Associations Between the American Heart Association’s Life’s Essential 8 and Cardiovascular, Cognitive and Mortality Outcomes: A Systematic Review and Meta-Analysis

Background Cardiovascular disease (CVD) is the leading cause of death worldwide, with most cases attributable to modifiable risk factors. The American Heart Association’s Life’s Essential 8 (LE8) provides a comprehensive measure of cardiovascular health, but its associations with major health outcomes have not yet been systematically synthesized. Methods and results We searched PubMed, Web of Science, EMBASE and ScienceDirect for prospective cohort studies published up to September 2025 evaluating LE8 in relation to health outcomes. Thirty-six publications from ten unique cohorts met inclusion criteria. Eight studies (N = 471,397; mean age 57.4; 54.2% female) contributed to the primary all-cause mortality analysis and seven to CVD mortality. The pooled hazard ratio per 10-point higher LE8 score was 0.82 (95% CI 0.79–0.85; 95% prediction interval 0.76-0.89) for all-cause mortality and 0.76 (95% CI 0.70–0.82; 95% prediction interval 0.62-0.92) for CVD mortality. Results were robust in sensitivity analyses. GRADE ratings were low for all-cause and very low for CVD mortality. Across outcomes with limited studies precluding meta-analysis, higher LE8 scores were consistently associated with lower risks of CVD, coronary heart disease, myocardial infarction, stroke, heart failure, atrial fibrillation, and vascular dementia, while no significant associations were found for Alzheimer’s dementia. Conclusion Higher LE8 scores were linked to lower risks of all-cause and cardiovascular mortality and several major non-communicable diseases, underscoring its value as a comprehensive framework for prevention. Future research should focus on diverse and underrepresented populations and clarify the contributions of individual LE8 components to guide targeted interventions. PROSPERO registration CRD420251005997