AHA Life's essential 8 and ideal cardiovascular health among young adults

Abstract

Objective: This study assessed cardiovascular health (CVH) in young adults using the 2022 AHA Life's Essential 8 (LE8) score and compared it with the Life's Simple 7 (LS7) score.

Methods: Individuals aged 18 to 44 years without a history of cardiovascular disease in the National Health and Nutrition Examination Survey (NHANES) cycles were included. Data from 2007-2008 to 2017-2018 were combined to create 3 groups (2007-2010, 2011-2014, and 2015-2018) for analysis. The LE8 score and its components were computed in the overall population and stratified by sex and race/ethnicity. Trends for the LE8 score were analyzed using adjusted linear regression models.

Results: Among 12,197 young adults, representing an estimated 89.4 million individuals, from the NHANES 2007-2018, the CVH in the overall population and across all subgroups was stable (P_trend >0.05). The blood lipid score improved across all subgroups (P_trend:<0.05). The mean LE8 score was 69.2±0.3. Females (71.4±0.4) had better CVH compared with males (67.2±0.4). Non-Hispanic Black individuals (65.1± 0.3) had the lowest CVH compared with Non-Hispanic White individuals (69.9±0.5), Mexican American individuals (67.3±0.3), and other race individuals (71.2±0.4). Of the 46.1 million individuals categorized as intermediate CVH by the LS7 score, 8.1 million (17.6%) and 2.3 million (5.0%) were reclassified to poor and ideal CVH by the LE8 score, respectively. Of the 40.1 million individuals categorized as ideal CVH by the LS7 score, 18.9 million (47.1%) and 0.1 million (0.2%) were reclassified to poor CVH and intermediate CVH by the LE8 score, respectively.

Conclusion: Among US young adults, there has been no improvement in CVH over the last decade with notable sex and race/ethnicity-associated differences in the LE8 score. Nearly 1 in 4 young adults had ideal CVH using the LE8 score compared with 1 in 2 individuals using the LS7 score.

Keywords: Cardiovascular health; Life's essential 8; Sleep; Young adults.

Fig. 1

Trends of the Life's Essential 8 Score in the 18-44 Year Age Group, Overall and Stratified by Sex from NHANES Cycles 2007 to 2018. This figure depicts the trends of the Life's Essential 8 (LE8) score and its components from 2007-2018. Two consecutive NHANES cycles were combined to create 3 groups (2007-2010, 2011-2014, and 2015-2018) for analyzing the trends of the LE8 score and its components. The overall population, males, and females have been depicted in black, red, and blue, respectively.

Fig. 2

Trends of the Life's Essential 8 Score in the 18-44 Year Age Group Stratified by Race/Ethnicity from NHANES Cycles 2007 to 2018. This figure depicts the trends of the Life's Essential 8 (LE8) score and its components from 2007-2018 stratified race/ethnicity. Two consecutive NHANES cycles were combined to create 3 groups (2007-2010, 2011-2014, and 2015-2018) for analyzing the trends of the LE8 score and its components. Non-Hispanic White, Non-Hispanic Black, Mexican American, and other races have been depicted in black, red, blue, and green, respectively.

Central Illustration: Sankey Diagram Depicting Reclassification of Cardiovascular Health Categories Using the Life's Simple 7 and Life's Essential 8 Scores. This figure depicts the reclassification of cardiovascular health (CVH) in young adults using the Life's Simple 7 (LS7) score and the Life's Essential 8 (LE8) Score. LS7 scores of 0-4, 5-9, and 10-14 were defined as poor, intermediate, and ideal CVH, respectively. LE8 scores of <50, 50-79, and ≥80 were defined as poor, intermediate, and ideal CVH, respectively. Of the 1.7 million individuals categorized as poor CVH by the LS7 score, 1.6 million (94.1%) remained in the poor CVH category and 0.1 million (5.9%) were reclassified to intermediate CVH when classified by the LE8 score. Of the 46.1 million individuals categorized as intermediate CVH by the LS7 score, 35.6 million (77.2%) remained in the intermediate CVH category, 8.1 million (17.6%) were reclassified as poor CVH, and 2.3 million (5.0%) were reclassified to ideal CVH by the LE8 score. Of the 40.1 million individuals categorized as ideal CVH by the LS7 score, 21.1 million (52.6%) remained in the ideal CVH category, 18.9 million (47.1%) were reclassified as intermediate CVH, and 0.1 million (0.2%) were reclassified to poor CVH by the LE8 score.