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Comparing the "Life's Essential 8" Scores of Older Adults Living With Cardiovascular Diseases: NHANES, 2013 to 2018
James M Walker1, Daniel J Won1, Ravi S Patel1
1Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL USA.
Insights
Cardiovascular health scores (Life's Essential 8) remained stable or declined in older adults, with significant drops seen in those with hypertension, stroke, and heart failure. These findings highlight concerning trends and prevention opportunities in this high-risk population.
Area of Science:
- Cardiology
- Public Health
- Gerontology
Background:
- The American Heart Association's Life's Essential 8 (LE8) framework assesses cardiovascular health.
- Previous research on LE8 scores primarily focused on individuals without pre-existing cardiovascular disease (CVD).
- This study investigates recent trends in LE8 scores specifically within older adult populations who have existing CVD.
Purpose of the Study:
- To examine trends in cardiovascular health scores among older US adults (65+) between 2013 and 2018.
- To assess how these trends differ between individuals with and without prevalent cardiovascular disease (CVD).
- To identify specific CVD conditions associated with significant changes in LE8 scores.
Main Methods:
- Utilized data from the National Health and Nutrition Examination Survey (NHANES) from 2013-2018.
- Calculated overall LE8 scores (0-100) for 3050 noninstitutionalized older US adults.
- Analyzed self-reported CVD diagnoses (coronary heart disease, stroke, heart failure, hypertension, angina, myocardial infarction) and their association with LE8 score changes using linear regression.
Main Results:
- LE8 scores generally remained stable or decreased from 2013-2014 to 2017-2018 across all participants.
- Older adults with hypertension showed a 4.1% decline in LE8 scores.
- Significant decreases were observed in those with stroke (11.5% decline) and heart failure (15.2% decline).
Conclusions:
- Cardiovascular health, as measured by LE8 scores, showed concerning stability or decline in older US adults prior to the COVID-19 pandemic.
- Individuals with hypertension, stroke, and heart failure experienced significant reductions in their LE8 scores.
- These findings underscore the need for enhanced primary and secondary CVD prevention strategies in older adults, a demographic at high risk for cardiovascular events.
Background:
The American Heart Association's Life's Essential 8 (LE8) framework quantifies cardiovascular health. Prior studies have focused on individuals without clinical cardiovascular disease (CVD). We sought to examine recent trends in LE8 scores among older adults with prevalent CVD.
Methods:
We included noninstitutionalized older US adults (ages 65+) from NHANES (National Health and Nutrition Examination Survey 2013-18). Overall LE8 scores (range 0-100; higher is better cardiovascular health) were calculated for all participants. CVD diagnoses were self-reported, including coronary heart disease, stroke, heart failure, hypertension, angina, and myocardial infarction. Percent change in LE8 scores from 2013 to 2018 was calculated for each diagnosis group, and a linear regression tested for significance of changes within groups.
Results:
The 3050 participants represented 37 908 305 US adults (54.7% women; mean age 72.6). LE8 scores tended to stay stable or decline between 2013 to 2014 and 2017 to 2018 for those with and without CVD. Significant decreases in mean LE8 scores occurred in those with hypertension, with a 4.1% decline (from 59.6 to 57.1 [P<0.01]); stroke, with an 11.5% decline (from 60.6 to 53.6 [P=0.01]); and heart failure, with a 15.2% decline (from 60.9 to 51.6 [P<0.001]).
Conclusions:
LE8 scores remained stable or declined for older US adults before the COVID-19 pandemic. Populations with hypertension, stroke, and heart failure had significant LE8 score declines. Because LE8 metrics include behavioral and physiologic metrics associated with CVD risk, these data indicate concerning trends and primary and secondary prevention opportunities in older US adults, who are at highest risk for incident and recurrent CVD events.
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