Scott Buzby , 2025-04-24 13:52:00
April 24, 2025
3 min read
Key takeaways:
- Cumulative CV health score at age 18 to 45 years was tied to reduced CVD risk at midlife.
- Individuals who improved yearly cumulative Life’s Essential 8 score by midlife also shared in the CV benefit.
Higher cumulative heart health score from age 18 to 45 years was associated with lower risk for cardiovascular disease and death at midlife, as too was improvement in CV health scores over the years, researchers reported.
A new analysis of the CARDIA study evaluating the impact of cumulative exposure to the American Heart Association Life’s Essential 8 on midlife CV health was published in JAMA Cardiology.
Cumulative CV health score at age 18 to 45 years was tied to reduced CVD risk at midlife. Image: Adobe Stock
“Cumulative health measurements — eg, cigarette pack-years, accumulated radiation exposure from CT scans, etc — have been extremely impactful in clinical medicine,” James Walker, BA, third-year medical student at Northwestern University Feinberg School of Medicine, told Healio. “However, most prior CV health research has relied on single point-in-time measurements rather than cumulative measurements. The AHA’s Life’s Essential 8 allowed us to quantify participants’ cumulative CV health, which we suspected would be an even more powerful way to represent the benefit of the Life’s Essential 8 construct.”
Life’s Essential 8 are clinically relevant biological and behavioral predictors of CV health, including diet, physical activity, smoking, sleep, BMI, non-HDL cholesterol, blood glucose and BP.
The CARDIA study
CARDIA was a prospective, epidemiological study initiated in 1985 and enrolled white and Black adults aged 18 to 30 years at baseline at four centers across the U.S. The present analysis included 4,832 participants (mean age at baseline, 25 years; 56% women).
James Walker
Walker and colleagues used data collected during the CARDIA study to evaluate the impact of cumulative Life’s Essential 8 score and score change on incident CVD and mortality after age 45 years.
Each Life’s Essential 8 metric was scored from zero to 100, and the overall score was the mean of all eight.
The primary outcome was incident CVD, including fatal or nonfatal MI, coronary revascularization, HF, stroke/transient ischemic attack, unstable angina hospitalization, carotid or peripheral arterial intervention or CV death. The secondary outcome was all-cause mortality.
Cumulative CV score and health at midlife
The researchers reported that compared with individuals in the lowest quartile of cumulative Life’s Essential 8 score, those in higher quartiles has significantly lower CVD risk at midlife:
- HR for the second quartile = 0.44; 95% CI, 0.32-0.61;
- HR for the third quartile = 0.26; 95% CI, 0.18-0.38; and
- HR for the fourth and highest quartile = 0.12; 95% CI, 0.07-0.21.
Similar trends were observed for mortality risk after age 45 years.
From age 18 to 45 years, a positive slope of Life’s Essential 8 score was independently associated with lower risk for incident CVD (HR = 0.65; 95% CI, 0.45-0.95), but not mortality after age 45 years, according to the study.
When Walker and colleagues stratified participants based on age, they noted that a 20 point-year higher cumulative Life’s Essential 8 score from age 32 to 45 years was associated with lower risk for incident CVD (HR = 0.91; 95% CI, 0.88-0.94) and mortality (HR = 0.95; 95% CI, 0.92-0.98) after age 45 years; however, these associations were not significant from age 18 to 31 years.
“The association between higher cumulative Life’s Essential 8 scores and lower midlife CVD risk was not a surprise, but the magnitude of benefit, especially in such a young cohort, was a surprise,” Walker said. “Furthermore, we did not anticipate that improvements in CV health, controlling for cumulative CV health, would be so beneficial. That is, for two individuals with the same cumulative CV health score — same area under the curve — during young adulthood, the one whose score improved was associated with significantly reduced risk for midlife CVD.”
The researchers estimated that living 1 year with an approximately 1% higher cumulative Life’s Essential 8 score was associated with approximately 3% lower risk for incident CVD and 4% lower risk for mortality after age 45 years, according to the study.
Moreover, they reported that no single component of the Life’s Essential 8 metrics appeared to dominate the association between cumulative score and incident CVD after age 45 years.
“The ‘point-years’ and ‘points up’ metrics introduce a novel, quantifiable framework for both clinicians and public health officials to track, communicate and intervene on low CV health from early adult life,” Walker told Healio. “In so doing, we could improve primordial prevention in addition to primary prevention.”
Reference:
For more information:
James Walker, BA, can be reached at james.walker@northwestern.edu and on X @Jim_Walker_.
