Association of Cardiovascular Health With Life Expectancy Free of Cardiovascular Disease, Diabetes, Cancer, and Dementia in UK Adults

Abstract

ImportanceThe average life expectancy has increased substantially in the past few decades in most industrialized countries; however, not all of the increased life expectancy is being spent in optimal health, especially among individuals with low socioeconomic status.ObjectiveTo quantify the associations between levels of cardiovascular health (CVH), estimated by the American Heart Association’s Life’s Essential 8 (LE8) metrics, with life expectancy free of major chronic disease, including cardiovascular disease (CVD), diabetes, cancer, and dementia, in UK adults.Design, Setting, and ParticipantsThis cohort study included 135 199 adults in the UK Biobank study who were initially free of major chronic disease and had complete data on LE8 metrics. Data analyses were performed in August 2022.ExposuresCardiovascular health levels, as estimated by LE8 score. The LE8 score, which consists of 8 components: (1) diet, (2) physical activity, (3) tobacco/nicotine exposure, (4) sleep, (5) body mass index, (6) non–high-density lipoprotein cholesterol, (7) blood glucose, and (8) blood pressure. The CVH level was evaluated at baseline and categorized into low (LE8 score <50), moderate (LE8 score ≥50 but <80), and high (LE8 score ≥80) levels.Main Outcomes and MeasuresThe primary outcome was the life expectancy free of 4 major chronic diseases (CVD, diabetes, cancer, and dementia).ResultsOf the 135 199 adults (44.7% men; mean [SD] age, 55.4 [7.9] years) included in the study, a total of 4712, 48 955, and 6748 men had low, moderate, and high CVH levels, respectively, and the corresponding numbers for women were 3661, 52 192, and 18 931. At age 50 years, the estimated disease-free years were 21.5 (95% CI, 21.0-22.0), 25.5 (95% CI, 25.4-25.6), and 28.4 (95% CI, 27.8-29.0) for men with low, moderate, and high CVH levels, respectively; the corresponding estimated disease-free years at age 50 years for women were 24.2 (95% CI, 23.5-24.8), 30.5 (95% CI, 30.4-30.6), and 33.6 (95% CI, 33.1-34.0). Equivalently, men with moderate or high CVH levels lived on average 4.0 (95% CI, 3.4-4.5) or 6.9 (95% CI, 6.1-7.7) longer years free of chronic disease, respectively, at age 50 years, compared with men with low CVH levels. The corresponding longer years lived free of disease for women were 6.3 (95% CI, 5.6-7.0) or 9.4 (95% CI, 8.5-10.2). For participants with high CVH level, there was not a statistically significant difference in disease-free life expectancy between participants with low and other socioeconomic status.Conclusions and RelevanceIn this cohort study, a high level of CVH, evaluated using the LE8 metrics, was associated with longer life expectancy free of major chronic diseases and may contribute to narrowing socioeconomic health inequalities in both men and women.

Metabolite Signature of Life’s Essential 8 and Risk of Coronary Heart Disease among Low-Income Black and White Americans

“…LE8 is the American Heart Association's updated and enhanced guideline to measure and promote CVH for individuals and populations 3 . The beneficial associations of following the LE8 with lower risks of CHD, CVD, and related mortality have been demonstrated in recent studies [4][5][6][7] . However, multi-racial/ethnic populations with low SES remain underrepresented in research studies, even though they have persistently experienced worse CVH and CVD outcomes, as well as systemic disadvantages to improve CVH, than White and middle-class Americans 2,41-43 .…”

“…LE8 includes 4 health behaviors (healthy diet, participation in physical activity, avoidance of nicotine, and healthy sleep [a new component of LE8]) and 4 health factors (weight, blood lipids, glucose, and blood pressure), and has a new scoring system with continuous scale to better reflect inter-individual differences. While a higher LE8 score has been recently associated with lower CVD incidence and mortality [4][5][6][7] , few studies have evaluated LE8 score and its association with incident CVD among Black and White Americans who have low socioeconomic status (SES) and face disproportionate CVD burdens. In addition, although some potential mechanisms have been identified (e.g., reduced inflammation and atherosclerosis) 8,9 , beyond those known CVD risk pathways, mechanisms and interindividual differences underlying the cardioprotective effects of LE8 and its included health behaviors and health factors are not fully understood.…”

A Rationale and Framework for Activating Employers as Agents of Change in the Implementation of Lifestyle as Medicine

“…17 Yet another cohort study involving more than 135,000 adults reported that higher scores on the American Heart Association's Life Essential 8 (an index of cardiovascular health) were associated with a longer life expectancy free from major chronic diseases (ie, cardiovascular disease, cancer, diabetes, and dementia). 18 While value-based care models are gathering momentum 9 and have the potential to promote heavier emphasis on Lifestyle as Medicine, 19 there is a critical role for employers to play. And employers may be uniquely suited for championing Lifestyle as Medicine.…”

Errors in Figure 1 and Supplement 1

“…In the Original Investigation titled “Association of Cardiovascular Health With Life Expectancy Free of Cardiovascular Disease, Diabetes, Cancer, and Dementia in UK Adults,” published online February 27, 2023, several of the bars in the graph of Figure 1 were reported incorrectly. Additionally, eFigures 4 and 5 were missing in Supplement 1.…”