Ideal cardiovascular health metrics and risk of cardiovascular disease or mortality: A meta-analysis

Effect of Daily Avocado Intake on Cardiovascular Health Assessed by Life's Essential 8: An Ancillary Study of HAT, a Randomized Controlled Trial

BACKGROUND

The effect of single food-based dietary interventions on the American Heart Association's cardiovascular health score, Life's Essential 8 (LE8), is unclear. The aim of this study was to examine the effect of daily avocado intake for 26 weeks on LE8 in adults with abdominal obesity.

METHODS AND RESULTS

An ancillary analysis including participants (n=969; aged 51±14 years) from the HAT (Habitual Diet and Avocado Trial), a randomized controlled trial, was conducted. The Avocado-Supplemented Diet Group was provided with 1 avocado per day, and the Habitual Diet Group was instructed to maintain their usual diet. LE8 component scores (diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipids, blood glucose, and blood pressure) were calculated using a modified American Heart Association algorithm. The LE8 score was calculated as the unweighted average of each component (range, 0-100 points). Between-group differences in the 26-week change in LE8 were assessed using general linear models. No significant between-group difference in the 26-week change in the LE8 score from baseline was observed (0.79 points [95% CI, -0.41 to 2.00]). However, avocado intake increased the LE8 component scores for diet (3.53 points [95% CI, 1.38-5.68]), sleep health (3.20 points [95% CI, 0.38-6.02]), and blood lipids (3.46 points [95% CI, 1.03-5.90]) compared with the Habitual Diet Group.

CONCLUSIONS

Intake of 1 avocado per day for 26 weeks did not significantly affect the total cardiovascular health score in US adults with abdominal obesity. However, diet quality, sleep health, and blood lipids improved with daily avocado intake.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: NCT03528031.

Sources of well-being and cardiovascular health: A mixed methods investigation from the MIDUS study

OBJECTIVE

Using mixed methods, we investigated whether different sources of well-being were associated with better cardiovascular health.

METHODS

Data came from adults (55% women; 19% Black, 75% White) with biomarker data from the Midlife in the United States (MIDUS) Study. At the second wave and in a refresher cohort, participants answered the question "What do you do to make your life go well?" Judges evaluated each response for the presence of 12 sources of well-being (e.g., positive relationships, faith, health maintenance). Participants were also assessed on 8 components of cardiovascular health at two waves, an average of 12 years apart. Concurrent (N = 2036) and longitudinal (N = 650) linear regressions examined the association between each well-being source in unadjusted models and models adjusted for sociodemographic factors and word count.

RESULTS

Adults who wrote about positive relationships, positive attitudes, enjoyment, coping, health maintenance, and planning tended to have better cardiovascular health in unadjusted models concurrently and longitudinally. In fully adjusted models, health maintenance (p < .001) and planning and organization (p = .004) were associated with better cardiovascular health concurrently. Additionally, health maintenance (p = .03) and work (p = .04) were associated with better cardiovascular health longitudinally.

CONCLUSIONS

Individuals who endorsed maintaining their health as central to well-being showed healthier cardiovascular outcomes 12 years later. Combining qualitative assessments of sources of well-being with clinically assessed measures of cardiovascular health highlights unique contributors of well-being that are relevant for health and may not be evident with conventional self-report measures.

County-level association between modifiable health behaviors and premature mortality in the United States

OBJECTIVE

Unhealthy lifestyle habits are associated with increased morbidity and mortality. This study aims to examine the county-level association of physical inactivity, insufficient sleep, and current smoking, three elements of the American Heart Association's Life's Essential 8, with premature mortality.

METHODS

Premature country-level age-adjusted death rate (AADR) in 2018-2020 were obtained from National Center for Health Statistics Mortality Files. County-level data were included from County Health Rankings data set for 2022. Counties were divided into deciles based on the percentage of adults with physical inactivity, insufficient sleep, and current smoking (separate decile for each metric) from Behavioral Risk Factor Surveillance System in 2019. Multivariable linear regression were used to evaluate the association of premature AADR with physical inactivity, insufficient sleep, and current smoking (lowest deciles as reference), controlling for median county income as a social determinant of health.

RESULTS

A total of 3082 counties were included in the analysis. Mean physical inactivity, current smoking, and insufficient sleep ranged from 20.7 % to 41 %, 13.4 % to 28.2 %, and 30.3 % to 43.7 % from 1st to 10th decile, respectively. There was a stepwise increase in premature mortality in each progressive decile with an increase in county-level physical inactivity, insufficient sleep, and current smoking, which remained significant in the adjusted analyses.

CONCLUSION

We demonstrate an independent association of county-level physical inactivity, insufficient sleep, and current smoking with premature mortality. Further research and public health efforts are needed to understand and mitigate these risk factors at the county level to improve health outcomes.

Life's Essential 8 and Cardiovascular Disease in Breast Cancer Survivors

PURPOSE OF REVIEW

To explore the role of optimal cardiovascular health as defined by the Life's Essential 8 in breast cancer survivors.

RECENT FINDINGS

Optimal cardiovascular health may be associated with decreased cancer mortality. Breast cancer survivors may derive additional benefit from obtaining ideal cardiovascular health as defined by the Life's Essential 8. Certain components of the Life's Essential 8 may impact cardiovascular risk but also cancer mortality, and risk for cancer therapy related cardiac dysfunction. Continued physical activity, avoidance of smoking, and control of lipids and blood pressure are beneficial in breast cancer survivors. More study is needed to define the role of anti-hyperglycemic agents, BMI, and sleep on CVD risk in breast cancer survivors. The Life's Essential 8 can be a tool to inform clinicians regarding a breast cancer survivor's disease risk and to identify potential areas of improvement.

Association between Life's essential 8 and stress urinary incontinence in women from the National Health and nutrition examination survey 2005-2018: A cross-sectional study

OBJECTIVE

Stress urinary incontinence (SUI) may be associated with cardiovascular disease. Life's Essential 8 (LE8), a recently updated measure of cardiovascular health (CVH), has been investigated for its association with SUI in women.

METHODS

The study adopted a cross-sectional design with national scope, incorporating 9332 women aged 20 and above, selected from the National Health and Nutrition Examination Survey dataset from 2005 to 2018. The LE8 metric, which varies from 0 to 100, was evaluated based on the criteria set by the American Heart Association. SUI was determined based on self-report. To evaluate these correlations, we employed models with multivariable logistic variables and a restricted cubic spline.

RESULTS

In the cross-sectional study, a total of 9332 participants were included (weighted average age, 52.23 years), and 4274 had SUI (weighted percentage, 48.64%). Considering potential confounders, it was found that higher LE8 scores were associated with lower odds of SUI (odds ratio [OR] for each 10-point increase was 0.83; 95% confidence interval [CI], 0.80-0.87). Compared to participants with lower LE8 scores, those with higher LE8 scores had a 57% lower probability of developing SUI. There was a statistically significant association between LE8 score and SUI among participants who were middle-aged, non-Hispanic white, had higher levels of education and income, and were living with a partner.

CONCLUSION

According to this study, there was an association between increase in Life's Essential 8 and reduction in SUI risk. Therefore, promoting optimal CVH may associate with reducing SUI in women.

Obesity Phenotypes, Lifestyle Medicine, and Population Health: Precision Needed Everywhere!

The worldwide prevalence of obesity is a key factor involved in the epidemic proportions reached by chronic societal diseases. A revolution in the study of obesity has been the development of imaging techniques for the measurement of its regional distribution. These imaging studies have consistently reported that individuals with an excess of visceral adipose tissue (VAT) were those characterized by the highest cardiometabolic risk. Excess VAT has also been found to be accompanied by ectopic fat deposition. It is proposed that subcutaneous versus visceral obesity can be considered as two extremes of a continuum of adiposity phenotypes with cardiometabolic risk ranging from low to high. The heterogeneity of obesity phenotypes represents a clinical challenge to the evaluation of cardiometabolic risk associated with a given body mass index (BMI). Simple tools can be used to better appreciate its heterogeneity. Measuring waist circumference is a relevant step to characterize fat distribution. Another important modulator of cardiometabolic risk is cardiorespiratory fitness. Individuals with a high level of cardiorespiratory fitness are characterized by a lower accumulation of VAT compared to those with poor fitness. Diet quality and level of physical activity are also key behaviors that substantially modulate cardiometabolic risk. It is proposed that it is no longer acceptable to assess the health risk of obesity using the BMI alone. In the context of personalized medicine, precision lifestyle medicine should be applied to the field of obesity, which should rather be referred to as 'obesities.'

Uncovering the Potential Link Between Polychlorinated Biphenyls and Cardiovascular Diseases: A Comprehensive Analysis

BACKGROUND

A family of persistent organic pollutants, known as polychlorinated biphenyls (PCBs), are extensively found in the environment and may be harmful to the cardiovascular system. Systematic reviews and meta-analyses are required to thoroughly evaluate the association between PCB exposure and cardiovascular disease (CVDs), despite the fact that studies on the subject have produced inconsistent results.

OBJECTIVE

The purpose of this study was to investigate the relationship between PCBs exposure and cardiovascular disease risk in order to provide more conclusive data to promote public health actions.

METHODS

The studies that met the inclusion criteria were screened out using the databases PubMed, Web of Science, ScienceDirect, and Cochrane Library. The comprehensive effect size (OR) was calculated using the random-effects model; the study's heterogeneity was analyzed using I2 statistics; the major reasons of heterogeneity were identified using subgroup analysis; and publication bias graphically was measured using the Egger's test.

RESULTS

A meta-analysis of 11 studies revealed that total PCBs (OR = 1.56, 95% CI: 1.20-1.75), non-dioxin-like PCBs (NDL-PCBs) (OR = 1.33, 95% CI: 1.15-1.53), and dioxin-like PCBs (DL-PCBs) (OR = 1.31, 95% CI: 1.10-1.57) were all found to be positively associated with the risk of cardiovascular disease. Subgroup analysis revealed that study type, biomaterials, and literature quality were the most significant drivers of variation. Furthermore, certain PCB homologues, such as non-dioxin-like (NDL)-PCB153 and dioxin-like (DL)-PCB118, are highly related with cardiovascular disease.

CONCLUSIONS

According to this meta-analysis, exposure to PCBs may increase the risk of cardiovascular disease. Notwithstanding major drawbacks, our results emphasize the significance of lowering exposure to PCBs and offering a solid theoretical basis for public health initiatives.

