Abstract 51: Association Between Cumulative “Life’s Essential 8” Scores Through Young Adulthood and Cardiovascular Disease Risk: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Background: Associations of cardiovascular health (CVH) with incident cardiovascular disease (CVD) largely come from studies with single measures of CVH in mid-life. We used the American Heart Association’s “Life’s Essential 8” (LE8) score to examine the association of cumulative CVH through young adulthood, and time course of CVH exposure, with risk of incident CVD in mid-life. Methods: We estimated subject-specific LE8 score trajectories of 3932 CARDIA young adults aged 18-45 years (56.2% female, 48.1% Black) using a spline-based mixed effect model. Using multivariable Cox proportional models, we assessed associations of 1) cumulative LE8 score (cumLE8) from 18-45 by quartile, 2) cumLE8 continuous score from 18-45 and LE8 score at age 45, and 3) cumLE8 continuous score and slope of LE8 score from ages 18-45, with incident fatal or non-fatal CVD after age 45, adjusting for age, sex, race, and maximal education. Area under the LE8 curve from ages 18-45 was used to calculate cumLE8 for each subject. Results: There were 3932 CARDIA participants (56.2% female, 48.1% Black). The mean cumLE8 exposure from 18-45 was 2075.2 points*years, and mean LE8 score at age 45 was 69.9 points (out of 100; higher is better). After adjustment, the lowest 2 quartiles (Q1 and Q2) of cumLE8 score (poorest CVH) from 18-45 had significantly higher hazards for CVD after age 45 compared to the highest (best CVH, Q4) ( Figure 1, Model 1 ). When cumLE8 score from 18-45 and LE8 score at age 45 were in the model together ( Model 2 ), both were significantly associated with lower risk for CVD. Likewise, both cumLE8 score and positive slope of (improving) LE8 score from ages 18-45 were significantly associated with lower hazards for incident CVD after age 45 ( Model 3 ). Conclusion: Greater cumulative CVH and improvement in CVH during young adulthood, as well as better CVH in middle age, were all independently associated with lower risk for incident CVD in mid-life. These results emphasize the importance of maintaining and improving CVH throughout young adulthood.