Relating Cumulative Life's Essential 8 Score With Cardiovascular Disease and Death: The Framingham Heart Study

The impact of cumulative cardiovascular health (CVH) exposure, quantified by the American Heart Association's Life's Essential 8 (LE8) score, and its timing (early vs late) on cardiovascular disease (CVD) events, CVD subtypes, and death is unknown.

We sought to evaluate the relation of cumulative CVH with risk of CVD, CVD subtypes, and death.

We defined cumulative LE8 (measured as point-years) as the area under the curve (AUC) from consecutive LE8 scores using data from Framingham Offspring participants (mean age 55 years, 53% women) between examinations 1 to 5 (1971-1995). We evaluated associations between cumulative LE8 and CVD risk (composite, and coronary heart disease, congestive heart failure, stroke) and death using Cox regression.

During a median follow-up of 28 years, we observed 935 CVD, 343 coronary heart disease, 412 congestive heart failure, 381 stroke, and 1,484 death events. Participants with higher LE8 AUC values (better cumulative CVH) were at lower risk of outcomes, compared to those with the lowest (Q4:Q1 HR: from 0.16 to 0.45). A 1 SD-higher (215 point-years) LE8 AUC was associated with a lower risk of all outcomes (HR: 0.55-0.86), adjusting for age at exam 5, sex, education, and either LE8 score at exam 5 or LE8 slope (positive slope indicates improving CVH).

Better cumulative CVH during middle age has strong associations with CVD and death later in life. Routine incorporation of LE8 scoring in clinical settings would provide an important opportunity for patients to improve their CVH and contribute to an overall healthier population.