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Research

Better Cumulative Cardiovascular Health During Young and Mid-Adulthood has Strong Associations with Cardiovascular Disease, Death Later in Life

“If we don’t adopt a healthy lifestyle early on in the life course, even if we improve over a long-time period through mid-adulthood, we may not be able to mitigate or reverse the risk of disease.”

The American Heart Association’s Life’s Essential 8 (LE8) score is a health tool, ranging from 0 to 100, that quantifies cardiovascular health (CVH) using information from eight lifestyle and risk factors, (body mass index, cholesterol, blood pressure, blood glucose, physical activity, diet, smoking, and sleep. It is well reported that maintaining a healthy heart helps to avoid developing heart disease and other disease outcomes, but most studies have reported associations using a single time point CVH score.

Using data from the Framingham Heart Study (FHS) spanning 25 years to calculate the cumulative burden of poor cardiovascular health from early to mid-adulthood, researchers observed that the average score for all participants was 65. They also found that higher cumulative LE8 scores (reflecting better CVH) are associated with lower risk of all disease outcomes; importantly, there was a striking 73% lower risk for CVD for participants at the highest quartile of cumulative LE8 compared to those at the lowest quartile (reflecting poor CVH).

“These results offer insights into the detrimental impact of the accumulated burden of unfavorable risk factors such as high body mass index, blood pressure, cholesterol, and lipids, as well as of an unhealthy lifestyle including a poor diet, lack of exercise, smoking, and insufficient sleep. Routine incorporation of LE8 scoring in a clinical setting to measure, monitor, and improve CVH status over time would afford clinicians an important opportunity to guide their patients to improve their scores on all LE8 components and contribute to an overall healthier population,” explains co-author Vanessa Xanthakis, PhD, associate professor of medicine at the school of Medicine and a primary investigator at FHS.  

The researchers used FHS data to define each of the eight components that comprise the LE8 score at each of the five examination cycles (exams 1 through 5; 1971 through 1995). They then calculated the area under the curve that was created for each participant using their LE8 scores at each exam, and also calculated the slope reflecting the rate at which the LE8 scores are changing over time (i.e. over the 25-year period) for each participant. They combined all the information for the entire sample of 3,231 participants.

According to the researchers, the LE8 score at examination cycle five (25 years), which served as baseline for the follow-up period also was significant. “This result indicates that regardless of whether a participant improved their CVH score during the 25 year period, if two participants have similar cumulative CVH scores during that period, the person with the higher LE8 score at the time when we start to evaluate future risk of disease will be at lower risk compared to their counterpart, highlighting the importance of adopting a healthy lifestyle in early adulthood,” adds corresponding author Donald Lloyd-Jones, MD, ScM, chief of the section of preventive medicine and epidemiology at the school, and director of the Framingham Center for Population and Prevention Science, FHS.

These findings appear online in the Journal of the American College of Cardiology—Advances.