Relations of Life's Essential 8 Score with Arterial and Microvascular Function: The Jackson Heart Study

Cardiovascular disease (CVD) poses a major burden on the US population, disproportionately impacting African Americans. Vascular function provides a window to assess cumulative risk predisposing individuals to adverse cardiovascular events. The American Heart Association (AHA) Life's Essential 8 (LE8) provides a means of scoring cardiovascular health, but has yet to be correlated with vascular function.

In a sample of Jackson Heart Study participants (N=2,186, mean age 57 years, 65% women), LE8 scores were calculated per AHA guidelines at baseline visits (2000-2004). Noninvasive vascular assessments using arterial tonometry and Doppler ultrasound were performed within an ancillary study (2012-2017). Tests measuring aortic and peripheral arterial stiffness included carotid-femoral pulse wave velocity, carotid brachial pulse wave velocity, carotid-radial pulse wave velocity, central pulse pressure, forward pressure wave, and characteristic impedance. Microvascular function tests included baseline and hyperemic brachial artery flow. Linear regression models, adjusted for age, age², sex and heart rate, examined the association between LE8 score (independent variable) and vascular function (dependent variables).

In adjusted models, higher LE8 scores were associated with lower carotid-femoral pulse wave velocity (β= -0.32; 95% confidence interval (CI), [-0.42, -0.21]; p<0.0001)), characteristic impedance (β= -0.57; 95% CI, [-0.93, -0.20]; p=0.0024)), forward pressure wave amplitude (β= -0.21; 95% CI, [-0.26, -0.16]; p<0.0001), central pulse pressure (β= -0.25; 95% CI, [-0.32, -0.19]; p<0.0001)) and brachial baseline flow (β= -0.013; 95% CI, [-0.023, -0.002]; p=0.021)). Higher LE8 scores were associated with higher brachial hyperemic flow (β= 0.095; 95% CI, [0.035, 0.16]; p=0.0018)). When jointly considering the LE8 components in an adjusted model, blood glucose and pressure were most significantly associated with vascular function parameters.

Our cross-sectional findings support the concept that a healthy lifestyle is associated with better vascular function. Future longitudinal studies are warranted to investigate whether improving LE8 scores lead to improved vascular function.