Changes in Cardiovascular Health, Genetic Risk, and Cardiometabolic Diseases: Evidence From a Large-Scale Cohort Study

BACKGROUND

Evidence has firmly established the association between superior cardiovascular health (CVH) and reduced susceptibility to cardiometabolic diseases (CMDs). In reality, CVH experiences dynamic fluctuations throughout individuals' lifespans. However, the association between changes in CVH and the impact on CMDs among individuals with different genetic risks remains unclear.

METHODS AND RESULTS

Based on a large-scale community-based cohort, we evaluated the association between baseline CVH (n=289 069), changes in CVH between 2 examinations (n=37 702), and the risk of CMDs and its individual components (ischemic heart disease, type 2 diabetes, and stroke) using Cox proportional hazards models, leveraging detailed repeatedly assessed lifestyle information and genetic data. Estimations were also stratified by age groups (≤65 years, >65 years) and genetic risk groups, defined by the tertiles of the polygenic risk score for CMDs components. Population-attributable fractions and relative risk reduction were calculated to assess the potential benefits of improvement in CVH in preventing CMDs. For participants whose baseline CVH ranged from ideal to poor, an ascending trend was exhibited in the risk of CMDs overall, as well as its individual components. Based on a median of 5.4-year follow-up after the reassessment of CVH, individuals with an enhancement from intermediate to ideal CVH demonstrated a 36% lower risk of CMDs (hazard ratio [HR], 0.64 [95% CI, 0.53-0.77]; P<0.001), compared with those with constantly intermediate CVH, while those deteriorating from intermediate to poor faced a 44% higher risk (HR, 1.44 [95% CI, 1.17-1.78]; P<0.001). Interestingly, changes in CVH exerted a more pronounced impact on CMD risk within younger populations (≤65 years) (Pinteraction=0.006). Notably, among participants with a high genetic risk of ischemic heart disease, those who improved their CVH status from intermediate to ideal exhibited a 50% lower risk of ischemic heart disease (HR, 0.50 [95% CI, 0.34-0.74]; P<0.001), compared with those with constantly intermediate CVH.

CONCLUSIONS

Individuals with better baseline CVH exhibited a lower risk of CMDs. Enhancement in CVH significantly mitigates the risk of CMDs, especially when efforts are made before the age of 65 years and within high genetic risk groups. These findings underscore the importance of interventions aimed at promoting cardiovascular well-being across entire populations, offering valuable insights for targeted preventive strategies and healthcare interventions.

Association between cardiovascular health and perceived quality of life in ethnically diverse adults: insights from the Community of Mine study using the American Heart Association's Life's Simple 7

PURPOSE

The association between cardiovascular health (CVH) with perceived quality of life (PQoL) and variations by sex and Hispanic ethnicity is not well understood.

METHODS

This study included 583 participants (42% Hispanic, 56% female, mean age 59 years). Linear regression modeled the covariate-adjusted associations between CVH, using the combined 7 components of Life's Simple 7 (LS7; ideal and intermediate, compared to poor), and PQoL (total and physical, social, and cognitive health domains). For individual LS7 components, we assessed effect modification by sex and Hispanic ethnicity.

RESULTS

Compared to individuals with poor CVH, those with intermediate (β [95% CI] = 0.22 [0.09, 0.35]) and ideal (β [95% CI] = 0.22 [0.08, 0.36]) CVH had higher overall PQoL. This effect was dominated by the physical PQoL domain. Of LS7 components, ideal body mass index (BMI) (β [95% CI] = 0.17 [0.03, 0.31]) and physical activity (β [95% CI] = 0.26 [0.12, 0.40]) were associated with overall PQoL. Ideal diet (β [95% CI] = 0.32 [0.08, 0.56]) and fasting plasma glucose (β [95% CI] = 0.32 [0.06, 0.58]) were associated with the physical PQoL domain. A higher PQoL score was associated with intermediate BMI in women, and physical PQoL was associated with smoking for women. A BMI*Hispanic interaction resulted in larger associations between intermediate/ideal BMI and physical PQoL in non-Hispanics.

CONCLUSION

Ideal or intermediate CVH health factors and health behaviors were associated with higher PQoL. Sex and ethnicity differences suggest that perceived quality of life is associated with BMI for women and non-Hispanics.

Emotional Distress and Cardiovascular Health in Young Adults with Type 1 Diabetes

Type 1 diabetes (T1D) is a complex chronic condition that places young adults aged 18-31 years at high risk for general and diabetes-related distress and poor cardiovascular health. Both general and diabetes distress are linked to higher A1C, a known risk factor for cardiovascular disease (CVD). The purpose of this cross-sectional quantitative descriptive study was to examine the associations between distress symptoms (general and diabetes) and cardiovascular health while considering covariates in young adults ages 18-31 years with T1D. One-hundred and sixty-five young adults with T1D, recruited from specialty clinics through two major health systems and online platforms, completed a demographic and clinical survey along with the 8-item PROMIS Emotional Distress Scale and 17-item Diabetes Distress Scale. Higher diabetes distress and higher general emotional distress were associated with lower cardiovascular health scores. Associations remained statistically significant after adjusting for age, T1D duration, sex at birth, race, and continuous subcutaneous insulin infusion. In young adults with type 1 diabetes, addressing both diabetes and general emotional distress may be important to improve cardiovascular health. However, longitudinal and experimental studies are needed to clarify underlying mechanisms and evaluate the effectiveness of interventions like cognitive behavioral therapy.

Relationship Between the Risk of Obstructive Sleep Apnea and Cardiovascular Health in Middle-Aged Korean Men and Women: A Nationwide Study

Background/Objectives: Cardiovascular health (CVH) can be conceptualized as encompassing seven health behaviors and metabolic factors that contribute to cardiovascular disease. We explored the relationship between the risk of obstructive sleep apnea (OSA) and CVH among middle-aged Korean adults. Methods: Data from 5909 participants, aged between 40 and 64 years, in the Korea National Health and Nutrition Examination Survey (2019-2021) were analyzed. The risk of OSA was assessed using STOP-Bang questionnaire. CVH metrics, including smoking status, diet, physical activity, body mass index (BMI), blood pressure, total cholesterol level, and fasting glucose concentration, were evaluated using American Heart Association criteria. Multivariate logistic regression analysis was employed to investigate the association between OSA risk and CVH. Results: Among study participants, 78.6% of men and 16.3% of women displayed moderate-to-high risk of OSA, while 45.4% of men and 17.2% of women exhibited poor CVH. The ORs (95% CIs) for poor CVH were 2.69 (2.08-3.49) for men at moderate risk of OSA and 6.54 (4.81-8.90) for those at high risk, compared to men at low risk. For women, the ORs were 3.21 (2.47-4.19) for those with moderate risk and 12.88 (6.29-26.38) for those with high risk of OSA, compared to women at low risk. CVH metrics associated with moderate-to-high OSA risk included high BMI, high blood pressure, elevated fasting glucose, and smoking. Conclusions: The risk of OSA was associated with poor CVH, while various CVH components were linked to moderate-to-high OSA risk. Managing both OSA and components of CVH is essential to minimize poor CVH.

The MARVIN Hypothesis: Linking Unhealthy Lifestyles to Intracranial Aneurysm Rupture Risk and Clinical Prognosis

Background and Objectives: The rising incidence of modifiable lifestyle risk factors and cardiovascular diseases, driven by poor diet, inactivity, excessive alcohol use, and smoking, may influence the development and rupture of intracranial aneurysms (IA). This study aimed to examine the impact of lifestyle-related and cardiovascular risk factors on IA rupture and patient outcomes. Materials and Methods: We developed the "MARVIN" (Metabolic and Adverse Risk Factors and Vices Influencing Intracranial Aneurysms) model and conducted a retrospective analysis of 303 patients with 517 IAs, treated between 2007 and 2020. Of these, 225 patients were analyzed for rupture status and 221 for clinical outcomes. The analysis focused on hypertension, diabetes, hypercholesterolemia, vascular diseases, nicotine and alcohol abuse, obesity, aneurysm rupture status, and clinical outcomes. Logistic regression was used to evaluate the impact of these risk factors. Results: Among those with risk factors, 24.9% (56/225) and 25.3% (56/221) had one, 32.0% (72/225) and 30.8% (68/221) had two, 20.0% (45/225) and 20.4% (45/221) had three, 12.0% (27/225) and 12.2% (27/221) had four, 4.0% (9/225) and 4.1% (9/221) had five, 0.9% (2/225) had six in both groups, and 0.4% (1/225) and 0.5% (1/221) had seven risk factors, respectively. Strong relationships were found between lifestyle-related vascular risk factors, indicating multiple comorbidities in patients with unhealthy habits. Smokers with ruptured aneurysms had higher WFNS (World Federation of Neurosurgical Societies) scores, but nicotine abuse did not affect long-term outcomes. The most significant predictors for poor outcomes were WFNS score and age, while age and a history of vascular diseases were protective against rupture. Despite the high prevalence of modifiable risk factors, they did not significantly influence rupture risk. Conclusions: The findings suggest a need for multifactorial risk assessment strategies in managing IA patients. Future studies with larger cohorts are required to confirm these results and better understand IA progression.

Association between vitamin D and cardiovascular health in Chinese children and adolescents: Basing on Life's Essential 8

BACKGROUND AND AIMS

The relationship between vitamin D and cardiovascular health (CVH) in children remains unclear. We aimed to explore the association between vitamin D and CVH metrics using the latest Life's Essential 8 (LE8) among Chinese children and adolescents.

METHODS AND RESULTS

A cross-sectional study containing 2680 participants aged 7-18 years (1340 boys and 1340 girls) was performed in South China in 2013. Vitamin D levels were categorized as follows: ≥20 ng/mL (sufficiency), 12 - < 20 ng/mL (inadequacy), and <12 ng/mL (deficiency). The CVH metrics of LE8 was assessed by overall CVH score, health behavior score, health factor score and high CVH, among which the health behaviors included diet, physical activity, nicotine exposure, and sleep health, as well as the health factors contained body mass index, blood lipids, blood glucose, and blood pressure. Different regression models were used to assess the associations between vitamin D levels and CVH metrics of LE8. Results showed that the prevalence of vitamin D deficiency and inadequacy was 7.5% and 44.4%, respectively. Boys had lower levels in overall CVH score, health behavior score, and health factor score than girls. After adjusting for potential confounds, upward trends in diet score, health behavior score, and high CVH were observed with increasing vitamin D levels.

CONCLUSION

Vitamin D levels were positively associated with high CVH based on LE8, and more attention should be paid on boys due to whose lower levels in CVH metrics.

Association of Life's Essential 8 with abdominal aortic calcification and mortality among middle-aged and older individuals

AIM

To assess the association of Life's Essential 8 (LE8) and the presence of abdominal aortic calcification (AAC) with mortality among middle-aged and older individuals.

