Life’s Essential 8 and SCORE2 for cardiovascular risk prediction in a middle-aged general population: the Akershus Cardiac Examination 1950 Study

Background 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 to guide health promotion, based on prediction of CVD. Purpose To evaluate and compare the prognostic value of Life’s Essential 8 (LE8) and its components, and to compare 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 and residing in Akershus County, Norway. Cardiovascular risk assessment, including calculation of LE8 and SCORE2, was performed at the baseline visit (2012–2015). Data collection comprised self-reported information (comorbidities, medication use and lifestyle), fasting blood samples and clinical examination. LE8 comprises two major domains with 4 corresponding components: LE8 Health Behaviors (diet, smoking, sleep and physical activity and LE8 Health Factors (blood pressure, blood glucose, cholesterol and body mass index (BMI)). Participants were followed through 2022 for incident major adverse cardiovascular events (MACE). Results Among 5,827 individuals invited to the ACE 1950 Study, 3,706 (64%) participated, and 2,938 without established CVD and with complete LE8 data were analysed. Mean age was 63.9 years, 53% were women, with a mean SCORE2 of 6.1 and LE8 score of 63.9. Only 9.8% had “optimal” cardiovascular health (CVH), while 78.0% were categorized as “intermediate” and 12.2% as “poor.” Physical activity (59.7%) and blood pressure (52.5%) most frequently fell in the “poor” category. During a median follow-up of 8.3 years, 197 (6.7%) experienced incident MACE. Both LE8 (total score, domains, and number of optimal components) and SCORE2 were significantly associated with MACE, with similar prognostic 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 in participants with “poor” CVH. See graphical abstract. Conclusions LE8 can be used in health promotion based on prognostic performance comparable to SCORE2, for counselling to a healthier lifestyle to optimize cardiovascular health in middle-aged populations.