Associations of cardiovascular health assessed by life’s crucial 9 with incident cardiovascular disease and dementia: A prospective cohort study

BACKGROUND: The associations of the renewed cardiovascular health (CVH) assessed by Life's Crucial 9 (LC9), which consisted of Life's Essential 8 (LE8) and psychological health, with incident cardiovascular disease (CVD) and dementia remained unexplored. OBJECTIVES: This study aims to investigate the associations and determine whether LC9 has a higher discrimination ability than LE8 in predicting incident CVD and dementia. DESIGN, SETTING, AND PARTICIPANTS: This study was a prospective population-based cohort study using data from the UK Biobank. MEASUREMENTS: LC9 was assessed as American Heart Association recommended. Incident CVD and dementia were based on self-reported data, hospital inpatient records, and death register records. RESULTS: Of 289,649 included participants, 137,480 (47.5 %) were male, and the mean age was 56.6 ± 8.1 years. Compared with participants having low LC9, those having moderate or high LC9 had lower risks of incident CVD (moderate: 0.46 [0.43-0.48]; high: 0.25 [0.23-0.27]; p for trend <0.001) and dementia (moderate: 0.57 [0.50-0.64]; high: 0.45 [0.39-0.52]; p for trend <0.001) after multivariate adjustment. Both the LE8 and LC9 achieved good discriminative performance for incident CVD (LE8 Harrell C-statistic= 0.7138 vs. LC9 Harrell C-statistic=0.7144, p = 0.136); the net reclassification improvement was estimated at 0.07 % (p = 0.749), and integrated discrimination improvement was estimated at 0.009 (p < 0.001). The results for dementia showed similar patterns. CONCLUSIONS AND RELEVANCE: Optimal LC9 was associated with lower risks of incident CVD and dementia. Although psychological health is essential for preventing CVD and dementia, including it into CVH's evaluation criteria did not significantly improve CVH's predictive performance.