METHODS

Participants aged older than 40 years were enrolled from the National Health and Nutrition Examination Survey 2013-2014. AAC was assessed using dual-energy X-ray absorptiometry. Mortality data were ascertained through linkage with the National Death Index until 31 December 2019. The LE8 score incorporates eight components: diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipids, blood glucose and blood pressure. The total LE8 score, an unweighted average of all components, was categorized into low (0-49), medium (50-79) and high (80-100) scores.

RESULTS

This study included 2567 individuals, with a mean LE8 score of 67.28 ± 0.48 and an AAC prevalence of 28.28%. Participants with low LE8 scores showed a significantly higher prevalence of AAC (odds ratio = 2.12 [1.12-4.19]) compared with those with high LE8 scores. Over a median 6-year follow-up, there were 222 all-cause deaths, and 55 cardiovascular deaths occurred. Participants with AAC had an increased risk of all-cause (hazard ratio [HR] = 2.17 [1.60-2.95]) and cardiovascular (HR = 2.35 [1.40-3.93]) mortality. Moreover, individuals with AAC and low or medium LE8 scores exhibited a 137% (HR = 2.37 [1.58-3.54]) and 119% (HR = 2.19 [1.61-2.99]) higher risk of all-cause mortality, as well as a 224% (HR = 3.24 [1.73-6.04]) and 125% (HR = 2.25 [1.24-4.09]) increased risk of cardiovascular mortality, respectively.

CONCLUSIONS

The LE8 score correlates with AAC prevalence in middle-aged and older individuals and serves as a valuable tool for evaluating the risk of all-cause and cardiovascular mortality in individuals with AAC.

Association of ideal cardiovascular health and history of gestational diabetes mellitus in NHANES 2007-2018

BACKGROUND

Population-based studies of ideal cardiovascular health (CVH) and gestational diabetes mellitus (GDM) are scarce.

METHODS

We conducted a cross-sectional analysis of 2007-2018 National Health Examination and Nutrition Survey women aged ≥ 20 years, who had data on Life's Simple 7 (LS7) metrics and self-reported GDM history. Each LS7 metric was assigned a score of 0 (non-ideal) and 1(ideal) and summed to obtain total ideal CVH scores (0-7). We used logistic regression models to assess associations between LS7 ideal CVH scores (0-7) and GDM history, accounting for socio-demographic factors.

RESULTS

Among 9199 women (mean age: 46 years, 8 % with a GDM history), there was a progressive decrease in the odds of past GDM history across increasing ideal CVH scores. Compared to females with 0-1 ideal CVH scores, females with ideal CVH scores of 3, 4 and 5-7 had an associated 39 % lower [odds ratio: 0.61 (95 % CI: 0.41-0.90)], 50 % lower [0.50 (0.33-0.76)] and 66 % lower [0.34 (0.20-0.56)] odds of past GDM history, respectively. There were notable racial/ethnic and citizenship/nativity differences in these associations.

CONCLUSIONS

Women with higher ideal CVH scores had lower odds of GDM history. Our findings underscore the importance of optimizing cardiometabolic health among women with GDM history.

Influence of physical activity measurement on the association between Life's Essential 8 and incident cardiovascular disease in older women

Objective

The American Heart Association's Life's Essential 8 (LE8) metric includes self-reported physical activity as one of the metrics for assessing cardiovascular health. Self-reported physical activity is prone to misclassification, whereas accelerometer measures are less biased. We examined associations of LE8 and incident cardiovascular disease (CVD) using self-reported and accelerometer-measured physical activity.

Methods

Participants in the Women's Health Initiative (WHI) Objective Physical Activity and Cardiovascular Health Study (n = 4,243; mean age = 79 ± 7 years) with no CVD history completed the WHI physical activity questionnaire and the Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire prior to wearing a hip-worn accelerometer for up to seven days in 2012-2014. LE8 components (physical activity, diet, sleep, body mass index, smoking, blood pressure, non-HDL cholesterol, and glucose) were scored according to guidelines. Scores were created using five physical activity measures: WHI questionnaire (LE8WHI), CHAMPS (LE8CHAMPS), accelerometer-measured physical activity (LE8A), and sample quantiles of accelerometer-measured physical activity (LE8AQ) and daily steps (LE8STEPS). Hazard ratios (HR) for physician-adjudicated CVD were estimated using Cox regression.

Results

707 incident CVD events occurred over an average 7.5 years. Multivariable HRs (95 % CI) comparing women in the highest vs. lowest quartiles of LE8 scores were: LE8WHI = 0.53 (0.43-0.67), LE8CHAMPS = 0.47 (0.38-0.60), LE8A = 0.44 (0.36-0.56), LE8AQ = 0.44 (0.35-0.55), and LE8STEPS = 0.45 (0.35-0.57).

Conclusions

The LE8-incident CVD association varies by physical activity measurement, however all methods showed reduced risk. Device-measures of physical activity may be more accurate in the LE8, but when impractical to implement, also support use of self-reported measures.

Ambient fine particulate matter and Life's essential 8 and mortality in adults in China: A Nationwide retrospective cohort study

BACKGROUND

Enhanced cardiovascular health (CVH) is linked to reduced mortality risks, whereas long-term exposure to fine particulate matter (PM2.5), elevates these risks. Whether long-term exposure to PM2.5 counteracts the health benefits of high CVH is unknown. The study aims to evaluate whether the association of CVH assessed by Life's Essential 8 (LE8) with death was consistent between participants with different PM2.5 exposures.

METHODS

We included 134,727 participants in the field survey of China Chronic Disease and Risk Factor Surveillance which was conducted from August 2013 to June 2014. The deaths of participants were obtained by linking to the National Mortality Surveillance System (2013-2018). The environmental data is obtained by satellite inversion. The participants' CVH scores were calculated using the LE8 method. Hazard ratio (HR) and 95% confidence intervals (95%CI) for mortality were calculated using Cox regression models.

RESULTS

A total of 2,936 all-cause deaths and 1,158 cardiovascular disease (CVD) deaths were recorded. Compared to those with low CVH, adults with high CVH demonstrated a reduced risk of all-cause mortality, irrespective of their PM2.5 exposure levels (P < 0.05, all P for interaction >0.05). Furthermore, in comparison to those with low CVH and highest PM2.5 exposure, adults with high CVH and lowest PM2.5 exposure exhibited HR of 0.18 (95%CI, 0.12-0.25) for all-cause mortality and 0.13 (95%CI, 0.08-0.22) for CVD mortality.

CONCLUSIONS

High CVH is associated with reduced all-cause mortality risk, regardless of PM2.5 exposure levels. For Chinese adults, sustaining high CVH is advisable, irrespective of their residential location.

Modifiable risk factors and metabolic health in risk of cardiovascular disease among US adults: A nationwide cross-sectional study

Background

Metabolic syndrome (MetS) could increase the risk of cardiovascular disease (CVD) by 2-fold. Ideal control of modifiable risk factors in Life's Simple 7 (LS7) could reduce the CVD risk among the general population. This study aimed to investigate the effects of controlling modifiable risk factors using LS7 in MetS to prevent CVD.

Methods

44463 participants in NHANES 1999-2018 were included. The primary endpoint was a composite of CVD, including angina pectoris, coronary artery disease, myocardial infarction, congestive heart failure, and stroke. Multivariable weighted logistic regression analyses estimated the associations. The diagnosis of MetS complied with Harmonized International Diabetes Federation Criteria. Measurement of modifiable risk factors used the 2010 American Heart Association LS7 guideline and was indicated by cardiovascular health (CVH).

Results

14034 individuals were diagnosed with MetS. 4835 participants had CVD. The weighted mean CVH was 8.06 ± 0.03. Intermediate and poor CVH were associated with increased risk for CVD in participants with similar metabolic states compared to ideal CVH. By taking participants with metabolic health and ideal CVH as health control, participants with MetS and poor CVH were demonstrated to have a 3-fold (adjusted odds ratio, 4.00; 95 % confidence interval, 3.21-4.98) greater risk for CVD. Notably, under the condition of ideal CVH, the risk of having CVD was comparable between metabolic health and MetS after fully adjusted.

Conclusion

Ideal control of Life's Simple 7 in metabolic syndrome contributes to a comparable risk of cardiovascular disease with healthy subjects. LS7 could be recognized as a guideline for secondary prevention in MetS.

Association of life's essential 8 score with risk of all-cause and cardiovascular disease-related mortality in individuals with hypertension

BACKGROUND

The American Heart Association (AHA) recently defined a new concept of cardiovascular health-Life's Essential 8 (LE8). We sought to examine whether LE8 score is associated with a risk of all-cause and cardiovascular disease (CVD)-related mortality in individuals with hypertension.

METHODS

This longitudinal study analyzed data from the National Health and Nutrition Examination Survey from 2007 to 2018 in people 20 years or older with hypertension. LE8 score (range 0-100) was measured according to the AHA definition and divided into unweighted tertiles into groups T1 (< 50.00), T2 (50.00-61.25), and T3 (≥ 61.25). Primary outcomes included all-cause mortality and CVD-specific mortality.

RESULTS

A total of 15,318 individuals with hypertension were included in this study, with a mean ± standard error age of 55.06 ± 0.25 years. During the median follow-up period of 76 months, 2525 all-cause mortality occurred, of which 806 were due to CVD. Compared with participants with hypertension in the T1 group, those in T2 and T3 respectively had 28% (adjusted HR = 0.72, 95% CI 0.63-0.83, P < 0.001) and 39% (adjusted HR = 0.61, 95% CI 0.52-0.72, P < 0.001) lower risk of all-cause mortality, the T2 and T3 groups were associated with 32% (adjusted HR = 0.68, 95% CI 0.53-0.88, P = 0.003) and 36% (adjusted HR = 0.64, 95% CI 0.49-0.84, P = 0.001) reduced risk of CVD mortality separately.

CONCLUSIONS

A higher LE8 score is associated with a lower risk of all-cause mortality and CVD mortality, and the higher LE8 score can be maintained in the clinic to improve prognosis by modifying the diet and lifestyle habits of individuals with hypertension.

Enhancing the Cardiovascular Health Construct With a Psychological Health Metric for Predicting Mortality Risk

Background

The American Heart Association's Life's Essential 8 (LE8) Presidential Advisory deemed psychological health foundational for cardiovascular health (CVH) but did not include it as a CVH metric.

Objectives

The purpose of this study was to evaluate associations of a CVH construct enhanced with a ninth metric for psychological health based on readily administered depression screening with mortality risk in U.S. adults.

