucose, blood pressure, blood lipids, and relevant covariates. We calculated lung function Z-score and LE8 scores, employing multiple linear regression, multivariable logistic regression, and restricted cubic spline models to evaluate their correlations. In this study of 10,400 participants (mean age 44 years; 48.75% male), participants were classified into threeforcedexpiratory volume in one second (FEV1) Z-score groups: Z1 (normal lung function, n = 9,600), Z2 (mild impairment, n = 618), and Z3 (moderate to severe impairment, n = 182). Significant differences in demographic characteristics and health parameters were observed among the groups. Notably, variations in the Healthy Eating Index 2015 (HEI-2015), physical activity, nicotine exposure, and sleep patterns were identified within the LE8 health behavior domain. Higher LE8 scores were found to be positively associated with lung function, even after adjusting for demographic and health factors. Further analysis revealed positive correlations between lung function and favorable dietary habits, higher physical activity levels, reduced nicotine exposure, and improved sleep quality. Conversely, BMI, blood lipids, blood glucose, and blood pressure exhibited variable effects. Subgroup and sensitivity analyses consistently supported findings, confirming a positive correlation between LE8 and lung function. Our study highlights significant associations between LE8 scores and lung function, demonstrating that higher LE8 scores, which reflect better cardiovascular health behaviors, are positively correlated with improved lung function.

Can cardiovascular health and its modifiable healthy lifestyle offset the increased risk of all-cause and cardiovascular deaths associated with insulin resistance?

BACKGROUND

Insulin resistance(IR) is associated with an increased risk of all-cause and cardiovascular death, and modifiable healthy lifestyles play an active role in the improvement of IR and the reduction of all-cause and cardiovascular death. Whether cardiovascular health (CVH) and modifiable healthy lifestyles within it can attenuate or even offset the heightened perils of both all-cause and cardiovascular deaths associated with insulin resistance remains unclear.

METHODS

The study encompassed 14,172 healthy participants from the 2005-2018 NHANES programme. Insulin resistance was evaluated using the TyG index, TyG-WC, and TyG-WHtR, while CVH was assessed employing the LE8 score, in addition to the LE4 index redefined according to four health behaviours. Weighted multifactor Cox regression models were used to assess the association of IR and CVH with all-cause and cardiovascular mortality, and dose-response relationships were assessed using restricted cubic spline. Furthermore, subjects were grouped according to IR and CVH scores, and generalised linear models were used to estimate the weighted mortality and risk of death for each group and to calculate the absolute risk difference. Finally, the predicted probability of all-cause and cardiovascular mortality risk as a function of IR was computed, and the complex relationship between the three was visualised using two-dimensional grouped scatter plots and three-dimensional surface plots.

RESULTS

Among the 14,172 healthy participants included in the study, 1534 deaths occurred over a mean follow-up period of 7.6 years (382 of these deaths were due to cardiovascular causes). The weighted Cox regression analysis indicated that elevated TyG-WC and TyG-WHtR correlated with a greater likelihood of mortality from all causes and cardiovascular events, whereas cardiovascular health was inversely associated with these risks. Additional stratification revealed a notable reduction in the likelihood of mortality from all causes and cardiovascular events as cardiovascular health improved, irrespective of the presence of insulin resistance. Additionally, participants with high insulin resistance but moderate or high cardiovascular health did not have significantly increased risks compared with those with low insulin resistance. Stratified scatter plots and 3D surface plots revealed that cardiovascular health and modifiable healthy lifestyles significantly reduced the risk of insulin resistance-related death, with greater reductions observed at higher insulin resistance levels.

CONCLUSIONS

In this cohort study, improving cardiovascular health and modifiable health behaviors significantly reduced the risk of insulin resistance-related all-cause and cardiovascular deaths. Maintaining cardiovascular health at moderate or high levels (LE8 ≥ 50) could offset the increased risks caused by insulin resistance.

Association between cardiometabolic index and biological ageing among adults: a population-based study

BACKGROUND

Cardiovascular health (CVH) is closely associated with ageing. This study aimed to investigate the association between cardiometabolic index (CMI), a novel indicator of cardiometabolic status, and biological ageing.

