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. 2023 Dec 5;12(23):e030764.
doi: 10.1161/JAHA.123.030764. Epub 2023 Nov 28.

Association of Life's Essential 8 With Cardiovascular Disease and Mortality: The Framingham Heart Study

Athanasios Rempakos  1 , Brenton Prescott  2 , Gary F Mitchell  3 , Ramachandran S Vasan  2   4   5   6 , Vanessa Xanthakis  2   4   7
Affiliations

Association of Life's Essential 8 With Cardiovascular Disease and Mortality: The Framingham Heart Study

Athanasios Rempakos et al. J Am Heart Assoc. .

Abstract

Background: The association of the American Heart Association's updated cardiovascular health score, the Life's Essential 8 (LE8), with cardiovascular disease (CVD) and death is not described in the FHS (Framingham Heart Study).

Methods and results: We evaluated Framingham Offspring participants at examinations 2 and 6 (n=2888 and 1667; and mean age, 44 and 57 years, respectively), free of CVD with information on LE8 components. Using age-sex-adjusted Cox models, we related LE8 and its change (examination 2 to examination 6) with CVD and death risk and compared associations with those of the Life's Simple 7 score. Mean LE8 score at examination 2 was 67 points (minimum, 26 points; maximum, 100 points). At both examinations, participants were reclassified to a different cardiovascular health status, depending on which method (LE8 versus Life's Simple 7) was used (60% of participants in ideal Life's Simple 7 status were in intermediate LE8 category). On follow-up after examination 2 (median, 30 and 33 years for CVD and death, respectively), we observed 966 CVD events, and 1195 participants died. Participants having LE8≥68 (sample median) were at lower CVD and death risk compared with those with LE8<68 (examination 2: CVD hazard ratio [HR], 0.47 [95% CI, 0.41-0.54]; death HR, 0.55 [95% CI, 0.49-0.62]; all P<0.001). Participants maintaining low LE8 scores during life course were at highest CVD and death risk (CVD: HRs ranging from 1.8 to 2.3; P<0.001; death HR, 1.45 [95% CI, 1.13-1.85]; P=0.003 versus high-high group).

Conclusions: Further studies are warranted to elucidate whether the LE8 score is a better marker of CVD and death risk, compared with Life's Simple 7 score.

Keywords: American Heart Association; Life's Essential 8; cardiovascular disease; ideal cardiovascular health.

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Figures

Figure 1
Figure 1. Sample derivation.
CVD indicates cardiovascular disease; Exam, examination; and LE8, Life's Essential 8.
Figure 2
Figure 2. Kaplan‐Meier plot for change in LE8 vs death (A) and CVD (B).
High, above median LE8 score; low, below median LE8 score. Median examination 2 LE8 score=69, and median examination 6 LE8 score=66. CVD indicates cardiovascular disease; and LE8, Life's Essential 8.
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