Methods

Participants were 21,183 adults (mean age: 48y, 51% female, 11% Black, 15% Hispanic, 65% White) from the 2011 to 2018 National Health and Nutrition Examination Survey. The LE8 algorithm was used to assess CVH. Two enhanced CVH constructs that include a ninth psychological health metric based on depression screening using the Patient Health Questionnaires (PHQ-2 and PHQ-9) were computed. Multivariable Cox proportional hazards models compared all-cause and cause-specific mortality risk across CVH score tertiles and a priori defined categories (high: 80-100, moderate: 50-79, low: 0-49) in the overall sample and by sex and race and ethnicity.

Results

There were 1,397 deaths (414 cardiovascular and 329 cancer deaths). High vs low CVH scores, enhanced with PHQ-2 and PHQ-9, were associated with 69% and 70% lower mortality risk, while a high vs low LE8 score was associated with 65% lower risk (p-trend<0.001). Higher LE8 and enhanced CVH scores predicted lower mortality risk in both sexes and in Black and White but not Hispanic adults and were also associated with lower cardiovascular and cancer mortality. Both enhanced CVH scores had excellent performance for predicting mortality, similar to the LE8 score (C-statistic = 0.843 vs 0.842, P < 0.001).

Conclusions

A CVH construct enhanced with psychological health strongly predicts mortality. Inclusion of psychological health as a ninth CVH metric, with depression screening as a feasible proxy in clinical and public health settings, should be considered.

Trends in cardiovascular health metrics and associations with long-term mortality among US adults with coronary heart disease

BACKGROUND AND AIMS

Our study examined the trends of cardiovascular health metrics in individuals with coronary heart disease (CHD) and their associations with all-cause and cardiovascular disease mortality in the US.

METHODS AND RESULTS

The cohort study was conducted based on the National Health and Nutrition Examination Survey 1999-2018 and their linked mortality files (through 2019). Baseline CHD was defined as a composite of self-reported doctor-diagnosed coronary heart disease, myocardial infarction, and angina pectoris. Cardiovascular health metrics were assessed according to the American Heart Association recommendations. Long-term all-cause and cardiovascular disease mortality were the primary outcomes. Survey-adjusted Cox regression models were used to estimate hazard ratios and corresponding 95% confidence intervals for the associations between cardiovascular health metrics and all-cause and cardiovascular disease mortality. The prevalence of one or fewer ideal cardiovascular health metrics increased from 14.15% to 22.79% (P < 0.001) in CHD, while the prevalence of more than four ideal cardiovascular health metrics decreased from 21.65% to 15.70 % (P < 0.001) from 1999 to 2018, respectively. Compared with CHD participants with one or fewer ideal cardiovascular health metrics, those with four or more ideal cardiovascular health metrics had a 35% lower risk (hazard ratio, 0.65; 95% confidence interval: 0.51, 0.82) and a 44% lower risk (0.56; 0.38, 0.84) in all-cause and cardiovascular disease mortality, respectively.

CONCLUSION

Substantial declines were noted in ideal cardiovascular health metrics in US adults with CHD. A higher number of cardiovascular health metrics was associated with lower all-cause and cardiovascular disease mortality in them.

Life's essential 8 and risk of subclinical atherosclerosis progression: a prospective cohort study

BACKGROUND

Previous studies have demonstrated the benefits of ideal cardiovascular health (CVH) in reducing cardiovascular risk. However, its role in subclinical atherosclerosis (SA) progression remains unclear. We aim to examine the association of CVH, estimated by the American Heart Association's new Life's Essential 8 (LE8), with the progression of SA.

METHODS

This prospective cohort study was conducted among 972 asymptomatic Chinese participants and followed up for 5.7 years. The LE8 score (range, 0-100) consisted of blood pressure, lipids, glucose, body mass index, smoking status, diet health, physical activity and sleep health was evaluated in 1998 and 2008-2009. Progression of SA was determined by carotid plaque and coronary artery calcification (CAC) in 2008-2009 and 2013-2014. Log-binomial regression model was used to estimate the association of LE8 score with SA progression.

RESULTS

Each 10 points increment in LE8 score was associated with 15.2% (RR: 0.848, 95% CI: 0.797-0.902), 17.7% (RR: 0.823, 95% CI: 0.766-0.884) and 12.0% (RR: 0.880, 95% CI: 0.845-0.916) lower risks of carotid plaque, CAC and overall SA progression, respectively. Compared with participants with non-ideal CVH at both visits, the participants with ideal CVH at both visits had 39.1% (RR: 0.609, 95% CI: 0.494-0.752), 41.0% (RR: 0.590, 95% CI: 0.456-0.764) and 29.7% (RR: 0.703, 95% CI: 0.598-0.825) lower risks of carotid plaque, CAC and overall SA progression, respectively.

CONCLUSIONS

Higher LE8 scores were associated with lower risks of SA progression. Besides, long-term maintenance of optimal CVH was more beneficial to prevent SA progression.

Life's Essential 8 and risk of non-communicable chronic diseases: Outcome-wide analyses

BACKGROUND

Life's Simple 7, the former construct of cardiovascular health (CVH) has been used to evaluate adverse non-communicable chronic diseases (NCDs). However, some flaws have been recognized in recent years and Life's Essential 8 has been established. In this study, we aimed to analyze the association between CVH defined by Life's Essential 8 and risk of 44 common NCDs and further estimate the population attributable fractions (PAFs) of low-moderate CVH scores in the 44 NCDs.

METHODS

In the UK Biobank, 170,726 participants free of 44 common NCDs at baseline were included. The Life's Essential 8 composite measure consists of four health behaviours (diet, physical activity, nicotine exposure, and sleep) and four health factors (body mass index, non-high density lipoprotein cholesterol, blood glucose, and blood pressure), and the maximum CVH score was 100 points. CVH score was categorized into low, moderate, and high groups. Participants were followed up for 44 NCDs diagnosis across 10 human system disorders according to the International Classification of Diseases 10th edition (ICD-10) code using linkage to national health records until 2022. Cox proportional hazard models were used in this study. The hazard ratios (HRs) and PAFs of 44 NCDs associated with CVH score were examined.

RESULTS

During the median follow-up of 10.85 years, 58,889 incident NCD cases were documented. Significant linear dose-response associations were found between higher CVH score and lower risk of 25 (56.8%) of 44 NCDs. Low-moderate CVH (<80 points) score accounted for the largest proportion of incident cases in diabetes (PAF: 80.3%), followed by gout (59.6%), sleep disorder (55.6%), chronic liver disease (45.9%), chronic kidney disease (40.9%), ischemic heart disease (40.8%), chronic obstructive pulmonary disease (40.0%), endometrium cancer (35.8%), lung cancer (34.0%), and heart failure (34.0%) as the top 10. Among the eight modifiable factors, overweight/obesity explained the largest number of cases of incident NCDs in endocrine, nutritional, and metabolic diseases (35.4%), digestive system disorders (21.4%), mental and behavioral disorders (12.6%), and cancer (10.3%); however, the PAF of ideal sleep duration ranked first in nervous system (27.5%) and neuropsychiatric disorders (9.9%).

CONCLUSIONS

Improving CVH score based on Life's Essential 8 may lower risk of 25 common NCDs. Among CVH metrics, avoiding overweight/obesity may be especially important to prevent new cases of metabolic diseases, NCDs in digestive system, mental and behavioral disorders, and cancer.

Impact of health practice index and cardiovascular health metrics on incident cardiovascular disease according to glucose tolerance status

Aims

To evaluate and compare the association of incident cardiovascular disease (CVD) with the Health Practice Index (HPI) reflecting only lifestyle habits and Ideal Cardiovascular Health Metrics (ICVHMs) consisting of lifestyle habits and factors targeted for control in the same population according to glucose status.

Methods

This retrospective cohort study included 1,28,162 participants aged 18-72 years with no history of CVD followed for ≥ 3 years between 2008 and 2016. Participants were classified according to normal glucose tolerance (86,174), prediabetes (36,096), or diabetes (5892). HPI and ICVHMs scores were classified into three groups (high/medium/low). Multivariate Cox regression hazard analysis examined CVD risk.

Results

During a mean follow-up of 5.2 years, 1057 CVD events occurred. In prediabetes, CVD risk was significantly higher in groups with both medium and low HPI scores and ICVHMs scores compared to high scores for normal glucose tolerance (hazard ratios [HRs] for high/medium/low HPI scores were 0.95 [0.78-1.17], 1.56 [1.29-1.89], and 2.41 [1.74-3.34] and for ICVHMs scores were 0.74 [0.50-1.11], 1.58 [1.26-1.98], and 2.63 [2.10-3.31], respectively). Regarding diabetes, compared with high HPI/ICVHMs scores in the normal glucose tolerance group, a significantly increased CVD risk was observed in the high-score HPI group, but not in the high-score ICVHMs group (HPI high/medium/low HR, 1.63 [1.22-2.18], 2.19 [1.69-2.83], and 2.26 [1.34 -3.83]; ICVHMs high/medium/low HR, 1.14 [0.47-2.81], 2.38 [1.75-3.23], and 3.31 [2.50-4.38], respectively).

Conclusions

In diabetes, ideal lifestyle practices alone were insufficient for primary prevention of CVD but had a greater impact on primary prevention of CVD in prediabetes.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13340-024-00708-7.

Association of the American Heart Association's new "Life's Essential 8" with all-cause mortality in patients with chronic kidney disease: a cohort study from the NHANES 2009-2016

BACKGROUND

People with chronic kidney disease (CKD) are more likely to die prematurely, and this increased risk of death is primarily attributable to deaths from cardiovascular disease (CVD). We aim to investigate the relationship between Life's Essential 8 (LE8), a newly proposed cardiovascular health (CVH) measurement system, and all-cause mortality of CKD patients among US adults.

METHODS

A total of 3,169 CKD patients aged 20 and older from the National Health and Nutritional Examination Survey in 2009-2016 were involved in this study. Participants were divided into low (0-49), moderate (50-79) and high (80-100) CVH groups according to LE8 score (range 0-100). The mortality was ascertained from the National Death Index. Cox proportional hazards regression and restricted cubic spline were used to investigate the relationship.

RESULTS

Among the 3,169 CKD patients, the median age was 66.0 (25.0) years and 1,671 (52.7%) were female, and the median follow-up time was 6.00 years. The median LE8 score of the study cohort was 57.5 (19.4). CKD patients with low CVH, health behavior (HB) and health factors (HF) scores presented with higher all-cause mortality (both log-rank P-values < 0.001). After adjusted for multiple confounders, patients in higher CVH group had a lower risk of all-cause mortality, with a HR (95%CI) of 0.32 (0.19-0.55). Similar results were observed in high HB group [HR 0.36 (0.25-0.50)]. The restricted cubic spline showed a significant inverse relationship between LE8, HB and HF scores with CKD all-cause mortality, while the protective effect seemed weaker for HF score. Above results remained robust in the sensitivity analysis. Stronger inverse associations were revealed in middle-aged patients and patients with higher education levels.

