The association of Life’s Essential 8 with risk of stroke: The EPIC-NL prospective cohort study

BACKGROUND AND AIMS: The American Heart Association released the Life's Essential 8 (LE8) metrics for cardiovascular health (CVH) promotion. This study aims to identify the association between LE8 and the risk of total, ischemic, and hemorrhagic stroke. METHODS AND RESULTS: We included 37,358 participants from the European Prospective Investigation into Cancer and Nutrition- Netherlands (EPIC-NL) population-based cohort. CVH was defined using the LE8 score based on diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipids, blood pressure, and blood glucose. The overall LE8 score was categorized as low (0-49), moderate (50-79), and high (80-100). Incident (non) fatal stroke events were ascertained via record linkage. Cox regression analyses were used to assess the association between LE8 and risk of stroke. The mean age of participants was 49 years ± 12 and 75 % of participants were female. The mean LE8 score of the participants was 72.3 ± 11.2. During median follow-up of 15.3 years (interquartile range: 14.1-16.5 years), 1323 (3.5 %) total stroke, 873 (2.3 %) ischemic stroke, and 247 (0.7 %) hemorrhagic stroke cases occurred. In the adjusted models, compared to low CVH score, moderate and high CVH scores were associated with a lower risk of total stroke (hazard ratio (HR): 0.52; 95 % confidence interval (CI): 0.41-0.65 for moderate CVH and HR: 0.33; 95 %CI: 0.25-0.43 for high CVH). CONCLUSIONS: Our data suggest a strong inverse relationship between LE8 and total, ischemic and hemorrhagic stroke among Dutch adults. Improving the LE8 score could be a valuable tool to aid in stroke prevention.