METHODS

Cross-sectional data were obtained from participants with comprehensive CMI and biological age data in the National Health and Nutrition Examination Survey from 2011 to 2018. Biological age acceleration (BioAgeAccel) is calculated as the differences between biological age and chronological age, and that biological age is derived from a model incorporating eight biomarkers. Weighted multivariable regression, sensitivity analysis, and smoothing curve fitting were performed to explore the independent association between CMI and the acceleration of biological age. Subgroup and interaction analyses were performed to investigate whether this association was consistent across populations.

RESULTS

In 4282 subjects ≥ 20 years of age, there was a positive relationship between CMI and biological age. The BioAgeAccel increased 1.16 years for each unit CMI increase [1.16 (1.02, 1.31)], and increased 0.99 years for per SD increase in CMI [0.99 (0.87, 1.11)]. Participants in the highest CMI quartile had a BioAgeAccel that was 2.49 years higher than participants in the lowest CMI quartile [2.49 (2.15, 2.83)]. In stratified studies, the positive correlation between CMI and biological age acceleration was not consistent across strata. This positive correlation was stronger in female, diabetes, and non-hypertension populations.

CONCLUSIONS

CMI is positively correlated with biological ageing in adults in the United States. Prospective studies with larger sample sizes are required to validate our findings.

A good night's rest: A contemporary review of sleep and cardiovascular health

Sleep is increasingly recognized as a significant contributor to the development of cardiovascular disease (CVD). Recent American Heart Association guidelines incorporate sleep duration into the "Life's Essential Eight" framework of ideal cardiovascular health. This article will review the evidence relating sleep duration, regularity, and quality with all-cause and cardiovascular mortality, cardiometabolic syndrome, and coronary artery disease in adults. Short sleep duration is strongly associated with cardiovascular mortality, cardiometabolic risk factors, and coronary artery disease. Limited studies also suggest a possible U-shaped association, with long sleep duration also associated with greater cardiovascular risk. Sleep regularity has emerged as a strong and independent risk factor for CVD-related mortality, cardiometabolic syndrome, and subclinical atherosclerosis. Less is known about the impact of sleep quality on CVD, though a number of observational studies suggest a possible association with metabolic syndrome and subclinical atherosclerosis. This review provides an update of the literature on the cardiovascular impact of sleep for the everyday clinician and highlights gaps in knowledge that warrant future research.

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

Background

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

Objectives

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

Methods

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

Results

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

Conclusion

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Associations of total, domain-specific, and intensity-specific physical activity with all-cause and cause-specific mortality in China: A population-based cohort study

BACKGROUND

Evidence of an association between physical activity (PA) and mortality has mainly focused on leisure-time physical activity (LTPA) and moderate-to-vigorous-intensity physical activity (MVPA). We aimed to assess the associations of total, domain-specific, and intensity-specific PA with all-cause and cause-specific mortality.

METHODS

We used baseline PA data from the China Kadoorie Biobank, including 482,067 participants aged 30-79 years from 10 areas in China. PA via self-report was quantified as a metabolic equivalent of task hours per day. Total PA was calculated by summing occupational, commuting, household, and leisure-time PA, and domain- and intensity-specific PAs were also calculated. Cox regression was used to estimate the associations of quintiles of different types of PA with all-cause and cause-specific mortality and adjust for potential confounders. Cause-specific mortalities were also examined in a competing risk analysis.

RESULTS

During a median follow-up of 12.1 years, 47,281 deaths occurred. Total PA was inversely associated with the risk of all-cause mortality, with a hazard ratio (HR) (95% confidence interval [95% CI]) of 0.69 (0.67-0.71) in the highest quintile as compared with the lowest quintile. Similar associations were observed for disease-specific mortality risks from cardiovascular disease, cancer, respiratory disease, diabetes, and nervous system disease, with HR (95% CI) for top vs. bottom quintile of PA of 0.68 (0.64-0.71), 0.80 (0.76-0.83), 0.39 (0.35-0.44), 0.44 (0.35-0.55), and 0.52 (0.38-0.73), respectively. In addition, the risk of all-cause mortality was lowered by 34%, 13%, 17%, and 30% for occupational PA, non-occupational PA, low-intensity PA, and MVPA, respectively, when comparing the highest quintile with the lowest quintile.

