Life's Essential 8 Score and Cardiovascular-Kidney Outcomes in ASCVD: A UK Biobank Prospective Cohort Study

BACKGROUND: Patients with atherosclerotic cardiovascular disease (ASCVD) have a high risk of recurrent major adverse cardiovascular events (MACE) and chronic kidney disease (CKD). Although Life's Essential 8 (LE8) has been studied for cardiovascular outcomes in secondary prevention, systematic evaluations of its association with cardiorenal events remain lacking. OBJECTIVES: To evaluate whether optimal cardiovascular health (CVH) was associated with lower risks of MACE and CKD in ASCVD patients. METHODS: This study included 10,253 UK Biobank participants with ASCVD, categorized into low (<50), moderate (50‒79), and high (≥80) CVH groups by LE8 score. Associations with MACE and CKD were assessed using Fine-Gray regression models, population-attributable fractions (PAF), and 1:2 propensity-matched analyses versus 16,545 non-ASCVD participants. RESULTS: During a median 13.3 years follow-up, 2,069 MACE and 1,290 CKD events occurred. Compared with high CVH, low CVH was associated with higher risks of MACE (subdistribution HR [sHR] 2.68, 95% CI 2.02-3.56, p <0.001) and CKD (sHR 2.34, 95% CI 1.57-3.48, p <0.001). Glucose control contributed the largest PAF to both MACE (10.5%) and CKD (15.1%), followed by smoking cessation (6.9% for MACE and 11.1% for CKD). Compared with matched non-ASCVD participants, ASCVD patients with high LE8 attenuated MACE (sHR 0.83, 95% CI 0.58-1.20; p = 0.33) and CKD (sHR 0.69, 95% CI 0.42-1.13; p = 0.14) risks. CONCLUSIONS: Higher LE8 scores were associated with lower risks of MACE and CKD in ASCVD patients. Glucose control and smoking were key modifiable contributors. High LE8 achievement may attenuate risks toward non-ASCVD levels.