CONCLUSIONS

LE8 and its subscales scores were inversely associated with all-cause mortality in patients with CKD. Promoting CVH in CKD patients is a potential way to improve their long-term survival rate.

Associations of life's essential 8 with MAFLD and liver fibrosis among US adults: a nationwide cross-section study

Background

Life's essential' 8 (LE8) is a newly updated cardiovascular health (CVH) metrics from the American Heart Association, with close relevance to metabolism. Our objective is to explore the association between LE8 scores and incidence of metabolic dysfunction-associated fatty liver disease (MAFLD) and advanced liver fibrosis in American adults.

Methods

This population-based cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) conducted between 2005 and 2018, encompassing adults aged 20 years or older. Validated non-invasive scoring systems were employed to define liver steatosis and advanced liver fibrosis. Multivariable logistic regression and smooth curve fitting techniques were applied to evaluate the associations. All analyses were adjusted for the survey' complex design parameters and accounted for sample weights.

Results

A total of 11,820 participants were included. A higher LE8 score was found to be inversely associated with the incidence of MAFLD and advanced liver fibrosis, with odds ratios (OR) of 0.64 (95% CI: 0.57-0.71) for MAFLD and 0.75 (95% CI: 0.61-0.92) for advanced liver fibrosis per 1 standard deviation (SD) increase in LE8 score. Similar patterns were found in the relationship between health behaviors/factors score and incidence of MAFLD and advanced liver fibrosis. In subgroup analyses, the interaction test showed that age, education level, marital status, CVD, hypertension and diabetes had a significant impact on the association between LE8 score and MAFLD (all P for interaction < 0.05). Among male, elderly, wealthy, other race, CVD, diabetes and depression participants, the correlation between LE8 score and advanced liver fibrosis was not statistically significant (P > 0.05). Younger participants exhibited a more pronounced negative association between the CVH metric and both MAFLD and advanced life fibrosis.

Conclusion

LE8 and its subscales score were inversely associated with the presence of MAFLD and advanced liver fibrosis in non-linear patterns. Optimal LE8 score may significantly reduce the risk of liver steatosis and fibrosis.

Epigenetic Age Mediates the Association of Life's Essential 8 With Cardiovascular Disease and Mortality

BACKGROUND

Life's Essential 8 (LE8) is an enhanced metric for cardiovascular health. The interrelations among LE8, biomarkers of aging, and disease risks are unclear.

METHODS AND RESULTS

LE8 score was calculated for 5682 Framingham Heart Study participants. We implemented 4 DNA methylation-based epigenetic age biomarkers, with older epigenetic age hypothesized to represent faster biological aging, and examined whether these biomarkers mediated the associations between the LE8 score and cardiovascular disease (CVD), CVD-specific mortality, and all-cause mortality. We found that a 1 SD increase in the LE8 score was associated with a 35% (95% CI, 27-41; P=1.8E-15) lower risk of incident CVD, a 36% (95% CI, 24-47; P=7E-7) lower risk of CVD-specific mortality, and a 29% (95% CI, 22-35; P=7E-15) lower risk of all-cause mortality. These associations were partly mediated by epigenetic age biomarkers, particularly the GrimAge and the DunedinPACE scores. The potential mediation effects by epigenetic age biomarkers tended to be more profound in participants with higher genetic risk for older epigenetic age, compared with those with lower genetic risk. For example, in participants with higher GrimAge polygenic scores (greater than median), the mean proportion of mediation was 39%, 39%, and 78% for the association of the LE8 score with incident CVD, CVD-specific mortality, and all-cause mortality, respectively. No significant mediation was observed in participants with lower GrimAge polygenic score.

CONCLUSIONS

DNA methylation-based epigenetic age scores mediate the associations between the LE8 score and incident CVD, CVD-specific mortality, and all-cause mortality, particularly in individuals with higher genetic predisposition for older epigenetic age.

Ideal cardiovascular health and cardiovascular-related events: a systematic review and meta-analysis

AIMS

The aim of this study was to systematically review and quantitatively summarize the evidence on the association between Life Simple's 7 (LS7) and multiple cardiovascular diseases (CVDs) and cardiometabolic diseases (CMDs).

METHODS AND RESULTS

EMBASE and PubMed were searched from January 2010 to March 2022 for observational studies that investigated the association between ideal cardiovascular health (CVH) with CVD or CMD outcomes in an adult population. Two reviewers independently selected studies according to the eligibility criteria, extracted data, and evaluated risk of bias. Data were analysed with a random-effects meta-analysis. This meta-analysis included 59 studies (1 881 382 participants). Participants with ideal CVH had a considerably lower risk of a variety of CVDs and CMDs as compared with those with poor CVH, varying from 40% lower risk for atrial fibrillation (AF) {hazard ratio [HR] = 0.60 [95% confidence interval (CI) 0.44-0.83]} to 82% lower risk for myocardial infarction [HR = 0.18 (95% CI 0.12-0.28)]. Intermediate CVH was associated with 27-57% lower risk in CVDs and CMDs compared with poor CVH, with the highest hazard for AF [HR = 0.73 (95% CI 0.59-0.91)] and the lowest hazard for peripheral arterial disease [HR = 0.43 (95% CI 0.30-0.60)].

CONCLUSION

Ideal and moderate CVH were associated with a lower incidence of CVDs and CMDs than poor CVH. Life Simple's 7 holds significant potential for promoting overall CVH and thereby contributing to the prevention of CVDs.

Life's essential 8 metrics and mortality outcomes in insulin resistance: The role of inflammation, vascular aging, and gender

BACKGROUND

Insulin resistance (IR) elevates cardiovascular disease (CVD) and mortality risks. Insulin resistance (IR) increases the risk of CVDs and mortality. Recently, the American Heart Association introduced the Life's Essential 8 (LE8) framework to assess cardiovascular health (CVH). However, its impact on mortality in IR populations is unknown.

METHODS

Analyzing 2005-2018 National Health and Nutrition Examination Survey data, we studied 5301 IR adults (≥20 years). LE8 scores were calculated and participants were categorized into low, moderate, and high CVH groups. Systemic immune-inflammation index (SII) and heart age/vascular age (HVA) were measured as potential mediators. Cox models estimated all-cause and CVD mortality hazard ratios (HRs), stratified by LE8 score and sex, and adjusted for covariates. Mediation analyses assessed SII and HVA's indirect effects. This study is an observational cohort study.

RESULTS

Over a 7.5-year median follow-up, 625 deaths occurred, including 159 CVD-related. Compared to low CVH, moderate and high CVH groups showed reduced all-cause (HR = 0.72, 95% CI 0.58-0.89; HR = 0.38, 95% CI 0.22-0.67) and CVD mortality (HR = 0.42, 95% CI 0.26-0.69; HR = 0.15, 95% CI 0.04-0.57). A 10-point LE8 increase correlated with 15% and 31% reductions in all-cause and CVD mortality, respectively. SII and HVA mediated up to 38% and 12% of these effects. The LE8's protective effect was more pronounced in men.

CONCLUSION

LE8 effectively evaluates CVH and lowers mortality risk in IR adults, partially mediated by SII and HVA. The findings inform clinical practice and public health strategies for CVD prevention in IR populations.

Cardiac magnetic resonance in advanced heart failure

Heart failure (HF) is a chronic and progressive disease that often progresses to an advanced stage where conventional therapy is insufficient to relieve patients' symptoms. Despite the availability of advanced therapies such as mechanical circulatory support or heart transplantation, the complexity of defining advanced HF, which requires multiple parameters and multimodality assessment, often leads to delays in referral to dedicated specialists with the result of a worsening prognosis. In this review, we aim to explore the role of cardiac magnetic resonance (CMR) in advanced HF by showing how CMR is useful at every step in managing these patients: from diagnosis to prognostic stratification, hemodynamic evaluation, follow-up and advanced therapies such as heart transplantation. The technical challenges of scanning advanced HF patients, which often require troubleshooting of intracardiac devices and dedicated scans, will be also discussed.

Life's Essential 8 in Relation to Cardiovascular Disease and Mortality in Individuals With Diabetes

Background

Evidence regarding the potential health effects of Life's Essential 8 (LE8) score among individuals with type 2 diabetes (T2D) is limited.

Objectives

The purpose of this study was to examine the associations of LE8 score with risk of cardiovascular disease (CVD) and mortality among individuals with T2D.

Methods

We prospectively followed 19,915 Chinese participants with T2D at baseline or diagnosed during follow-up (Kailuan Study: 2006-2020), who were free of CVD at diagnosis of diabetes. Diet, lifestyle, and health conditions were repeatedly assessed every 2 years. The LE8 score (range 0-100), was calculated based on 8 components: diet quality, physical activity, smoking status, sleep health, body mass index, blood lipids, blood glucose, and blood pressure. We used time-varying cox models to model the associations.

Results

During a median follow-up of 11.5 years in participants with T2D, there were 3,295 incident CVD cases and 3,123 deaths. Higher LE8 score was associated with lower risk of CVD incidence and total mortality among participants with diabetes. The multivariate-adjusted HRs for the highest quintile of LE8 score compared with the lowest quintile were 0.56 (95% CI: 0.53-0.59) for CVD, 0.57 (95% CI: 0.53-0.62) for heart disease, 0.53 (95% CI: 0.49-0.57) for stroke, and 0.73 (95% CI: 0.69-0.78) for total mortality (all P trend <0.001). Furthermore, compared with participants with stable or decreased LE8 score after diabetes diagnosis, those with increased LE8 score had 17% to 42% lower risk of CVD, heart disease, stroke, and mortality.

Conclusions

A higher LE8 score was associated with a substantially lower risk of CVD incidence and total mortality among adults with T2D.

Cardiovascular Health Trajectories in Adolescence and Their Association With Sociodemographic and Cardiometabolic Outcomes in Spain

PURPOSE

To determine cardiovascular health (CVH) trajectories and their association with sociodemographic and cardiometabolic outcomes in adolescence.

