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Adherence to life's essential 8 and progression trajectory of cardiometabolic multimorbidity: a prospective cohort
Hao Bai1,2,3, Chengmiao Qiu4, Miaomiao Fan5
1Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, Shandong, China.
Insights
Improving cardiovascular health (CVH) using the Life's Essential 8 (LE8) score is crucial for preventing cardiometabolic multimorbidity (CMM). Higher LE8 scores significantly reduce the risk of developing CMM and its progression.
Area of Science:
- Cardiovascular Health
- Public Health
- Epidemiology
Background:
- The American Heart Association's Life's Essential 8 (LE8) score assesses cardiovascular health (CVH).
- Limited research exists on the LE8 score's impact on cardiometabolic multimorbidity (CMM) development and progression.
- This study investigates the association between LE8 and CMM progression.
Purpose of the Study:
- To examine the relationship between the updated Life's Essential 8 (LE8) score and the progression of cardiometabolic multimorbidity (CMM).
- To assess how CVH, as measured by LE8, influences transitions between healthy states, cardiometabolic diseases, and mortality.
Main Methods:
- A prospective cohort study involving 264,597 participants from the UK Biobank.
- Cardiometabolic multimorbidity (CMM) defined as having at least two of type 2 diabetes, stroke, or ischemic heart disease.
- Multi-state models analyzed the risk of transitions between health states, CMM onset, and death based on LE8 scores.
Main Results:
- Each 1-SD increase in LE8 score reduced the risk of developing first cardiometabolic diseases (FCMD) (HR: 0.64) and progressing to CMM (HR: 0.80).
- Higher LE8 scores were associated with reduced mortality risk from baseline (HR: 0.83).
- The behavior subscale of LE8 decreased risks for transitions to death, while the biological subscale increased these risks.
Conclusions:
- The Life's Essential 8 (LE8) score-defined cardiovascular health (CVH) significantly impacts the progression from healthy states to cardiometabolic multimorbidity (CMM) and death.
- Improving overall CVH is a vital strategy for the comprehensive prevention of CMM.
- The study underscores the importance of monitoring and enhancing CVH for better cardiometabolic outcomes.
Background:
The Life's Essential 8 (LE8) score, developed by the American Heart Association to evaluate cardiovascular health (CVH), was recently updated. Few studies have explored its effect on the incidence, progression, and prognosis of cardiometabolic multimorbidity (CMM). This study examines the association between the LE8 and the progress of CMM.
Methods:
This prospective cohort study included 264,597 participants from the UK Biobank. CMM was defined as the presence of at least two of the three cardiometabolic diseases (CMDs): type 2 diabetes (T2D), stroke, and ischemic heart disease (IHD). Multi-state models were employed to investigate the relationship between the LE8 score and its subscales with risk of transitions from healthy to the onset of first cardiometabolic diseases (FCMD), followed by progression to CMM and to death.
Results:
Over a median follow-up of 13.94 years, 33,868 individuals developed at least one CMD, 4282 were diagnosed with CMM, and 4955 died. The results indicated that for each 1-SD increase in the LE8 score, a notable reduction was observed in the rate of progression from baseline to FCMD, baseline to death, and FCMD to CMM, with hazard ratios (HRs) of 0.64 (95% CI: 0.63, 0.65), 0.83 (95% CI: 0.81, 0.85), and 0.80 (95% CI: 0.78, 0.83), respectively. However, no correlation was found between the LE8 score and the transition from FCMD or CMM to death. By contrast, per 1-SD increment in the behavior scale score was associated with decreased risk of transition from FCMD to death (HR: 0.93; 95% CI: 0.90, 0.95) and from CMM to death (HR: 0.89; 95% CI: 0.88, 0.95), while per 1-SD increment in the biological scale score was associated with increased risk of transition from FCMD to death (HR: 1.10; 95% CI: 1.07, 1.14), and from CMM to death (HR: 1.22; 95% CI: 1.15, 1.29).
Conclusion:
The LE8 defined CVH influences the progression from a healthy state to FCMD, CMM, and death, highlighting the importance of improving CVH as a comprehensive approach for preventing CMM.
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