Gender differences in the association between Life's essential 8 and cardiovascular disease: a U.S.-based cross-sectional analysis

Abstract

Background: This research aims to elucidate the gender differences in the association between cardiovascular disease (CVD) prevalence and Life's Essential 8 (LE8), a recently updated measure of cardiovascular health (CVH).

Methods: This study included participants from the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2018.The scores of LE8, health behavior, health factor and each metric based on diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipid, blood glucose, and blood pressure were classified as low (0-49 points), moderate (50-79 points), and high (80-100 points). The scores of LE8, health behavior and health factor as continuous variables were also used for dose-response analysis. The main outcomes included the prevalence of CVD. The definition of CVD based on self-reported history of coronary heart disease or stroke.

Results: A total of 23,307 individuals were included in this analysis. Participants with CVD had significantly lower LE8 scores compared to those without CVD, and females demonstrated higher CVH levels compared to males including total LE8 scores and the scores of diet, nicotine exposure, blood lipid, blood glucose, and blood pressure (P < 0.05). Moreover, the LE8 score demonstrated a non-linear association with CVD in both males and females (all P-values for non-linearity were < 0.001). Furthermore, compared to the low LE8 level, a high LE8 level was associated with a 78% decreased risk of CVD in males (HR: 0.22, 95% CI: 0.16-0.31) and an 83% decreased risk in females (HR: 0.17, 95% CI: 0.11-0.26). Consistently, compared to low levels of health behaviors and health factors, higher levels were significantly associated with a decreased risk of CVD in both males and females (All P < 0.001). Additionally, the area under the curve (AUC) for the total LE8 score in CVD discrimination was significantly higher in females than in males (P < 0.001).

Conclusion: Higher CVH scores were associated with a lower risk of CVD, especially in females. These findings highlight the need for gender-specific preventive strategies in CVH promotion, with a particular focus on improving LE8 scores in high-risk populations.

Keywords: Cardiovascular disease; Cardiovascular health; Gender differences; Life’s Essential 8.

Fig. 1

Flowchart of the sample selection from National Health and Nutrition Examination Survey (NHANES) 2005–2018

Fig. 2

Differences in the levels of eight health indexes between male and female

Fig. 3

RCS analysis. A The dose–response relationship between LE8 scores and CVD in males. B The dose–response relationship between health behavior scores and CVD in males. C The dose–response relationship between health factor scores and CVD in males. D The dose–response relationship between LE8 scores and CVD in females. E The dose–response relationship between health behavior scores and CVD in females. F The dose–response relationship between health factor scores and CVD in females

Fig. 4

Receiver operating characteristic (ROC) curve. A The diagnostic capability of LE8 scores in discriminating CVD across different genders. B The diagnostic capability of health behavior scores in discriminating CVD across different genders. C The diagnostic capability of health factor scores in discriminating CVD across different genders