The Utility of Using the All of Us Research Program to Examine AHA's Life's Essential 8

The American Heart Association's Life's Essential 8 (LE8) metrics of blood pressure, body mass index, glucose, cholesterol, smoking, diet, sleep, and physical activity are measurable outcomes to gauge cardiovascular health in individuals and populations.

The aim of this study was to determine the utility of using the National Institutes of Health All of Us Research Program data to quantify LE8 contemporary in a United States cohort.

This was a cross-sectional observational study of primary (participant-reported and researcher-measured) and secondary (electronic health records) data from Version 7 All of Us data. Adults aged 20-100 years were included. Our primary outcome was percentage of participants with complete data for all LE8 cardiovascular health indicators within 1 year of enrollment. We used All of Us researcher-measured blood pressure and body mass index, health record serum glycosylated hemoglobin (HbA1c), total and non-high-density lipoprotein cholesterol, and participant-reported cigarette use, age, race, and sex data. We described the availability of LE8 in the dataset and then calculated sex differences in LE8 using independent samples t -tests with equal variance, Wilcoxon rank sum test, or chi-square tests.

There were no data for diet, sleep, or physical activity. The final sample with complete data was 56,565 primarily middle-aged adults, and over half were female. Overall, the sample had higher mean systolic blood pressure, high mean body mass index indicating obesity, and average to high HbA1c, indicating few participants meet the definition of ideal cardiovascular health. Nearly half of participants reported lifetime cigarette use of ≥100 cigarettes. Data for non-high-density cholesterol were missing in half of participants. Compared to males, females were younger by 4.2 years and had lower average systolic and diastolic blood pressure, higher mean body mass index, higher total cholesterol, and lower median HbA1c, and fewer reported lifetime cigarette use.

Important data for modifiable lifestyle factors of diet, physical activity, and sleep are missing from the All of Us dataset. We recommend adding these missing variables to future surveys. Nevertheless, this snapshot of cardiovascular health shows that, on average, adults in the United States had poorer than recommended cardiovascular health for cardiovascular disease risk.