CONCLUSIONS

PA was inversely associated with the risk of all-cause and cause-specific mortality, regardless of domain and intensity. Any PA can bring long-term beneficial health effects.

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

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

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

AIMS

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

METHODS AND RESULTS

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

CONCLUSION

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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 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.

Life's Essential 8, genetic susceptibility, and risk of incident pancreatic cancer: A prospective cohort study

The association between the American Heart Association (AHA) Life's Essential 8 (LE8) and the risk of pancreatic cancer (PC) remains unclear. Our goal was to assess the relationships between LE8, genetic susceptibility, and PC risk. This cohort consisted of 234,102 participants from the UK Biobank. The components of LE8 include diet, nicotine exposure, sleep, physical activity, blood glucose, body mass index, blood lipids, and blood pressure. LE8 is classified into three categories: low cardiovascular health (CVH), moderate CVH, and high CVH. Measurements were made using Cox proportional risk models to estimate impact of associations between LE8, genetic susceptibility, and incidence of PC in participants. Compared to participants with low LE8 scores, those with moderate and high LE8 scores had a 53% (HR, 0.47; 95% CI, 0.39-0.57) and 70% (HR, 0.30; 95% CI, 0.22-0.41) lower risk of developing PC, respectively. Interestingly, among individuals with high genetic risk, high LE8 scores were associated with greater benefits (HR, 0.24; 95% CI, 0.15-0.40), whereas the protective effect was weaker among those with low genetic risk (HR, 0.40; 95% CI, 0.21-0.75). Participants with a high LE8 score and a low polygenic risk score (PRS) had the lowest risk of PC (HR, 0.19; 95% CI: 0.11-0.33). Furthermore, we observed a significant additive interaction between LE8 and PRS. A higher LE8 score is associated with a lower risk of PC, especially for participants with a high PRS. These findings have important implications for participants most genetically predisposed to PC and for targeted strategies for PC prevention.

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.

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.

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.

Association of steatotic liver disease with all-cause and cardiovascular mortality among prehypertensive or hypertensive patients

Background

Prehypertension and hypertension often coexist with non-alcoholic fatty liver disease (NAFLD) during the progression of cardiovascular disease (CVD). International academic liver societies have recently reached a consensus to replace NAFLD with the new term 'steatotic liver disease' (SLD). In this study, we aimed to evaluate the impact of different SLD subtypes on all-cause and CVD mortality in individuals with prehypertension or hypertension.

Methods

We included 6074 adults from the National Health and Nutrition Examination Survey (2003-18). The US fatty liver index was used as the diagnostic criterion for SLD, and participants were classified into no SLD, metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic dysfunction-associated and alcohol-related liver disease (MetALD), and alcohol-related liver disease (ALD). For cases of MASLD, MetALD, and ALD, we further assessed advanced fibrosis using the fibrosis-4 (FIB-4) index. Additionally, we calculated hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox proportional hazards regression models to assess the associations of SLD subtypes and advanced fibrosis with all-cause and CVD mortality.

Results

There were 3505 (57.7%) participants with no SLD, 1284 (21.1%) with MASLD, 777 (12.8%) with MetALD, and 508 (8.4%) with ALD. During a median follow-up period of 8.2 years, the risk of all-cause and CVD mortality progressively increased in participants with MASLD (HR = 1.28; 95% CI = 1.01-1.63 and HR = 1.55; 95% CI = 1.04-2.33, respectively), MetALD (HR = 1.41; 95% CI = 1.05-1.88 and HR = 1.78; 95% CI = 1.10-2.87, respectively), and ALD (HR = 1.83; 95% CI = 1.32-2.53 and HR = 1.80; 95% CI = 1.01-3.19, respectively). Among the individuals with MASLD, MetALD, and ALD, advanced fibrosis was also associated with an increased risk of all-cause and CVD mortality.

