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Impact of Life's Essential Eight and Inflammatory Markers on Long-term Cardiovascular Disease Risk and All-cause
Claudia E Bambs1,2, Ian Pollack3, Justin Swanson4
1School of Public Health, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
Insights
Life's Essential 8 (LE8) improves cardiovascular health and lowers mortality risk. Elevated interleukin-6 (IL-6) independently increases risk, highlighting inflammation's role.
Area of Science:
- Cardiovascular disease research
- Public health and epidemiology
- Biomarkers and disease risk
Background:
- Life's Essential 8 (LE8) are American Heart Association-defined factors for cardiovascular health.
- LE8 does not currently include inflammatory markers, despite their link to cardiovascular diseases.
- This study examines LE8 components and inflammatory markers in relation to health outcomes.
Purpose of the Study:
- To analyze the longitudinal association of LE8 components and inflammatory markers with cardiovascular disease and mortality.
- To determine if inflammatory markers are independent risk factors for adverse health outcomes.
- To investigate the role of inflammation in cardiovascular health beyond LE8 metrics.
Main Methods:
- 1,869 participants from the Heart SCORE study provided baseline LE8 metrics and inflammatory markers (IL-6, hsCRP).
- Cox-proportional hazard ratios assessed associations between LE8 score quartiles, inflammatory markers, and incident atherosclerotic cardiovascular disease (ASCVD) and all-cause mortality.
- Analyses adjusted for age, sex, race, socioeconomic status, and other LE8 metrics.
Main Results:
- Higher LE8 scores were significantly associated with lower ASCVD and all-cause mortality over 12 years.
- Ideal blood glucose was the strongest predictor of lower ASCVD risk; no smoking was the strongest predictor of lower all-cause mortality.
- Elevated IL-6 was independently associated with higher ASCVD risk and lower all-cause mortality, while hsCRP showed no association.
Conclusions:
- Higher LE8 scores and metrics are linked to reduced mortality risk in diverse adults.
- Elevated IL-6 independently predicts increased ASCVD and mortality risk, even when controlling for LE8 score.
- Future research should explore integrating inflammatory burden management with LE8 for enhanced cardiovascular disease prevention.
Background:
Life's Essential 8 (LE8) are the key health behaviors and factors for improving and maintaining cardiovascular health, as defined by the American Heart Association. However, despite the association of cardiovascular diseases with inflammation, LE8 does not include inflammatory markers as a component. We analyzed the longitudinal association of LE8 components and inflammatory measures with health outcomes among a community-based population.
Methods:
Baseline LE8 metrics and inflammatory markers (interleukin-6 [IL-6] and high sensitivity C-reactive protein [hsCRP]) were measured among 1,869 participants (age 59±7.5 years, 41.9% Black) in the longitudinal Heart SCORE study. Cox-proportional hazard ratios were used to assess the association of incident atherosclerotic cardiovascular disease (ASCVD) and all-cause mortality across quartiles of LE8 score, and to assess inflammatory markers as an independent risk factor.
Results:
Compared to the lowest quartile, all higher quartiles of LE8 Score were significantly associated with lower risk of all-cause mortality and ASCVD over a median of 12 years of follow-up. After adjusting for all other LE8 metrics as well as by age, sex, race and socioeconomic risk, ideal level of blood glucose was the single most significant factor associated with lower risk of ASCVD (HR 0.26 [0.12-0.58], p=0.001). For all-cause mortality, no smoking emerged as the main protective LE8 component (HR 0.29 [0.16-0.53], p<0.001). When added to LE8, interleukin-6 (IL-6) was independently associated with ASCVD (HR 1.54 [1.05-2.25], p=0.03),while lower IL-6 was associated with lower all-cause mortality (HR 0.52 [0.30-0.90] p=0.02). HsCRP was not associated with either outcome.
Conclusions:
Higher LE8 Score and metrics are associated with lower risk of all-cause and ASCVD mortality as well as non-fatal events in this longitudinal cohort of White and Black adults. Additionally, elevated IL-6 levels were associated with higher risk of ASCVD and all-cause mortality even when accounting for total LE8 score. Future studies should investigate the role of modifying inflammatory burden in addition to LE8 components in prevention of adverse health outcomes.
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