Association Between Life's Essential 8 Scores and Heart Failure: Insights From NHANES (2007-2020)

Heart failure (HF) is a major public health concern due to the associated high morbidity, mortality, and growing economic burden. Thus, early prevention and identification of modifiable risk factors are crucial to reducing the prevalence of HF. The American Heart Association has recently introduced the Life's Essential 8 (LE8) metrics, which offer a comprehensive framework for assessing cardiovascular health. This research aims to investigate the association between the LE8 metrics and the prevalence of HF among the American population, exploring whether the LE8 metrics are associated with HF prevalence and can contribute to the risk stratification of HF in public health settings.

The present cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) 2007-2020, including participants aged ≥20 years with complete data on HF and the LE8 metrics. Multiple logistic regression analysis was conducted to evaluate the relationship between LE8 and the prevalence of HF. Subgroup analyses combined with interaction tests were utilized to investigate potentially affecting factors. Furthermore, the dose-response association was analyzed using smooth curve fitting, while the receiver operating characteristic (ROC) curve was employed to examine the predictive performance of the LE8 metrics in HF patients.

A dose-response reverse linear association was identified between the LE8 scores and HF prevalence within the American population. When comparing the group with the lowest LE8 score to that with the highest score, the latter exhibited a 70% decrease regarding HF prevalence (odds ratio (OR) = 0.30; 95% confidence interval (CI), 0.22-0.43; p < 0.01) in the fully adjusted model. Moreover, variables including physical activity, nicotine exposure, sleep health, body mass index (BMI), and plasma glucose were identified as independently associated with the prevalence of HF.

Higher LE8 scores were associated with a lower prevalence of HF, suggesting that the LE8 metrics may be a useful tool for identifying at-risk individuals in population health.