Cross-sectional and longitudinal associations between Life’s Essential 8 and frailty in community-dwelling older adults

Objective: The American Heart Association recently updated an algorithm-Life's Essential 8 (LE8)-for evaluating cardiovascular health (CVH). However, the cross-sectional and longitudinal associations between LE8 score and frailty among community-dwelling older adults remain unclear. Methods: We analyzed the health examination database of community-dwelling older adults aged 65 and above in an administrative district of Shenzhen, China, from 2018 to 2022, based on China's National Essential Public Health Service Package (NEPHSP). The LE8 score was calculated as the average of eight metrics: nicotine exposure, physical activity, diet, sleep health, body mass index, blood lipids, blood glucose, and blood pressure. A 30-item frailty index (FI) was constructed that excluded deficits related to cardiovascular disease. The data were analyzed using logistic regression models and Cox proportional hazards models. Results: A total of 59,654 older adults participated in the cross-sectional analyses, with 57,742 providing longitudinal data. Over a mean follow-up period of 1.21 years, 1,365 incidents of frailty were identified. In the cross-sectional analysis, a higher LE8 score was associated with lower odds of frailty. In the longitudinal analysis, a higher LE8 score was associated with reduced hazard ratios for frailty incidence. These associations remained significant after adjusting for covariates such as age, sex, registration, marital status, educational level, drinking habit, hypertension, type 2 diabetes, heart disease, stroke, and total cholesterol. Conclusion: Better CVH was significantly associated with a lower frailty risk among community-dwelling older adults. Our findings highlight the importance of enhancing CVH as a preventive measure against frailty within the primary healthcare system.