Life's Essential 10 and brain health: A prospective cohort study

Maintaining brain health while extending life expectancy is an important public health challenge in aging societies. However, the association between cardiovascular health (CVH) and brain health has not been fully established. This study aims to develop a Life's Essential 10 (LE10) framework for assessing CVH and to evaluate the effects of different CVH levels on life expectancy free of stroke and dementia.

This prospective cohort study included adults aged 37-73 years from the UK Biobank who had no history of stroke or dementia at baseline and had complete data on LE10 metrics and covariates. The LE10 framework developed in this study was based on Life's Essential 8 (LE8), which comprises eight domains, diet, physical activity, nicotine exposure, sleep duration, body mass index, blood lipids, blood pressure, and blood glucose, and additionally incorporated alcohol consumption and sedentary behavior. A total score was calculated by assigning a score to each domain, and participants were categorized as having low, moderate, or high CVH. The primary outcome was life expectancy free of stroke and dementia. Secondary outcomes included the risk of the composite endpoint of stroke or dementia, the risk of all-cause mortality, and total life expectancy.

Among 122 953 participants, with a mean age of 55.7 years and 48.4% being women, 13.2%, 60.0%, and 26.8% had low, moderate, and high CVH, respectively. During a median follow-up of 13.8 years, 4 776 composite endpoint events, 3 317 cases of stroke, 1 697 cases of dementia, and 7 825 deaths were recorded. Compared with low CVH, high CVH was associated with a lower risk of the composite endpoint in both men (HR=0.59, 95% CI 0.52 to 0.67) and women (HR=0.50, 95% CI 0.42 to 0.59). High CVH was also associated with a lower risk of all-cause mortality in men (HR=0.44, 95% CI 0.39 to 0.48) and women (HR=0.35, 95% CI 0.31 to 0.40). At 50 years of age, men with high CVH had a stroke- and dementia-free life expectancy of 31.8 years (95% CI 31.1 to 32.5), compared with 24.9 years (95% CI 24.5 to 25.2) among those with low CVH. The corresponding estimates for women were 35.5 years (95% CI 34.7 to 36.2) and 28.4 years (95% CI 27.8 to 28.9), respectively. Analyses of stroke- and dementia-free life expectancy at 60 and 70 years of age and comparisons of total life expectancy across CVH groups consistently showed that higher CVH was associated with longer disease-free survival and total life expectancy.

Higher CVH, as assessed using the LE10 framework, was closely associated with better preservation of brain health and a lower risk of all-cause mortality. Improving the CVH-related behaviors and metabolic factors included in LE10 may contribute to greater longevity and the maintenance of brain health.