Abstract 35: Adherence to Life’s Essential 8, Genetic Susceptibility, and Incident Cardiovascular Disease: A Prospective Study of 137,794 UK Biobank Participants

Abstract

Introduction: The American Heart Association recently introduced an enhanced approach to assess cardiovascular health (CVH): Life’s essential 8 (LE8). Sleep was included as a new component. The current study sought to analyze the relationship between levels of CVH, indicated by the LE8 score, and risks of coronary heart disease (CHD), stroke, and cardiovascular disease (CVD). Hypothesis: We hypothesized that higher CVH, indicated by the LE8 score, was associated with lower risks of CHD, stroke, and CVD; LE8 might also interact with genetic susceptibility. Methods: The current study included 137,794 participants free of CVD from the UK Biobank. CVH was scored at baseline by LE8 (DASH diet score, physical activity, nicotine exposure, sleep health, body mass index, blood lipids, blood glucose, and blood pressure). The LE8 score ranged from 0 to 100; and was categorized as low (0-49), moderate (50-79), and high (80-100). Weighted genetic risk scores (GRS) for CHD and stroke were calculated. Cox proportional hazard model was used to assess the relationship between LE8 and incident CVD outcomes, and potential interaction with age, gender, and GRS. We also compared the performance of LE8 with Life’s Simple 7 (LS7) using Harrell’s C-index. Results: During a median of 10 years, 8,595 CVD cases (6,968 CHD and 1,948 strokes) were documented. A higher LE8 score was associated with remarkably lower risks of CHD, stroke, and CVD (p<0.001 for all). Comparing the high CVH to the low CVH, the adjusted HRs (95% CI) were 0.34 (0.30, 0.38) for CHD, 0.45 (0.37, 0.54) for stroke, and 0.36 (0.33, 0.40) for CVD. Moreover, the model with LE8 achieved higher accuracy and outperformed the model with LS7 (C-index: 0.7417 vs. 0.7345, p<0.001 for CHD, 0.7208 vs. 0.7165, p<0.001 for stroke, and 0.7339 vs. 0.7276, p<0.001 for CVD). The protective associations of the LE8 score with CVD outcomes were more pronounced among women (p-interaction <0.001 for CHD and 0.0013 for CVD, respectively), and among younger adults (p-interaction <0.001, 0.007, and <0.001 for CHD, stroke, and CVD, respectively). In addition, we found a significant interaction between the GRS of CHD and the LE8 score (p-interaction <0.001). The inverse association was stronger among those with a lower genetic risk of CHD. Conclusions: High level of CVH, defined by LE8, was associated with significantly lower risks of CHD, stroke, and CVD. Such relationships are more pronounced among women, younger adults, and people with a lower genetic predisposition.