METHODS

One thousand eighty adolescents attending 24 secondary schools enrolled in the SI! Program for Secondary Schools trial in Spain were assessed at approximately 12, 14, and 16 years of age. CVH was assessed according to American Heart Association criteria based on seven metrics (smoking status, body mass index, physical activity, diet, blood pressure, total cholesterol, and blood glucose), and CVH trajectories were identified by latent class trajectory modeling. Associations between CVH trajectories, sociodemographic characteristics, and cardiometabolic outcomes were analyzed using generalized linear and Poisson models.

RESULTS

Five CVH trajectory groups were identified: poor-stable (27 adolescents [2.5%]), intermediate-substantial rise (79 [7.3%]), intermediate-substantial decline (63 [5.8%]), intermediate-mild decline (403 [37.3%]), and intermediate-mild rise (508 [47.1%]). Boys and adolescents from families with low-average income, low-intermediate educational attainment, and a migrant background more frequently belonged to groups with lower baseline CVH and poor or declining trajectories. The intermediate-substantial decline group had the highest prevalence ratio for overweight/obesity (3.84; 95% confidence interval: 2.86-5.16) and metabolic syndrome (4.93; 95% confidence interval: 1.21-20.04) at age 16, whereas prevalence was lowest in the intermediate-mild rise group.

DISCUSSION

Adolescent CVH trajectories differ according to socioeconomic characteristics and are associated with cardiometabolic outcomes. Primordial prevention interventions should be implemented early in life, taking into account CVH trajectories and with a particular focus on vulnerable populations.

Precision Cardio-oncology: Update on Omics-Based Diagnostic Methods

OPINION STATEMENT

Cardio-oncology is an emerging interdisciplinary field dedicated to the early detection and treatment of adverse cardiovascular events associated with anticancer treatment, and current clinical management of anticancer-treatment-related cardiovascular toxicity (CTR-CVT) remains limited by a lack of detailed phenotypic data. However, the promise of diagnosing CTR-CVT using deep phenotyping has emerged with the development of precision medicine, particularly the use of omics-based methodologies to discover sensitive biomarkers of the disease. In the future, combining information produced by a variety of omics methodologies could expand the clinical practice of cardio-oncology. In this review, we demonstrate how omics approaches can improve our comprehension of CTR-CVT deep phenotyping, discuss the positive and negative aspects of available omics approaches for CTR-CVT diagnosis, and outline how to integrate multiple sets of omics data into individualized monitoring and treatment. This will offer a reliable technical route for lowering cardiovascular morbidity and mortality in cancer patients and survivors.

Financial strain is associated with poorer cardiovascular health: The multi-ethnic study of atherosclerosis

Objective

Psychosocial stress is associated with increased cardiovascular disease (CVD) risk. The relationship between financial strain, a toxic form of psychosocial stress, and ideal cardiovascular health (CVH) is not well established. We examined whether financial strain was associated with poorer CVH in a multi-ethnic cohort free of CVD at baseline.

Methods

This was a cross-sectional analysis of 6,453 adults aged 45-84 years from the Multi-Ethnic Study of Atherosclerosis. Financial strain was assessed by questionnaire and responses were categorized as yes or no. CVH was measured from 7 metrics (smoking, body mass index, physical activity, diet, total cholesterol, blood glucose and blood pressure). A CVH score of 14 was calculated by assigning points to the categories of each metric (poor = 0 points, intermediate = 1 point, ideal = 2 points). Multinomial logistic regression was used to examine the association of financial strain with the CVH score (inadequate 0-8, average 9-10, and optimal 11-14 points) adjusting for sociodemographic factors, depression and anxiety.

Results

The mean age (SD) was 62 (10) and 53 % were women. Financial strain was reported by 25 % of participants. Participants who reported financial strain had lower odds of average (OR, 0.82 [95 % CI, 0.71, 0.94]) and optimal (0.73 [0.62, 0.87]) CVH scores. However, in the fully adjusted model, the association was only significant for optimal CVH scores (0.81, [0.68, 0.97]).

Conclusion

Financial strain was associated with poorer CVH. More research is needed to understand this relationship so the burden of CVD can be decreased, particularly among people experiencing financial hardship.

Association between adherence to the EAT-Lancet sustainable reference diet and cardiovascular health among European adolescents: the HELENA study

BACKGROUND

The EAT-Lancet Commission proposed a global reference diet to promote healthy diets within planetary boundaries. Studies evaluating the associations between the reference diet with health outcomes among adolescents are scarce. Thus, our aim was to assess the association between adherence to the EAT-Lancet diet and cardiovascular health among European adolescents.

METHODS

Data from the HELENA study were used. Usual dietary intake was assessed using two 24-h dietary recalls and adherence to the EAT-Lancet diet was assessed using the Planetary Health Diet Index (PHDI), a 16-component index that ranges from 0 to 150 points. Cardiovascular health was assessed through the seven-component Ideal Cardiovascular Health (ICH) score: never smoked, eutrophic body mass index, moderate-to-vigorous physical activity, healthy dietary pattern, low blood pressure, low fasting plasma glucose, and low total cholesterol. Total ICH score was categorized into ideal (5-7) and non-ideal (0-4).

RESULTS

A 10-point increment in the PHDI was associated with a lower probability of a non-ideal ICH status (OR 0.84, [95% CI: 0.75, 0.94]) among European adolescents, after adjusting for age, sex, socio-economic status, and total energy intake. Furthermore, a 10-point increment in the PHDI was associated with lower probability of high blood pressure (OR: 0.87 [0.79, 0.96]) and a lower probability of high blood cholesterol (OR: 0.88 [0.78, 0.99]).

CONCLUSION

Our study suggests that a higher PHDI may be associated with a better cardiovascular health status among European adolescents.

Evidence for the Association Between Adverse Childhood Family Environment, Child Abuse, and Caregiver Warmth and Cardiovascular Health Across the Lifespan: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

BACKGROUND

This study aimed to quantify the association between childhood family environment and longitudinal cardiovascular health (CVH) in adult CARDIA (Coronary Artery Risk Development in Young Adults) Study participants. We further investigated whether the association differs by adult income.

METHODS

We applied the CVH framework from the American Heart Association including metrics for smoking, cholesterol, blood pressure, glucose, body mass index, physical activity, and diet. CVH scores (range, 0-14) were calculated at years 0, 7, and 20 of the study. Risky Family environment (range, 7-28) was assessed at year 15 retrospectively, for childhood experiences of abuse, caregiver warmth, and family or household challenges. Complete case ordinal logistic regression and mixed models associated risky family (exposure) with CVH (outcome), adjusting for age, sex, race, and alcohol use.

RESULTS

The sample (n=2074) had a mean age of 25.3 (±3.5) years and 56% females at baseline. The median risky family was 10 with ideal CVH (≥12) met by 288 individuals at baseline (28.4%) and 165 (16.3%) at year 20. Longitudinally, for every 1-unit greater risky family, the odds of attaining high CVH (≥10) decreased by 3.6% (OR, 0.9645 [95% CI, 0.94-0.98]). Each unit greater child abuse and caregiver warmth score corresponded to 12.8% lower and 11.7% higher odds of ideal CVH (≥10), respectively (OR, 0.872 [95% CI, 0.77-0.99]; OR, 1.1165 [95% CI, 1.01-1.24]), across all 20 years of follow-up. Stratified analyses by income in adulthood demonstrated associations between risky family environment and CVH remained significant for those of the highest adult income (>$74k), but not the lowest (<$35k).

CONCLUSIONS

Although risky family environmental factors in childhood increase the odds of poor longitudinal adult CVH, caregiver warmth may increase the odds of CVH, and socioeconomic attainment in adulthood may contextualize the level of risk. Toward a paradigm of primordial prevention of cardiovascular disease, childhood exposures and economic opportunity may play a crucial role in CVH across the life course.

Prevalence of cardiometabolic risk and health factors among Puerto Rican young adults in the Boricua Youth Study - Health Assessment

We describe and compare the prevalence of cardiometabolic risk factors and ideal cardiovascular health (CVH) among Puerto Rican young adults in the San Juan metro area in Puerto Rico and the South Bronx, NY. As part of the Boricua Youth Study - Health Assessment, (mean age 23 ± 0.1 years) objective anthropometric, blood pressure and blood samples were collected. Information on diet, physical activity and sleep were collected via surveys. Life's Essential 8 metrics were characterized as continuous with higher scores indicating more optimal CVH and categorically (80-100 scores for ideal CVH). Mean CVH score among NY participants was lower (61.9) than in PR (68.9). No participant had all ideal health metrics, 36% of participants in PR had 5 or more ideal CVH; while only 16% in NY met this criterion. The prevalence of cardiometabolic risk factors was high for obesity (35% in NY, 19% in PR) and diabetes (17% NY, 20% PR). In this ethnically homogenous population, we found low levels of ideal CVH that varied across study site, suggesting differences by sociocultural context. Interventions to maintain and improve CVH across the life course, tailored to sociocultural environments, are necessary for the prevention of cardiovascular disease.

Heart transplantation: advances in expanding the donor pool and xenotransplantation

Approximately 65 million adults globally have heart failure, and the prevalence is expected to increase substantially with ageing populations. Despite advances in pharmacological and device therapy of heart failure, long-term morbidity and mortality remain high. Many patients progress to advanced heart failure and develop persistently severe symptoms. Heart transplantation remains the gold-standard therapy to improve the quality of life, functional status and survival of these patients. However, there is a large imbalance between the supply of organs and the demand for heart transplants. Therefore, expanding the donor pool is essential to reduce mortality while on the waiting list and improve clinical outcomes in this patient population. A shift has occurred to consider the use of organs from donors with hepatitis C virus, HIV or SARS-CoV-2 infection. Other advances in this field have also expanded the donor pool, including opt-out donation policies, organ donation after circulatory death and xenotransplantation. We provide a comprehensive overview of these various novel strategies, provide objective data on their safety and efficacy, and discuss some of the unresolved issues and controversies of each approach.

Ideal cardiovascular health metrics and risk of type 2 diabetes: A systematic review and dose-response meta-analysis of prospective cohort studies

BACKGROUND AND AIMS

Studies suggest a potential link between ideal cardiovascular health (CVH) and the risk of type 2 diabetes (T2D). However, systematic reviews are lacking to pool these data and present a balanced review about this association.

METHODS AND RESULTS

We performed a systematic search of PubMed/Medline, Web of Sciences, and Scopus from inception until November 2022 to search for prospective observational studies assessing the link between ideal CVH metrics, as introduced by the American Heart Association, and the risk of T2D in adults. Nine cohort studies with 78,912 participants and 6242 cases of T2D were included. The pooled relative risk of T2D for the highest versus the lowest category of ideal CVH metrics was 0.36 (95% confidence interval [CI]: 0.25, 0.47; risk difference: 5 fewer per 100 patients, 95% CI: 6 fewer, 4 fewer; Grading of Recommendations Assessment, Development and Evaluation certainty = high). Each unit increase in the components of the ideal CVH metrics was associated with a 20% lower risk of T2D. Dose-response meta-analysis indicated a monotonic inverse association between ideal CVH metrics and the risk of T2D. Results from analysis of individual components showed that having a normal weight, adopting a healthy diet, and having normal blood pressure levels were associated with a reduced risk of T2D.

