What question did this study set out to answer?

To evaluate whether cumulative cardiovascular health, measured by American Heart Association Life's Essential 8 scores from ages 18 to 45 years, is associated with midlife incident cardiovascular disease and all-cause mortality.

April 23, 2025JAMA CardiologyOpen Access

Cumulative Life’s Essential 8 Scores and Cardiovascular Disease Risk

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Cardiovascular disease (n=4832). Intervention: Cumulative Life's Essential 8 (LE8) score (Quartile 4) vs. Cumulative LE8 score (Quartile 1). Primary outcome: Incident cardiovascular disease after age 45 years (HR 0.12, 95% CI 0.07-0.21).

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Key result

Highest Life's Essential 8 scores in young adulthood linked to ~88% lower midlife CVD risk.

HR 0.12
95% CI 0.07-0.21
n=4,832

Why the study?

Most literature on cardiovascular health and incident CVD and mortality has relied on single midlife measurements, leaving unclear how cumulative cardiovascular health over time influences later-life CVD and mortality.

Does higher cumulative cardiovascular health (Life's Essential 8 score) from age 18 to 45 years reduce incident cardiovascular disease and mortality in midlife?

Population

4832 CARDIA participants from 4 US centers

Comparison

Higher vs lower cumulative LE8 score quartiles from age 18 to 45 years

Design

Cohort study

Authors

JWJames WalkerNorthwestern University DWDaniel WonNorthwestern University JGJames GuoNorthwestern University

Discussion

Member takes

Implication

Supports maintaining high Life's Essential 8 from young adulthood; extends cumulative CVH evidence but leaves open causal effects on midlife CVD.

Key Points

To evaluate whether cumulative cardiovascular health, measured by American Heart Association Life's Essential 8 scores from ages 18 to 45 years, is associated with midlife incident cardiovascular disease and all-cause mortality.
Multicenter CARDIA cohort study evaluated 4,832 participants (55.7% female, 44.3% male) recruited from 4 US centers between 1985 and 2020.
Cumulative Life's Essential 8 (LE8) scores were calculated as the area under the curve for health metrics across age 18 to 45 years.
Multivariate Cox proportional hazard models evaluated associations of cumulative score quartiles, age-45 scores, and score trajectories with post-age-45 outcomes.
Compared with quartile 1, higher cumulative LE8 quartiles demonstrated lower risks of incident CVD: Q2 HR 0.44 (95% CI, 0.32-0.61), Q3 HR 0.26 (95% CI, 0.18-0.38), and Q4 HR 0.12 (95% CI, 0.07-0.21).
Higher cumulative LE8 quartiles were also associated with reduced all-cause mortality: Q2 HR 0.51 (95% CI, 0.36-0.71), Q3 HR 0.38 (95% CI, 0.26-0.55), and Q4 HR 0.29 (95% CI, 0.18-0.45).
Both higher cumulative LE8 scores and an improving score trajectory from age 18 to 45 years remained independently associated with reduced hazards for incident CVD after age 45 years.

Study Design

Type

Cohort (n=4,832)

Multicenter

Yes

Structured PICO

Does higher cumulative cardiovascular health (Life's Essential 8 score) from age 18 to 45 years reduce incident cardiovascular disease and mortality in midlife?

Population

4,832 participants from the Coronary Artery Risk Development in Young Adults (CARDIA) study from 4 US centers, 55.7% female, 44.3% male.

Intervention

Higher cumulative Life's Essential 8 (LE8) score from age 18 to 45 years

Comparator

Lower cumulative Life's Essential 8 (LE8) score (e.g., Quartile 1)

Outcome

Incident cardiovascular disease and all-cause mortality after age 45 yearshard clinical

Main Result

Effect estimate: HR 0.12 (95% CI 0.07-0.21)

Greater cumulative cardiovascular health and improvement during young adulthood are independently associated with a substantially lower risk of incident CVD and mortality in midlife.

Limitations

The unweighted approach of LE8 does not have the same predictive utility as weighted approaches like AHA's 10-year and 30-year CVD outcome risk calculators
Sleep data were not collected until the year 15 examination, requiring imputation for earlier examinations
Cohort composition of only Black and White participants limits generalizability beyond these racial groups
Methodologies for measuring cumulative CVH and slope do not account for all the variability in an individual's CVH
Potential for residual confounding

Cite This Study

Walker et al. (2025) conducted a cohort in Cardiovascular disease (n=4,832). Cumulative Life's Essential 8 (LE8) score (Quartile 4) vs. Cumulative LE8 score (Quartile 1) was evaluated on Incident cardiovascular disease after age 45 years (HR 0.12, 95% CI 0.07-0.21). A cumulative Life's Essential 8 score in the highest quartile from age 18 to 45 years reduced the hazard of incident cardiovascular disease in midlife by 88% compared to the lowest quartile.

synapsesocial.com/papers/6a11cf6535a4eec8fedce2ed https://doi.org/10.1001/jamacardio.2025.0630

Topics

Women and heart disease

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Implication

Supports maintaining high Life's Essential 8 from young adulthood; extends cumulative CVH evidence but leaves open causal effects on midlife CVD.

Cumulative Life’s Essential 8 Scores and Cardiovascular Disease Risk

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Topics

Cumulative Life’s Essential 8 Scores and Cardiovascular Disease Risk

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Topics

Also Consider