Conclusions

Individuals with MASLD, MetALD, and ALD had a higher risk of all-cause and CVD mortality than those without SLD. Therefore, early intervention strategies targeting SLD prevention and management may help individuals with prehypertension and hypertension to improve their long-term health.

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.

Predicted Heart Age and Life's Essential 8 Among U.S. Adults: NHANES 2015-March 2020

INTRODUCTION

This study examined the association between American Heart Association's (AHA) cardiovascular health (CVH) metrics, Life's Essential 8 (LE8), and predicted heart age among U.S. adults.

METHODS

The sample comprised 7,075 participants aged 30-74 years without CVD and/or stroke from the National Health and Nutrition Examination Survey (NHANES) 2015-March 2020. LE8 was measured according to AHA's metrics (overall score ranging from 0 to 100 points), and nonlaboratory-based Framingham Risk Score was used to estimate predicted heart age. Analyses were completed in June 2024.

RESULTS

Median LE8 scores were 62.8 for men and 66.0 for women. Over 80% of participants had less than optimal CVH scores, affecting 141.5 million people and 1-in-6 participants had a low CVH score, impacting 30.0 million people. Mean predicted heart age and excess heart age (EHA, difference between actual and predicted heart age) were 56.6 (95% CI 56.1-57.1) and 8.6 (8.1-9.1) years for men and 54.0 (53.4-54.7) and 5.9 (5.2-6.5) years for women. Participants in the low CVH group (scores<50), had an EHA that was 20.7 years higher than those in the high CVH group (score 80-100). Compared to the high CVH group, participants in low CVH group had 15 times (for men) and 44 times (for women) higher risk of having EHA ≥10 years. The pattern of differences in predicted heart age, EHA, and prevalence of EHA ≥10 years by LE8 groups remained largely consistent across subpopulations.

CONCLUSIONS

These findings highlight the importance of maintaining a healthy lifestyle to improve cardiovascular health and reduce excess heart age.

Association of life's essential 8 with all-cause and cause-specific mortality in metabolic dysfunction-associated steatotic liver disease

The American Heart Association has updated the cardiovascular health (CVH) assessment tool, referred to as the Life's Essential 8 (LE8). Metabolic dysfunction-associated steatotic liver disease (MASLD) is now the most common chronic liver disease worldwide and is linked to an elevated risk of mortality. We aimed to explore the association of LE8 with all cause and cause-specific mortality in MASLD in a prospective cohort study. A total of 10,050 participants with MASLD from the NHANES 2005-2018 dataset were included in the study. LE8 was evaluated by combining four health behaviors and four health factors, with scores of 0-49 categorized as low CVH, 50-79 as moderate CVH, and 80-100 as high CVH. In the fully adjusted model, each one-point increase in the LE8 score corresponded to a 2.7, 2.7, and 1.6% decrease in all-cause, CVD, and cancer mortality risk, respectively, in people with MASLD. Compared to low CVH, being in moderate/high CVH was negatively associated with most mortality outcomes, while health factors lost significant association with cancer mortality.

The association between cardiovascular health and obstructive sleep apnea symptoms: findings from NHANES

Objective

To investigate the association between cardiovascular health (CVH) and obstructive sleep apnea (OSA) within the U.S. population.

Methods

This study enrolled 12,540 participants aged 20 years and older from the 2007-2008 and 2015-2018 cycles of the National Health and Nutrition Examination Surveys (NHANES). Weighted univariate and multivariate logistic regression were utilized to examine the relationship between CVH and OSA symptoms. Life's Essential 8 (LE 8) metrics was employed to evaluate the CVH status of participants. Identification of OSA symptoms was determined based on a sleep questionnaire. They include (1) how often you snore; (2) how often you snort/stop breathing; or (3) how often you feel overly sleepy during day. Individuals who answered that they snore 3 or more per week; snort/stop breathing 3 or more per week and feel overly sleepy during day 16-30 times per month were classified as having OSA symptoms.

