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. 2023 Jun 22:10:1173550.
doi: 10.3389/fcvm.2023.1173550. eCollection 2023.

Life's Essential 8 and carotid artery plaques: the Swedish cardiopulmonary bioimage study

Ángel Herraiz-Adillo  1 , Viktor H Ahlqvist  2 , Sara Higueras-Fresnillo  1   3 , Daniel Berglind  2   4 , Patrik Wennberg  5 , Cecilia Lenander  6 , Bledar Daka  7 , Mattias Ekstedt  1   8 , Johan Sundström  9   10 , Francisco B Ortega  11   12 , Carl Johan Östgren  1   8 , Karin Rådholm  1   10 , Pontus Henriksson  1
Affiliations

Life's Essential 8 and carotid artery plaques: the Swedish cardiopulmonary bioimage study

Ángel Herraiz-Adillo et al. Front Cardiovasc Med. .

Abstract

Background: To quantify cardiovascular health (CVH), the American Heart Association (AHA) recently launched an updated construct of the "Life's Simple 7" (LS7) score, the "Life's Essential 8" (LE8) score. This study aims to analyse the association between both CVH scores and carotid artery plaques and to compare the predictive capacity of such scores for carotid plaques.

Methods: Randomly recruited participants aged 50-64 years from the Swedish CArdioPulmonary bioImage Study (SCAPIS) were analysed. According to the AHA definitions, two CVH scores were calculated: i) the LE8 score (0, worst CVH; 100, best CVH) and two different versions of the LS7 score [(0-7) and (0-14), 0 indicating the worst CVH]. Ultrasound-diagnosed carotid plaques were classified as no plaque, unilateral, and bilateral plaques. Associations were studied by adjusted multinomial logistic regression models and adjusted (marginal) prevalences, while comparison between LE8 and LS7 scores was performed through receiver operating characteristic (ROC) curves.

Results: After exclusions, 28,870 participants remained for analysis (50.3% women). The odds for bilateral carotid plaques were almost five times higher in the lowest LE8 (<50 points) group [OR: 4.93, (95% CI: 4.19-5.79); adjusted prevalence 40.5%, (95% CI: 37.9-43.2)] compared to the highest LE8 (≥80 points) group [adjusted prevalence 17.2%, (95% CI: 16.2-18.1)]. Also, the odds for unilateral carotid plaques were more than two times higher in the lowest LE8 group [OR: 2.14, (95% CI: 1.82-2.51); adjusted prevalence 31.5%, (95% CI: 28.9-34.2)] compared to the highest LE8 group [adjusted prevalence 29.4%, (95% CI: 28.3-30.5)]. The areas under ROC curves were similar between LE8 and LS7 (0-14) scores: for bilateral carotid plaques, 0.622 (95% CI: 0.614-0.630) vs. 0.621 (95% CI: 0.613-0.628), P = 0.578, respectively; and for any carotid plaque, 0.602 (95% CI: 0.596-0.609) vs. 0.600 (95% CI: 0.593-0.607), P = 0.194, respectively.

Conclusion: The new LE8 score showed inverse and dose-response associations with carotid plaques, particularly bilateral plaques. The LE8 did not outperform the conventional LS7 score, which showed similar ability to predict carotid plaques, especially when scored as 0-14 points. We conclude that both the LE8 and LS7 may be useful in clinical practice for monitoring CVH status in the adult population.

Keywords: Doppler ultrasound; SCAPIS project; carotid atherosclerosis; health promotion; healthy lifestyle; population-based.

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Conflict of interest statement

JS reports stock ownership in Anagram kommunikation AB and Symptoms Europe AB. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of the study.
Figure 2
Figure 2
Life's Essential 8 and Carotid plaques. Panel A illustrates the multinomial regression model to estimate odds ratios of unilateral carotid plaque and bilateral carotid plaques across Life's Essential 8 scores (adjusted for sex, age, and study site). Panel B illustrates the adjusted prevalences of unilateral carotid plaque/s and bilateral carotid plaques across Life's Essential 8 scores (adjusted for sex, age, and study site).
Figure 3
Figure 3
Unadjusted receiver operating characteristic (ROC) curves to predict bilateral carotid plaques and any carotid plaque/s for Life's Essential 8, Life's Simple 7 (0–7) and Life's Simple 7 (0–14).
See this image and copyright information in PMC

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