Abstract P370: Prevalence of the AHA Life's Essential 8 in Midlife Women and Its Prospective Associations With Total Mortality and Cardiovascular Diseases Events: The Study of Women’s Health Across the Nation (SWAN)

Objective: Midlife women face significant acceleration in CVD risk during the menopause transition. We aim to determine the cardiovascular health (CVH) as measured by Life's Essential 8 (LE8) in midlife women and to test the associations of midlife LE8 with future CVD events/total mortality. Methods: Participants were from the SWAN study, a multi-ethnic study of the menopause transition. LE8 includes diet, physical activity (PA), nicotine exposure, sleep, BMI, and blood lipids/glucose/pressure. The total and each LE8 scores (0 [lowest] - 100 [highest]) were calculated using AHA definitions. Scores were grouped into low (0-49), intermediate (50-74) and high (75-100) to characterize women. CVD events were self-reported between visits 1-16 and included: myocardial infarction, stroke, heart failure and revascularization. A subset of the events was adjudicated via medical record. Death certificates were obtained. Cox proportional hazards model was used to test the association between continuous LE8 metrics and CVD events/total mortality. Results: A total of 3302 women (mean age 46±3 years, 54% premenopausal) free of CVD at baseline were included. Among them, 28% achieved high total LE8 scores (mean 83±6) and many women had low scores on sleep, PA and diet ( Figure ). During a median (IQR) follow-up of 19 (7) years, 156 deaths and 202 CVD events were recorded. Higher midlife LE8 scores were associated with significantly lower risk of total mortality and CVD events adjusting for demographic and health factors ( Figure ). For individual components, BMI, blood lipids/glucose/pressure, nicotine exposure and sleep were associated with CVD events; BMI, blood glucose/pressure, nicotine exposure and PA were associated with total mortality ( Figure ). Conclusions: The prevalence of healthy diet, physical activity and healthy sleep is low in midlife women. Lower CVH is an independent risk factor of subsequent risk of CVD events/total mortality in midlife women. The findings highlight the need to promote healthy behaviors in midlife women.