Department of Preventive Medicine (H.N., A.M.P., J.S., J.T.W., D.M.L.-J., N.B.A.), Northwestern University Feinberg School of Medicine, Chicago, IL.
Ann & Robert H. Lurie Children's Hospital of Chicago, IL (A.M.P.).
Circ Cardiovasc Qual Outcomes. 2024 May;17(5):e010568. doi: 10.1161/CIRCOUTCOMES.123.010568. Epub 2024 Apr 19.
The American Heart Association recently launched updated cardiovascular health metrics, termed Life's Essential 8 (LE8). Compared with Life's Simple 7 (LS7), the new approach added sleep health as an eighth metric and updated the remaining 7 health factors and behaviors. The association of the updated LE8 score with long-term cardiovascular disease (CVD) outcomes and death is unknown.
We pooled individual-level data from 6 contemporary US-based cohorts from the Cardiovascular Lifetime Risk Pooling Project. Total LE8 score (0-100 points), LE8 score without sleep (0-100 points), and prior LS7 scores (0-14 points) were calculated separately. We used multivariable-adjusted Cox models to evaluate the association of LE8 with CVD, CVD subtypes, and all-cause mortality among younger, middle, and older adult participants. Net reclassification improvement analysis was used to measure the improvement in CVD risk classification with the addition of LS7 and LE8 recategorization based on score quartile rankings.
Our sample consisted of 32 896 US adults (7836 [23.8%] Black; 14 941 [45.4%] men) followed for 642 000 person-years, of whom 9391 developed CVD events. Each 10-point higher overall LE8 score was associated with lower risk by 22% to 40% for CVD, 24% to 43% for congenital heart disease, 17% to 34% for stroke, 23% to 38% for heart failure, and 17% to 21% for all causes of mortality events across age strata. LE8 score provided more granular differentiation of the related CVD risk than LS7. Overall, 19.5% and 15.5% of the study participants were recategorized upward and downward based on LE8 versus LS7 categories, respectively, and the recategorization was significantly associated with CVD risk in addition to LS7 score. The addition of recategorization between LE8 and LS7 categories improved CVD risk reclassification across age groups (clinical net reclassification improvement, 0.06-0.12; <0.01).
These findings support the improved utility of the LE8 algorithm for assessing overall cardiovascular health and future CVD risk.
美国心脏协会最近推出了更新的心血管健康指标，称为“生命的八大要素”（LE8）。与“生命七大要素”（LS7）相比，新方法将睡眠健康作为第八个要素，并更新了其余 7 个健康因素和行为。更新后的 LE8 评分与长期心血管疾病（CVD）结局和死亡之间的关系尚不清楚。
我们从心血管终生风险汇集计划的 6 个基于美国的当代队列的个体水平数据中进行了汇总。分别计算总 LE8 评分（0-100 分）、不包括睡眠的 LE8 评分（0-100 分）和之前的 LS7 评分（0-14 分）。我们使用多变量调整的 Cox 模型来评估 LE8 与 CVD、CVD 亚型以及年轻、中年和老年参与者全因死亡率之间的关系。净重新分类改善分析用于衡量在 CVD 风险分类方面的改善，该改善是基于分数四分位排名对 LS7 和 LE8 重新分类的基础上实现的。
我们的样本包括 32896 名美国成年人（7836[23.8%]名黑人；14941[45.4%]名男性），随访 642000 人年，其中 9391 人发生了 CVD 事件。总 LE8 评分每增加 10 分，CVD 风险降低 22%-40%，先天性心脏病风险降低 24%-43%，中风风险降低 17%-34%，心力衰竭风险降低 23%-38%，全因死亡率风险降低 17%-21%，在不同年龄组中均呈此趋势。LE8 评分比 LS7 评分更能精细地区分相关的 CVD 风险。总体而言，根据 LE8 与 LS7 分类，分别有 19.5%和 15.5%的研究参与者向上和向下重新分类，重新分类与 LS7 评分之外的 CVD 风险显著相关。在 LE8 和 LS7 分类之间增加重新分类可改善各年龄段的 CVD 风险再分类（临床净重新分类改善，0.06-0.12；<0.01）。
这些发现支持 LE8 算法在评估整体心血管健康和未来 CVD 风险方面的改进效用。