Results

Significant inverse associations were observed between LE8 scores and symptoms of OSA after adjusting for covariates. The 95% CI was 0.750 (0.630,0.893) for the moderate CVH group and 0.573 (0.454,0.723) for the high CVH group. Subgroup analyses, stratified by age and gender, highlighted a significant interaction between LE8 scores and OSA symptoms with age (P < 0.0001). Participants under 60 years old in the high CVH group exhibited a reduced likelihood OSA symptoms (OR: 0.470; 95% CI: 0.345,0.641). Restricted cubic splines (RCS) in a multivariate regression analysis showed a non-linear relationship between LE8 score and OSA. Our finding demonstrates a substantial decrease in OSA symptom prevalence with increased LE 8 scores.

Conclusion

The results demonstrate a strong inverse correlation between LE8 scores and OSA symptoms. Participants with higher LE8 scores showed a reduced likelihood of experiencing OSA symptoms.

Life's essential 8 and mortality in US adults with metabolic dysfunction-associated steatotic liver disease

BACKGROUND

Metabolic dysfunction-associated steatotic liver disease (MASLD) is linked to increased all-cause mortality due to metabolic dysfunctions like obesity, diabetes, and cardiovascular diseases. This study examines the association between Life's Essential 8 (LE8) scores and both all-cause and cardiovascular disease (CVD) mortality in MASLD participants.

METHODS

Data from 5,916 MASLD participants in the NHANES (2005-2018) were analyzed. Associations between LE8 scores and all-cause and CVD mortality were assessed using Cox proportional hazards models, with follow-up until December 31, 2019. Dose-response relationships and survival differences were evaluated using Kaplan-Meier survival curves and Restricted Cubic Spline models.

RESULTS

Over a median follow-up of 7.6 years, moderate and high LE8 scores were associated with 33% (HR: 0.67; 95% CI: 0.56-0.79) and 47% (HR: 0.53; 95% CI: 0.33-0.84) lower risk of all-cause mortality, respectively, compared to low scores. For CVD mortality, the adjusted HRs were 0.56 (95% CI: 0.41-0.78) and 0.35 (95% CI: 0.12-1.0). Higher LE8 scores were significantly associated with reduced cumulative incidence of all-cause and CVD mortality (log-rank P < 0.001). A 10-point increase in health behavior scores, particularly in diet, physical activity, and nicotine exposure, was linked to an 11% reduction in all-cause mortality risk and an 11% reduction in CVD mortality risk. Among health factors, only blood glucose showed a significant association with CVD mortality.

CONCLUSION

Higher LE8 scores in MASLD patients are associated with lower mortality risk, suggesting the potential value of promoting cardiovascular health in this population. Further research is needed to confirm these associations.

Lifestyle Factors and Associations with Individual and Comorbid Cardiometabolic and Pulmonary Disease Among U.S. Adults

BACKGROUND

Although lifestyle factors have been linked to chronic diseases among adults, their association with diagnosed individual and comorbid cardiometabolic (CMD) and pulmonary disease (PD) is not fully known. This study aimed to examine the associations between lifestyle factors and individual and comorbid CMD and PD among U.S. adults.

METHODS

We used cross-sectional data from the 2017-2020 National Health and Nutrition Examination Survey (n = 7394). Health care provider's diagnosis of CMD and PD and lifestyle factors (i.e., past 5-day tobacco use, past 12-month alcohol use, diet, sleep troubles, and physical activity) were assessed. Adjusted odds ratios were estimated using logistic and multinomial logistic regression.

RESULTS

Trouble sleeping was associated with increased odds of CMD (OR: 2.47) and PD (OR: 2.29) individually, while physical activity was associated with lower odds (OR: 0.75, OR: 0.77). Past 5-day tobacco (OR: 2.36) and past year alcohol (OR: 1.61) use were associated with increased PD odds. Lifestyle factors were associated with increased odds of comorbid CMD and PD.