CONCLUSIONS

Having an ideal CVH profile and a unit increase in any CVH metric are inversely associated with the risk of T2D.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022376934.

Relation of Life's Essential 8 to the genetic predisposition for cardiovascular outcomes and all-cause mortality: results from a national prospective cohort

AIMS

To evaluate the independent, mediating, interactive, and associated effects of Life's Essential 8 (LE8) and genetic predisposition on the risk of cardiovascular outcomes and all-cause mortality.

METHODS AND RESULTS

We retrieved a total of 254 783 individuals from the UK Biobank. LE8 was determined by eight metrics (nicotine exposure, physical activity, diet, sleep, body mass index, blood pressure, blood glucose, and blood lipids), and was characterized as low, moderate, and high cardiovascular health (CVH). Genetic predisposition was estimated using the polygenic risk score (PRS). Cox regressions were performed to evaluate the associations between LE8, PRS, and outcomes. During a median follow-up of 12.53 years, all-cause mortality occurred in 10 257 of 197 473 participants, cardiovascular mortality in 2074 of 215 675, and incident cardiovascular disease (CVD) in 71 774 of 215 675. Individuals with moderate or high CVH experienced a lower risk [hazard ratios (HRs) 0.33 to 0.81] of adverse health outcomes compared with their counterparts with low CVH. A substantial proportion (16.1∼69.8%) of health outcomes could be attributable to moderate or high LE8, and up to 51.2% of the associations between PRS and adverse outcomes were mediated by LE8. In high PRS group, individuals with high CVH had lower CVD mortality (HR: 0.26, 95% confidence interval: 0.18, 0.39), compared to those with low CVH.

CONCLUSION

Ideal CVH was associated with lower risks of cardiovascular outcomes and all-cause mortality, with a more pronounced association observed in individuals with high PRS for CVD. Improving CVH according to LE8 guidelines should be encouraged, especially for those with PRS that indicate high CVD risk.

Associations of updated cardiovascular health metrics, including sleep health, with incident diabetes and cardiovascular events in older adults with prediabetes: A nationwide population-based cohort study

AIMS

To investigate the association of updated cardiovascular health (CVH) metrics, including sleep health, with the risk of diabetes and major adverse cardiovascular events (MACE) in older adults with prediabetes.

METHODS

A total of 7,948 older adults with prediabetes aged ≥ 65 years were included in this study. CVH was assessed using seven baseline metrics according to the modified American Heart Association recommendations.

RESULTS

During a median follow-up time of 11.9 years, 2,405 (30.3%) cases of diabetes and 2,039 (25.6%) MACE were recorded. Compared with the poor composite CVH metrics group, the multivariable-adjusted hazard ratios (HRs) in the intermediate and ideal composite CVH metrics groups were respectively 0.87 (95% confidence intervals [CI] = 0.78-0.96) and 0.72 (95% CI = 0.65-0.79) for diabetes events and 0.99 (95% CI = 0.88-1.11) and 0.88 (95% CI = 0.79-0.97) for MACE. The ideal composite CVH metrics group had a lower risk of diabetes and MACE in older adults aged 65-74 years, but not in those aged ≥ 75 years.

CONCLUSIONS

Ideal composite CVH metrics in older adults with prediabetes were associated with a lower risk of diabetes and MACE.

Association of cardiovascular health at old age with all-cause mortality: a prospective cohort study in China

BACKGROUND

Cardiovascular disease has become the leading cause of death worldwide, but there is a lack of data on whether cardiovascular health (CVH) is associated with elderly mortality in China. We investigated the relationship between the ideal CVH score of Chinese elderly and the all-cause mortality.

METHODS

The Beijing Elderly Comprehensive Health Cohort Study included a total of 4,499 participants aged 60 years and above. The CVH metric was calculated at baseline and had a score ranging from 0 to 12. The relationship of CVH metrics with all-cause mortality was investigated using Cox proportional hazard regression analysis. The robustness of results was tested using subgroup and sensitivity analysis.

RESULTS

The median CVH score among participants was 8.00 (2.00), with only 8.0% scoring 11-12 points. 667 deaths were observed during an average follow-up time of 8.2 years. Participants with a CVH score of 11-12 had a decreased risk of all-cause mortality when compared to those with a CVH score of 0-4(HR = 0.584, 95% CI: 0.373-0.913). Participants had a 7.5% lower risk of all-cause death with each unit higher CVH score (HR = 0.925, 95%CI: 0.885-0.967) with a linearly decreasing trend (P nonlinear = 0.575). The relationships were greater in younger elderly people and stroke patients (P interaction = 0.011 and 0.037. respectively). The consistency of significant trends in sensitivity analysis shows the robustness of association (P trend < 0.001).

CONCLUSIONS

Among the Chinese elderly, there was a linear relationship between improving CVH scores and a lower risk of all-cause mortality. Because of the enormous benefits brought by one point, strategies are essential for improving cardiovascular health attainment.

TRIAL REGISTRATION

This study was registered at China Clinical Trial Registration Center (ChiCTR2100049866).

Ideal Cardiovascular Health and Risk of Cardiovascular Events or Mortality: A Systematic Review and Meta-Analysis of Prospective Studies

Cardiovascular diseases (CVD) remain the leading cause of morbidity and mortality worldwide, hence significant efforts have been made to establish behavior and risk factors associated with CVD. The American Heart Association proposed a 7-metric tool to promote ideal cardiovascular health (CVH). Recent data demonstrated that a higher number of ideal CVH metrics was associated with a lower risk of CVD, stroke, and mortality. Our study aimed to perform a systematic review and meta-analysis of prospective studies investigating the association of ideal CVH metrics and CVD, stroke, and cardiovascular mortality (CVM) in the general population. Medline and Scopus databases were searched from January 2010 to June 2022 for prospective studies reporting CVH metrics and outcomes on composite-CVD, coronary heart disease, myocardial infarction, stroke, and CVM. Each CVH metrics group was compared to another. Twenty-two studies totaling 3,240,660 adults (57.8% men) were analyzed. The follow-up duration was 12.0 ± 7.2 years. Our analysis confirmed that a higher number of ideal CVH metrics led to lower risk for CVD and CVM (statistically significant for composite-CVD, stroke, and CVM; p < 0.05). Conclusion: Even modest improvements in CVH are associated with CV-morbidity and mortality benefits, providing a strong public health message about the importance of a healthier lifestyle.

Life's Essential 8 and the risk of cardiovascular disease death and all-cause mortality in Finnish men

AIMS

The aim of the study was to examine the association between Life's Essential 8 (LE8) and the risk of cardiovascular and all-cause mortality.

METHODS AND RESULTS

The LE8 was computed for 1662 men, aged 42-60 years, without pre-existing history of cardiovascular disease (CVD) at baseline in the Kuopio Ischaemic Heart Disease study. The LE8 factors include diet, physical activity, nicotine exposure, sleep, body mass index, blood pressure, blood glucose, and lipids. Each LE8 factor was scored between 0 and 100 points. The summation of all points generated the total LE8 score, which was categorized into quartiles ≤-420, >420-485, >485-550, and >550. Multivariable Cox regression models were used to estimate hazard ratios and 95% confidence intervals of LE8 scores for the outcomes. During a median follow-up of 30 years, 402 and 987 men died from CVD and any cause, respectively. The total LE8 score among participants ranged from 185 to 750. The higher the LE8 scores, the lower the risk of dying from CVD and all-cause. Following adjustment for age, alcohol consumption, and socio-economic status, every 50-unit increase in LE8 score was associated with 17% and 14% lower risk of CVD and all-cause deaths, respectively. Men within LE8 top quartile had 60% lower risk of CVD mortality when compared with those within the bottom quartile.

CONCLUSION

Life's Essential 8 was strongly and inversely associated with the risk of CVD death and all-cause mortality among ageing men. Measures that promote optimal LE8 scores should be encouraged among the general population.

Association of Life's Essential 8 with all-cause and cardiovascular mortality among US adults: A prospective cohort study from the NHANES 2005-2014

BACKGROUND AND AIMS

This study aims to investigate the association of Life's Essential 8 (LE8), the recently updated algorithm for quantifying cardiovascular health (CVH) by the American Heart Association (AHA), with long-term outcomes among US adults.

METHODS AND RESULTS

This population-based prospective cohort study analyzed data of 23,110 participants aged 20 years or older from the National Health and Nutrition Examination Survey from 2005 to 2014 and their linked mortality data through December 2019. LE8 score (range 0-100) was measured according to AHA definitions and was categorized into low (0-49), moderate (50-79), and high (80-100) CVH. The weighted mean age of the study population was 47.0 years (95% confidence interval [CI], 46.4-47.5 years), and 11,840 were female (weighted percentage, 51.5%; 95% CI, 50.9-52.1%). During a median follow-up period of 113 months (up to 180 months), 2942 all-cause deaths occurred, including 738 CVD deaths. The LE8 score was significantly and inversely related to mortality from all causes (adjusted hazard ratio [HR] for per 10-score increase in LE8 score, 0.86; 95% CI, 0.82-0.90) and cardiovascular disease (adjusted HR for per 10-score increase in LE8 score, 0.81; 95% CI, 0.75-0.87). Compared with participants having low CVH, those having high CVH had a reduction of 40% (adjusted HR, 0.60; 95% CI, 0.48-0.75) in the risk for all-cause mortality and 54% (adjusted HR, 0.46; 95% CI, 0.31-0.68) in the risk for cardiovascular mortality.

CONCLUSIONS

Higher LE8 score was independently associated with lower risks of all-cause and cardiovascular mortality among US adults.

Association of Life's Simple 7 with mild cognitive impairment in community-dwelling older adults in China: a cross-sectional study

Background

Life's Simple 7 (LS7), a metric composed of seven intervenable cardiovascular risk factors, is initiated by the American Heart Association to improve cardiovascular health. The components of LS7 have been reported as risk factors for dementia. However, few studies investigated the association between LS7 metric and mild cognitive impairment (MCI).

