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. 2025 Apr 26:zwaf247.
doi: 10.1093/eurjpc/zwaf247. Online ahead of print.

Life's Essential 8 and progression of cardiometabolic multimorbidity trajectory: a prospective study of UK Biobank

Miao Huang  1 , Ru Fu  1 , Xiexiong Zhao  1 , Tao Liu  1 , Xiaogang Li  1 , Weihong Jiang  1
Affiliations

Life's Essential 8 and progression of cardiometabolic multimorbidity trajectory: a prospective study of UK Biobank

Miao Huang et al. Eur J Prev Cardiol. .

Abstract

Aims: To evaluate the impact of Life's Essential 8 (LE8) on the onset and progression trajectory of cardiometabolic multimorbidity (CMM).

Methods and results: This prospective study included 240,346 participants (median age, 57 years) free of CMDs at baseline from the UK Biobank. LE8 scores were divided into low, moderate, and high cardiovascular health (CVH) groups at baseline, with higher LE8 scores representing better CVH. CMM was defined as the coexistence of two or three cardiometabolic diseases, including type 2 diabetes (T2D), ischemic heart disease, and stroke. Multi-state model was applied to explore the role of LE8 level in each transition stage of CMM trajectory. During a median follow-up of 14.01 years, 29,551 participants developed first cardiometabolic disease (FCMD), 3,183 developed CMM, and 15,763 died. LE8 scores were significantly associated with an increased risk of transition from health to FCMD or to death, with adjusted HRs (CIs) for high CVH levels of 0.22 (0.20-0.23) and 0.23 (0.21-0.25), respectively. Similar associations were observed in the transitions from FCMD to CMM (HRs: 0.41; 95% CIs: 0.34-0.50) and from FCMD to death (HRs: 0.82; 95% CIs: 0.68-0.98). CVH levels had an impact on disease-specific transitions except from stroke and T2D to death and from CMM to death.

Conclusions: This study revealed that LE8 may influence the progression of CMM trajectory. Our results highlight that managing behavior and health factors of LE8 is an important way to mitigate the progression of CMM trajectory.

Keywords: Cardiometabolic disease; Cardiometabolic multimorbidity; Cardiovascular health; Life’s Essential 8; Trajectory.

Plain language summary

This prospective cohort study of 240,346 people found that participants who followed Life’s Essential 8 (LE8) guidelines and achieved higher scores had better health outcomes in terms of the onset and progression of cardiometabolic disease (CMD). Aiming for LE8 scores of 80 or higher, whether by improving behavioral styles or intervening in health parameters, was effective in reducing the risk of CMD onset or further progression to cardiometabolic multimorbidity or even death. In particular, the study found that for people potentially at risk of developing type 2 diabetes (T2D), every 10-point increase in LE8 score reduced the risk of transitioning from a healthy state to T2D by about 40%. Early prevention based on the LE8 guidelines to minimize the loss of cardiovascular health therefore deserves greater public attention in our aging society.

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