Association of Life's Essential 8 with Cardiovascular Events and Mortality: The Cardiovascular Disease Lifetime Risk Pooling Project (LRPP)

BackgroundThe American Heart Association (AHA) recently launched updated cardiovascular health (CVH) metrics, termed Lifes Essential 8 (LE8). Compared to Lifes Simple 7 (LS7), the new approach added sleep health as an eighth metric and updated the remaining 7 metrics. Whether the updated LE8 score outperforms the original LS7 score in predicting cardiovascular disease (CVD) is not known. We examined the association of LE8 scores with CVD, subtype CVD events and all-cause mortality. MethodsWe pooled individual-level data from 6 contemporary US-based cohorts from the Cardiovascular Lifetime Risk Pooling Project (LRPP). Total LE8 score (0-100 points), LE8 score without sleep (0-100 points), as well as prior LS7 scores (0-14 points), were calculated separately. We used multivariable-adjusted Cox models to evaluate the association of LE8 with CVD, CVD subtypes, and all-cause mortality among younger, middle, and older aged adult participants. Reclassification was defined based on the concordant/discordant categories of LS7 and LE8 scores quartile rankings across age groups. ResultsOur sample consisted of 32,896 US adults (7836 [23.8%] Black; 14941 [45.4%] men) followed for 642,000 person-years; of whom 9,391 developed CVD events. Each 10-point higher overall LE8 score was associated with 23-40% lower CVD risk across age groups. Reclassification of CVH from LS7 to LE8 was related to heath behaviors as well as health factors and was significantly associated with CVD risk. ConclusionsThese findings support the improved utility of the LE8 algorithm for assessing overall cardiovascular health and future CVD risk.