CONCLUSIONS

Lifestyle factors were associated with increased odds of individual and comorbid CMD and PD among adults. CMD and PD prevention should involve promoting lifestyle modification and implementation of policies that eliminate structural barriers to healthy lifestyle adoption.

Moderating effect of Life's essential 8 on the association of depression symptoms with all-cause and cardiovascular mortality

BACKGROUND

The association between Life's essential 8 (LE 8), depression, and mortality still unexplored.

METHODS

Data of 23,247 participants aged ≥20 years old were extracted from the National Health and Nutrition Examination Survey (NHANES) 2005-2018 in this retrospective cohort study. Depression symptoms were determined by the 9-item Patient Health Questionnaire (PHQ-9) and antidepressant use. Cardiovascular health was assessed using LE 8. Potential covariates were selected using weighted univariate Cox regression models. The associations of LE 8, depression symptoms, with mortality were explored via univariate and multivariate Cox proportional hazards models, and restricted cubic spline. And the relationships were further investigated with stratified by LE 8 scores. The results were presented as hazard ratios (HRs) and 95 % confidence intervals (CIs).

RESULTS

Of the total 23,247 adults, 3208 (15.95 %) suffered from depression symptoms. After 99.75 months of mean follow-up time, 2400 individuals were died. Of these, 781 deaths were from cardiovascular disease (CVD). Depression symptoms were associated with higher odds of all-cause mortality (HR = 1.24, 95%CI: 1.06-1.45) and CVD mortality (HR = 1.36, 95%CI: 1.04-1.77). LE 8 score < 80 was marginal significance associated with all-cause mortality (HR = 1.14, 95%CI: 0.99-1.32). LE 8 had moderating effects on the associations of depression symptoms with all-cause (HR = 1.39, 95%CI: 1.16-1.67, P trend <0.05) and CVD mortality (HR = 1.63, 95%CI: 1.09-2.46, P trend <0.05).

CONCLUSION

Higher LE 8 scores may moderate the association of depression symptoms with all-cause and CVD mortality. Adherence to healthier lifestyle behaviors may improve the prognosis of depression.

Association between "Life's Essential 8" cardiovascular health and apparent treatment-resistant hypertension among US adults from the NHANES, 2005 to 2018

Background

The association between healthy lifestyle and American Heart Association (AHA) Life's Essential 8 (LE8) score and apparent treatment-resistant hypertension(aTRH)remains uncertain. We aimed to explore the association between healthy lifestyle and higher LE8 score and apparent treatment-resistant hypertension in the general population.

Methods

Using NHANES data from 2005 to 2018, we included and analyzed information on 7,474 participants eligible for this study. The association between LE8 and aTRH was explored using logistic regression models, and the association between LE8 and antihypertension drugs uncontrolled hypertension was further explored using logistic regression models.

Results

Participants with higher LE8 scores tended to be non-Hispanic white and married or living with a partner; have low income and higher education; and be without Chronic kidney disease (CKD)(all p-values <0.001). Compared to subjects with low CVH, participants with moderate and high CVH exhibited lower risks of 47% and 76%, respectively. After adjusting for covariates, there was no evidence of a nonlinear association between LE8 and aTRH (p for nonlinearity = 0.456). Physical activity (PA), body mass index (BMI), and blood glucose were associated with aTRH (all p-values < 0.05), while diet, nicotine exposure, sleep, and blood lipids were not significantly associated with aTRH. Compared to the low LE8 group, the ORs for the high LE8 group were 0.46 (95% CI, 0.28 to 0.76) and 0.07 (95% CI, 0.02 to 0.20) for uncontrolled hypertension with 1-2 and 3-4 antihypertensive drugs, respectively. In the sensitivity analysis, subgroup analyses were performed on all covariates, and the results remained stable.

Conclusion

In our study, we found a significant association between higher LE8 scores and a lower risk of aTRH. Our findings suggest that implementing various healthy lifestyle practices and managing known cardiovascular risk factors could be a feasible comprehensive preventive approach to aTRH.