Life's Essential 8 and carotid artery plaques: the Swedish cardiopulmonary bioimage study

Abstract

BackgroundTo 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.MethodsRandomly 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.ResultsAfter 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), P = 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), P = 0.194, respectively.ConclusionThe 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.

Life’s Essential 8 in relation to self-rated health and health-related quality of life in a large population-based sample: the SCAPIS project

“…In June 2022, the AHA launched the new construct LE8 to overcome some of the LS7 limitations, particularly the restricted sensitivity in measuring inter-individual variation and intra-individual changes over time [ 5 ]. In contrast to previous findings in SCAPIS, which reported similar predictive capacity for coronary stenosis and carotid plaques between LE8 and LS7 [ 20 ], in the present study, LE8 performed slightly better than LS7 for discriminating a poor outcome in SRH, mental-HRQoL, and physical-HRQoL. Though the clinical utility of this improvement is probably small, the updated scoring algorithm and the inclusion of sleep health in LE8 seem to have some added value beyond LS7 to convey SRH and HRQoL.…”

“…LE8 was defined based on the AHA criteria and incorporates 4 health behaviors: diet, physical activity, nicotine exposure, and sleep health, and 4 health factors measurements: BMI, non-HDL cholesterol, fasting blood glucose/glycosylated hemoglobin, and blood pressure [ 5 ]. Details about measurement and calculation of health behaviors and health factors in LE8 and LS7 have been published elsewhere [ 20 ].…”

“…LS7 was defined in accordance with the AHA criteria and incorporates 4 health behaviors: diet, physical activity, BMI, and smoking status, and 3 health factors: total cholesterol, blood glucose, and blood pressure [ 4 ]. In SCAPIS, with the exception of sleep health, the measurements, techniques, and questionnaires to obtain the LS7 score were similar to those in LE8, though the calculation of scores differed [ 20 ]. In LS7, as the AHA recommended, dietary habits were consistent with the Dietary Approaches to Stop Hypertension (DASH) eating plan [ 4 ].…”

“…Similarly, several studies have confirmed the association of LS7 and cardiovascular disease and mortality [ 18 , 19 ]. Although there are currently studies showing that LE8 is strongly linked to the atherosclerotic burden [ 20 ], cardiovascular disease [ 21 , 22 ], as well as cardiovascular and all-cause mortality [ 23 , 24 ], no studies have examined LE8 in relation to SRH or HRQoL. Whether the utility of the novel LE8 score extends beyond its intended purpose to monitor cardiovascular health is important, since routine collection of LE8 in cardiovascular medicine could be used to convey other aspects of health including SRH or HRQoL.…”

Physical fitness in male adolescents and atherosclerosis in middle age: a population-based cohort study

“…Participants were classified as having either no plaque, unilateral plaque/s or bilateral carotid plaques. 31 For splines analysis, a carotid plaque score was calculated as follows: no plaque=0, unilateral plaque/s=1 and bilateral plaques=2.…”