What is the association of Life’s Essential 8 with all-cause and cardiovascular disease-specific mortality later in life?

In a recent study published in the BMC Medicine journal, researchers examined the correlation between the American Heart Association's "Life's Essential 8" and all-cause mortality rates.

Background

The American Heart Association (AHA) introduced Life's Simple 7 in 2010, outlining seven behavioral and health factors considered ideal goals for achieving optimal cardiovascular health (CVH). These factors include maintaining a healthy diet, engaging in regular physical activity, maintaining a normal body mass index (BMI), refraining from smoking, maintaining normal blood pressure, achieving normal fasting glucose levels, and maintaining normal total cholesterol levels.

The Strategic Planning Task Force and Statistical Committee of the AHA recently proposed Life's Essential 8 objectives for the preservation of optimal CVH. Currently, there is a lack of studies that have evaluated the efficacy of the recently introduced CVH metrics in Life's Essential 8 with respect to mortality.

About the study

In the present study, researchers investigated the correlation between the individual and total CVH metrics based on Life's Essential 8 and mortality due to all-cause and CV disease (CVD) in the later stages of life.

This study utilized data from the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2018. The baseline data utilized in this study included sleep health information gathered between 2005 and 2006. The study involved the participation of 39,749 adults aged 20 years or older in the NHANES between 2005 and 2018. This study sample comprised 19,951 individuals between the ages of 30 and 79.

The evaluation of physical activity was conducted via a self-reported questionnaire, which collected data on the number of minutes of moderate to vigorous physical activity engaged in per week. The study identified five distinct categories of nicotine exposure, namely current smokers, individuals who currently use inhaled nicotine delivery systems, never smokers, and former smokers.

The duration of sleep per night was categorized into seven groups based on the number of hours slept: less than four hours, four to less than five hours, five to less than six hours, six to less than seven hours, seven to less than nine hours, nine to less than 10 hours, and 10 or more hours. The categorization of BMI levels was as follows: BMI levels greater than or equal to 40.0, between 35.0 and 39.9, between 30.0 and 34.9, between 25.0 and 29.9, and less than 25.0 kg/m².

The study employed blood samples as a means of quantifying both total and high-density lipoprotein (HDL) cholesterol levels. The classification of non-HDL cholesterol levels was based on five categories: 220 or more, between 190 and 219, between 160 and 189, between 130 and 159, and less than 130 mg/dL. 

Results

The study results indicated that 19.5% of the adult population attained a high cumulative CVH score, while 24.1% obtained a low score. Individuals with elevated CVH scores exhibited a greater likelihood of being female, younger, married, and attaining a high level of education and a high ratio of family income to poverty.

Individuals who have previously experienced a stroke or heart disease exhibited a decreased likelihood of higher CVH scores. The mortality densities for CVD and all causes per 1,000 person-years, standardized for age and sex, were significantly lower among adults with intermediate and high levels of total CVH scores compared to those with low levels. The study found that individuals who attained a greater CVH score exhibited a statistically significant decrease in the cumulative incidence rate of mortality caused by all causes and CVD-specific death.

Compared to adults exhibiting a low total CVH score, individuals with high and intermediate scores demonstrated a 64% and 38% decrease in the likelihood of experiencing CVD-specific mortality, respectively. A statistically significant association was observed between elevated blood glucose levels and a decreased risk of CVD-related mortality.

While there were no statistically significant correlations found between other individual CVH metrics such as BMI, physical activity, blood pressure, and sleep health, comparable patterns were noted where higher scores were linked to a decreased risk of CVD-specific mortality.

Conclusion

The study findings highlighted that the occurrence of a high CVH score among adults in the United States was minimal. Additionally, the overall CVH score exhibited a negative correlation with both CVD-specific and all-cause mortality.

The primary factors contributing to all-cause mortality were physical inactivity, an unhealthy diet, and nicotine exposure. Meanwhile, physical inactivity, increased blood glucose, and elevated blood pressure were identified as the three significant contributors to CVD-related mortality.

The results also showed the importance of prioritizing primary and primordial prevention strategies that focus on improving CVH health metrics. This is particularly crucial for health factors and behaviors that have high PAFs, as strengthening these efforts can effectively reduce the risk of premature mortality in the future.

Written by

Bhavana Kunkalikar

Bhavana Kunkalikar is a medical writer based in Goa, India. Her academic background is in Pharmaceutical sciences and she holds a Bachelor's degree in Pharmacy. Her educational background allowed her to foster an interest in anatomical and physiological sciences. Her college project work based on ‘The manifestations and causes of sickle cell anemia’ formed the stepping stone to a life-long fascination with human pathophysiology.