Relations of Life's Essential 8 Score with Arterial and Microvascular Function: The Jackson Heart Study.

BACKGROUND

Cardiovascular disease (CVD) poses a major burden on the US population, disproportionately impacting African Americans. Vascular function provides a window to assess cumulative risk predisposing individuals to adverse cardiovascular events. The American Heart Association (AHA) Life's Essential 8 (LE8) provides a means of scoring cardiovascular health, but has yet to be correlated with vascular function.

METHODS

In a sample of Jackson Heart Study participants (N=2,186, mean age 57 years, 65% women), LE8 scores were calculated per AHA guidelines at baseline visits (2000-2004). Noninvasive vascular assessments using arterial tonometry and Doppler ultrasound were performed within an ancillary study (2012-2017). Tests measuring aortic and peripheral arterial stiffness included carotid-femoral pulse wave velocity, carotid brachial pulse wave velocity, carotid-radial pulse wave velocity, central pulse pressure, forward pressure wave, and characteristic impedance. Microvascular function tests included baseline and hyperemic brachial artery flow. Linear regression models, adjusted for age, age, sex and heart rate, examined the association between LE8 score (independent variable) and vascular function (dependent variables).

RESULTS

In adjusted models, higher LE8 scores were associated with lower carotid-femoral pulse wave velocity (β= -0.32; 95% confidence interval (CI), [-0.42, -0.21]; <0.0001)), characteristic impedance (β= -0.57; 95% CI, [-0.93, -0.20]; =0.0024)), forward pressure wave amplitude (β= -0.21; 95% CI, [-0.26, -0.16]; <0.0001), central pulse pressure (β= -0.25; 95% CI, [-0.32, -0.19]; <0.0001)) and brachial baseline flow (β= -0.013; 95% CI, [-0.023, -0.002]; =0.021)). Higher LE8 scores were associated with higher brachial hyperemic flow (β= 0.095; 95% CI, [0.035, 0.16]; =0.0018)). When jointly considering the LE8 components in an adjusted model, blood glucose and pressure were most significantly associated with vascular function parameters.

CONCLUSIONS

Our cross-sectional findings support the concept that a healthy lifestyle is associated with better vascular function. Future longitudinal studies are warranted to investigate whether improving LE8 scores lead to improved vascular function.