Methods

The study was carried out in a primary care facility between 8 June and 10 July 2022. A total of 297 community-dwelling residents aged 65 years or older were recruited. Sociodemographic, comorbidity, and lifestyle characteristics were collected through the questionnaires, and biological parameters were obtained from blood sample examinations. Logistic regression was used to analyze the association between LS7 scores (overall, behavioral, and biological) and individual components with MCI, adjusting sex, age, education, and cardiovascular disease (CVD).

Results

In comparison with the cognitively intact group (n = 195), the MCI group (n = 102) had a lower education level and a higher proportion of hypertension. Multivariate logistic regression analysis, adjusting sex, age, education, and CVD demonstrated a significant association between MCI and overall LS7 score [odd ratio = 0.805, 95% confidence interval (0.690, 0.939)] and biological score [odd ratio = 0.762, 95% confidence interval (0.602, 0.965)].

Conclusion

Life's Simple 7 was associated with MCI in community-dwelling older adults, indicating that LS7 could be used as guidance in the prevention of dementia in the community.

The Role of Aldosterone and Ideal Cardiovascular Health in Incident Cardiovascular Disease: The Jackson Heart Study

Background

Higher levels of ideal cardiovascular health (ICH) are associated with lower levels of aldosterone and incidence of cardiovascular disease (CVD). However, the degree to which aldosterone mediates the association between ICH and CVD incidence has not been explored. Thus, we investigated the mediational role of aldosterone in the association of 5 components of ICH (cholesterol, body mass index (BMI), physical activity, diet and smoking) with incident CVD and the mediational role of blood pressure (BP) and glucose in the association of aldosterone with incident CVD in a cohort of African Americans (AA).

Methods

The Jackson Heart Study is a prospective cohort of AAs adults with data on CVD outcomes. Aldosterone, ICH metrics and baseline characteristics were collected at exam 1 (2000-2004). ICH score was developed by summing 5 ICH metrics (smoking, dietary intake, physical activity, BMI, and total cholesterol) and grouped into two categories (0-2 and ≥3 metrics). Incident CVD was defined as stroke, coronary heart disease, or heart failure. Cox proportional hazard regression models were used to model the association of categorical ICH score with incident CVD. The R Package Mediation was utilized to examine: 1) The mediational role of aldosterone in the association of ICH with incident CVD and 2) The mediational role of blood pressure and glucose in the association of aldosterone with incident CVD.

Results

Among 3,274 individuals (mean age: 54±12.4 years, 65% female), there were 368 cases of incident CVD over a median of 12.7 years. The risk of incident CVD was 46% lower (HR: 0.54; 95%CI 0.36, 0.80) in those with ≥3 ICH metrics at baseline compared to 0-2. Aldosterone mediated 5.4% (p = 0.006) of the effect of ICH on incident CVD. A 1-unit increase in log-aldosterone was associated with a 38% higher risk of incident CVD (HR 1.38, 95%CI: 1.19, 1.61) with BP and glucose mediating 25.6% (p<0.001) and 4.8% (p = 0.048), respectively.

Conclusion

Aldosterone partially mediates the association of ICH with incident CVD and both blood pressure and glucose partially mediate the association of aldosterone with incident CVD, emphasizing the potential importance of aldosterone and ICH in risk of CVD among AAs.

Less than ideal cardiovascular health among adults is associated with experiencing adverse childhood events: BRFSS 2019

Ideal cardiovascular health (CVH) is associated with a lower risk of heart disease and stroke while adverse childhood events (ACEs) are related to health behaviors (e.g., smoking, unhealthy diet) and conditions (e.g., hypertension, diabetes) associated with CVH. Data from the 2019 Behavioral Risk Factor Surveillance System was used to explore ACEs and CVH among 86,584 adults ≥18 years from 20 states. CVH was defined as poor (0-2), intermediate (3-5), and ideal (6-7) from summation of survey indicators (normal weight, healthy diet, adequate physical activity, not smoking, no hypertension, no high cholesterol, and no diabetes). ACEs was summed by number (0,1, 2, 3, and ≥4). A generalized logit model estimated associations between poor and intermediate CVH (ideal as referent) and ACEs accounting for age, race/ethnicity, sex, education, and health care coverage. Overall, 16.7% (95% Confidence Interval[CI]:16.3-17.1) had poor, 72.4% (95%CI:71.9-72.9) had intermediate, and 10.9% (95%CI:10.5-11.3) had ideal CVH. Zero ACEs were reported for 37.0% (95%CI:36.4-37.6), 22.5% (95%CI:22.0-23.0) reported 1, 12.7% (95%CI:12.3-13.1) reported 2, 8.5% (95%CI:8.2-8.9) reported 3, and 19.3% (95%CI:18.8-19.8) reported ≥4 ACEs. Those with 1 (Adjusted Odds Ratio [AOR] = 1.27;95%CI = 1.11-1.46), 2 (AOR = 1.63;95%CI:1.36-1.96), 3 (AOR = 2.01;95%CI:1.66-2.44), and ≥ 4 (AOR = 2.47;95%CI:2.11-2.89) ACEs were more likely to report poor (vs. ideal) CVH compared to those with 0 ACEs. Those who reported 2 (AOR = 1.28;95%CI = 1.08-1.51), 3 (AOR = 1.48;95%CI:1.25-1.75), and ≥ 4 (AOR = 1.59;95%CI:1.38-1.83) ACEs were more likely to report intermediate (vs. ideal) CVH compared to those with 0 ACEs. Preventing and mitigating the harms of ACEs and addressing barriers to ideal CVH, particularly social and structural determinants, may improve health.

Differences in Ideal Cardiovascular Health Between Sexual Minority and Heterosexual Adults

Importance

Research on the cardiovascular health (CVH) of sexual minority adults has primarily examined differences in the prevalence of individual CVH metrics rather than comprehensive measures, which has limited development of behavioral interventions.

Objective

To investigate sexual identity differences in CVH, measured using the American Heart Association's revised measure of ideal CVH, among adults in the US.

Design, Setting, and Participants

This cross-sectional study analyzed population-based data from the National Health and Nutrition Examination Survey (NHANES; 2007-2016) in June 2022. Participants included noninstitutional adults aged 18 to 59 years. We excluded individuals who were pregnant at the time of their interview and those with a history of atherosclerotic cardiovascular disease or heart failure.

Exposures

Self-identified sexual identity categorized as heterosexual, gay/lesbian, bisexual, or something else.

Main Outcomes and Measures

The main outcome was ideal CVH (assessed using questionnaire, dietary, and physical examination data). Participants received a score from 0 to 100 for each CVH metric, with higher scores indicating a more favorable CVH profile. An unweighted average was calculated to determine cumulative CVH (range, 0-100), which was recoded as low, moderate, or high. Sex-stratified regression models were performed to examine sexual identity differences in CVH metrics, disease awareness, and medication use.

Results

The sample included 12 180 participants (mean [SD] age, 39.6 [11.7] years; 6147 male individuals [50.5%]). Lesbian (B = -17.21; 95% CI, -31.98 to -2.44) and bisexual (B = -13.76; 95% CI, -20.54 to -6.99) female individuals had less favorable nicotine scores than heterosexual female individuals. Bisexual female individuals had less favorable body mass index scores (B = -7.47; 95% CI, -12.89 to -1.97) and lower cumulative ideal CVH scores (B = -2.59; 95% CI, -4.84 to -0.33) than heterosexual female individuals. Compared with heterosexual male individuals, gay male individuals had less favorable nicotine scores (B = -11.43; 95% CI, -21.87 to -0.99) but more favorable diet (B = 9.65; 95% CI, 2.38-16.92), body mass index (B = 9.75; 95% CI, 1.25-18.25), and glycemic status scores (B = 5.28; 95% CI, 0.59-9.97). Bisexual male individuals were twice as likely as heterosexual male individuals to report a diagnosis of hypertension (adjusted odds ratio [aOR], 1.98; 95% CI, 1.10-3.56) and use of antihypertensive medication (aOR, 2.20; 95% CI, 1.12-4.32). No differences in CVH were found between participants who reported their sexual identity as something else and heterosexual participants.

Conclusion and Relevance

Results of this cross-sectional study suggest that bisexual female individuals had worse cumulative CVH scores than heterosexual female individuals, whereas gay male individuals generally had better CVH than heterosexual male individuals. There is a need for tailored interventions to improve the CVH of sexual minority adults, particularly bisexual female individuals. Future longitudinal research is needed to examine factors that might contribute to CVH disparities among bisexual female individuals.

Association of the American Heart Association's new "Life's Essential 8" with all-cause and cardiovascular disease-specific mortality: prospective cohort study

BACKGROUND

The American Heart Association recently updated its construct of what constitutes cardiovascular health (CVH), called Life's Essential 8. We examined the association of total and individual CVH metrics according to Life's Essential 8 with all-cause and cardiovascular disease (CVD)-specific mortality later in  life.

METHODS

Data were from the National Health and Nutrition Examination Survey (NHANES) 2005-2018 at baseline linked to the 2019 National Death Index records. Total and individual CVH metric scores including diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipids, blood glucose, and blood pressure were classified as 0-49 (low level), 50-74 (intermediate level), and 75-100 (high level) points. The total CVH metric score (the average of the 8 metrics) as a continuous variable was also used for dose-response analysis. The main outcomes included all-cause and CVD-specific mortality.

RESULTS

A total of 19,951 US adults aged 30-79 years were included in this study. Only 19.5% of adults achieved a high total CVH score, whereas 24.1% had a low score. During a median follow-up of 7.6 years, compared with adults with a low total CVH score, those with an intermediate or high total CVH score had 40% (adjusted hazard ratio [HR] 0.60, 95% confidence interval [CI] 0.51-0.71) and 58% (adjusted HR 0.42, 95% CI 0.32-0.56) reduced risk of all-cause mortality. The corresponding adjusted HRs (95%CIs) were 0.62 (0.46-0.83) and 0.36 (0.21-0.59) for CVD-specific mortality. The population-attributable fractions for high (score ≥ 75 points) vs. low or intermediate (score < 75 points) CVH scores were 33.4% for all-cause mortality and 42.9% for CVD-specific mortality. Among all 8 individual CVH metrics, physical activity, nicotine exposure, and diet accounted for a large proportion of the population-attributable risks for all-cause mortality, whereas physical activity, blood pressure, and blood glucose accounted for a large proportion of CVD-specific mortality. There were approximately linear dose-response associations of total CVH score (as a continuous variable) with all-cause and CVD-specific mortality.

CONCLUSIONS

Achieving a higher CVH score according to the new Life's Essential 8 was associated with a reduced risk of all-cause and CVD-specific mortality. Public health and healthcare efforts targeting the promotion of higher CVH scores could provide considerable benefits to reduce the mortality burden later in life.