Life’s Essential 8 score and SCORE2 for Cardiovascular Risk Prediction in a Middle-Aged Cohort from the General Population: The Akershus Cardiac Examination 1950 Study

Aims Better control of modifiable risk factors offers substantial potential to prevent cardiovascular disease (CVD). Risk scores can be used to identify and quantify risk and for health promotion, based on prediction of CVD. We aimed to evaluate and compare the prognostic value of Life’s Essential 8 (LE8) and its components, and to contrast LE8 with the established risk prediction tool SCORE2. Methods The Akershus Cardiac Examination 1950 (ACE1950) Study is an ongoing prospective birth cohort study including all men and women born in 1950 residing in Akershus County, Norway. Calculation of Life’s Essential 8 (LE8) and SCORE2 was performed at the baseline visit (2012–2015). Participants were followed through 2022 for incident major adverse cardiovascular events (MACE). Results Among 3,706 participants (attendance rate 64%), 2,938 without established CVD and with complete LE8 data were included. Mean age 63.9 years, 53% women, with a mean SCORE2 of 6.1 and a LE8 score of 63.9. Only 9.8% had “Optimal” cardiovascular health (CVH) according to LE8. During a median follow-up of 8.3 years, 6.7% experienced incident MACE. Both LE8 (total score, domains, and number of optimal components) and SCORE2 were significantly associated with MACE, with comparable predictive performance (LE 8 HR 1.53, 95% CI 1.35-1.73; SCORE 2 HR 1.82, 95% CI 1.57-2.10, p for comparison = 0.30). The highest risk was observed among participants with “Poor” CVH. Conclusions LE8 can be used in health promotion based on prognostic value comparable to SCORE2, for counselling to a healthier lifestyle to preserve cardiovascular health.