Cardiovascular health, as per life's essential 8, and unhealthy aging trajectories

Cardiovascular health (CVH) is associated with individual age-related health outcomes, but its relation to unhealthy aging trajectories remains uncertain. We assessed whether CVH is associated with the baseline burden of unhealthy aging and its progression over time, and whether these associations differ by sex.

We analyzed 2,487 adults aged 65 years or older enrolled in the Seniors-ENRICA-2 cohort (Madrid, Spain). CVH was assessed at three timepoints over a 5.2-year follow-up using the American Heart Association's Life's Essential 8 (LE8) score (range: 0-100; higher values indicate better CVH). Unhealthy aging was quantified with two complementary indicators: the Deficit Accumulation Index (DAI) and an Intrinsic Capacity Impairment Score (ICIS) (both 0-100; higher scores indicate worse health). Mixed-effects linear regression models with random intercepts and slopes estimated associations per 10-point higher LE8 with baseline levels and rates of change in DAI and ICIS.

Better CVH was associated with lower baseline levels of both the DAI (mean difference per 10-point increment in LE8: -2.93 points; 95% confidence interval [CI]: -3.25; -2.61 in women and -2.05 points; 95% CI: -2.41; -1.70 in men) and the ICIS (-3.44 points; 95% CI: -3.98; -2.91 in women and -2.12 points; 95% CI: -2.70; -1.54 in men) as well as with a slower annual increase in the DAI (-0.10 points per year; 95% CI: -0.17; -0.03), but not with the increase in the ICIS (-0.02 points per year; 95% CI: -0.16; 0.12). The strongest inverse associations were seen in the functional impairment and self-rated health domains of DAI, and the locomotion domain of the ICIS. Higher physical activity, better sleep health, adequate body mass index, and optimal blood glucose emerged as key contributors to slower health decline.

Better CVH, as measured by the LE8 score, was associated with fewer and a slower accumulation of age-related health deficits in older adults. These findings suggest that promoting CVH may help delay functional decline and support healthier aging trajectories.