Herraiz-Adillo Ángel, Ahlqvist Viktor H, Higueras-Fresnillo Sara, Berglind Daniel, Wennberg Patrik, Lenander Cecilia, Daka Bledar, Ekstedt Mattias, Sundström Johan, Ortega Francisco B, Östgren Carl Johan, Rådholm Karin, Henriksson Pontus
Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
Front Cardiovasc Med. 2023 Jun 22;10:1173550. doi: 10.3389/fcvm.2023.1173550. eCollection 2023.
To quantify cardiovascular health (CVH), the American Heart Association (AHA) recently launched an updated construct of the "Life's Simple 7" (LS7) score, the "Life's Essential 8" (LE8) score. This study aims to analyse the association between both CVH scores and carotid artery plaques and to compare the predictive capacity of such scores for carotid plaques.
Randomly recruited participants aged 50-64 years from the Swedish CArdioPulmonary bioImage Study (SCAPIS) were analysed. According to the AHA definitions, two CVH scores were calculated: i) the LE8 score (0, worst CVH; 100, best CVH) and two different versions of the LS7 score [(0-7) and (0-14), 0 indicating the worst CVH]. Ultrasound-diagnosed carotid plaques were classified as no plaque, unilateral, and bilateral plaques. Associations were studied by adjusted multinomial logistic regression models and adjusted (marginal) prevalences, while comparison between LE8 and LS7 scores was performed through receiver operating characteristic (ROC) curves.
After exclusions, 28,870 participants remained for analysis (50.3% women). The odds for bilateral carotid plaques were almost five times higher in the lowest LE8 (<50 points) group [OR: 4.93, (95% CI: 4.19-5.79); adjusted prevalence 40.5%, (95% CI: 37.9-43.2)] compared to the highest LE8 (≥80 points) group [adjusted prevalence 17.2%, (95% CI: 16.2-18.1)]. Also, the odds for unilateral carotid plaques were more than two times higher in the lowest LE8 group [OR: 2.14, (95% CI: 1.82-2.51); adjusted prevalence 31.5%, (95% CI: 28.9-34.2)] compared to the highest LE8 group [adjusted prevalence 29.4%, (95% CI: 28.3-30.5)]. The areas under ROC curves were similar between LE8 and LS7 (0-14) scores: for bilateral carotid plaques, 0.622 (95% CI: 0.614-0.630) vs. 0.621 (95% CI: 0.613-0.628), = 0.578, respectively; and for any carotid plaque, 0.602 (95% CI: 0.596-0.609) vs. 0.600 (95% CI: 0.593-0.607), = 0.194, respectively.
The new LE8 score showed inverse and dose-response associations with carotid plaques, particularly bilateral plaques. The LE8 did not outperform the conventional LS7 score, which showed similar ability to predict carotid plaques, especially when scored as 0-14 points. We conclude that both the LE8 and LS7 may be useful in clinical practice for monitoring CVH status in the adult population.
为了量化心血管健康（CVH），美国心脏协会（AHA）最近推出了更新后的“生命简单7要素”（LS7）评分结构，即“生命基本8要素”（LE8）评分。本研究旨在分析这两种CVH评分与颈动脉斑块之间的关联，并比较这些评分对颈动脉斑块的预测能力。
对从瑞典心肺生物图像研究（SCAPIS）中随机招募的50 - 64岁参与者进行分析。根据AHA的定义，计算了两种CVH评分：i）LE8评分（0分表示最差的CVH；100分表示最佳的CVH）以及两种不同版本的LS7评分[（0 - 7）和（0 - 14），0分表示最差的CVH]。超声诊断的颈动脉斑块分为无斑块、单侧斑块和双侧斑块。通过调整后的多项逻辑回归模型和调整后的（边际）患病率研究关联，而通过受试者操作特征（ROC）曲线对LE8和LS7评分进行比较。
排除后，剩余28,870名参与者进行分析（50.3%为女性）。与最高LE8（≥80分）组相比，最低LE8（<50分）组双侧颈动脉斑块的几率几乎高出五倍[比值比（OR）：4.93，（95%置信区间（CI）：4.19 - 5.79）；调整后患病率40.5%，（95% CI：37.9 - 43.2）]。同样，与最高LE8组相比，最低LE8组单侧颈动脉斑块的几率高出两倍多[OR：2.14，（95% CI：1.82 - 2.51）；调整后患病率31.5%，（95% CI：28.9 - 34.2）]，而最高LE8组的调整后患病率为29.4%，（95% CI：28.3 - 30.5）。LE8和LS7（0 - 14）评分的ROC曲线下面积相似：对于双侧颈动脉斑块，分别为0.622（95% CI：0.614 - 0.630）和0.621（95% CI：0.613 - 0.628），P = 0.578；对于任何颈动脉斑块，分别为0.602（95% CI：0.596 - 0.609）和0.600（95% CI：0.593 - 0.607），P = 0.194。
新的LE8评分与颈动脉斑块呈反向和剂量反应关联，尤其是双侧斑块。LE8在预测颈动脉斑块方面并不优于传统的LS7评分，后者显示出相似的预测能力，特别是当评分为0 - 14分时。我们得出结论，LE8和LS7在临床实践中对于监测成年人群的CVH状况可能都有用。
