Associations of Cardiovascular Health with Arterial Health in Adults Free of Cardiovascular Disease

In adults without cardiovascular disease (CVD), there is limited understanding of the association between overall cardiovascular health (CVH) and arterial health. In 2330 Framingham Heart Study Offspring participants free of CVD (60±9 years; 57% women) with Life's Essential 8 (LE8) and applanation tonometry data (Exam 7), we calculated CVH scores per American Heart Association's LE8 guidelines. Multivariable-adjusted regression analyses examined the relations of LE8 with aortic stiffness and pressure pulsatility negative inverse carotid-femoral pulse wave velocity (niCFPWV), central pulse pressure (CPP), respectively, and examined effect modification by age and sex. We also evaluated niCFPWV and CPP as mediators of the relation between LE8 and death outcomes (CVD, all-cause mortality). Higher LE8 scores (better CVH) were associated with lower niCFPWV standardized (std) β= -0.20±0.02, p<0.0001 and CPP (std β= -0.11±0.02, p<0.0001). While age- and sex- interactions were not significant, stratified analysis revealed stronger association of LE8 with arterial health in women (niCFPWV: std β= -0.11±0.02, p<0.0001 vs. std β= -0.06±0.03, p=0.04; CPP: std β= -0.13±0.03, p<0.001 vs. std β= -0.06±0.03, p=0.07 in women vs. men, respectively). niCFPWV and CPP mediated 19% and 10% of the association between LE8 and CVD mortality, respectively, and 17% and 15% of the association between LE8 and all-cause mortality, respectively. Better CVH measured by LE8 was associated with lower arterial stiffness and pressure pulsatility, both of which mediate a significant proportion of the associations between CVH and CVD/death outcomes. These findings underscore the importance of optimal cardiovascular health behaviors and factors in maintaining arterial health.