What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Cardiovascular Health (n=21667). Intervention: Time period (2017-2018) vs. Time period (2005-2006). Primary outcome: Age-standardized mean score of overall cardiovascular health (Life's Essential 8) (p=0.82).

March 27, 2023Open Access

Using the New “Life’s Essential 8” Metrics to Evaluate Trends in Cardiovascular Health Among US Adults From 2005 to 2018: Analysis of Serial Cross-sectional Studies

Key Result

The overall cardiovascular health score based on Life's Essential 8 metrics did not significantly change among US adults between 2005-2006 and 2017-2018.

Study Design

Type

Cross-Sectional (n=21,667)

Structured PICO

Population

21,667 US adults aged 20-79 years from the National Health and Nutrition Examination Survey (NHANES) between 2005-2006 and 2017-2018, excluding pregnant/breastfeeding women and individuals with self-reported CVD history.

Outcome

Age-standardized mean scores of overall cardiovascular health (CVH) and each of the Life's Essential 8 (LE8) components (diet, physical activity, nicotine exposure, sleep health, BMI, blood lipids, blood glucose, blood pressure) from 2005 to 2018.surrogate

Overall cardiovascular health among US adults did not significantly improve from 2005 to 2018 according to the Life's Essential 8 metrics, with worsening trends in BMI and blood glucose offsetting improvements in other areas.

Main Result

Absolute Event Rate: 65% vs 65.5%

p-value: p=0.82

Limitations

Based on data from 7 surveys over a rather short time period (<15 years)
Data on diet, physical activity, nicotine exposure, and sleep health were obtained by self-report, which may be inaccurate due to recall and social desirability biases
The 8 behavioral and health components are given equal weight in calculating the overall score
Other factors like familial history/genetics or comorbidities that can alter CVD risk were not included
Missing values on relevant variables, especially for dietary variables, might have affected the representativeness of the study population

Abstract

Background The recently published “Life’s Essential 8” (LE8) by the American Heart Association has overcome some limitations in evaluating cardiovascular health (CVH) in the previous “Life’s Simple 7.” Objective We aimed to examine the secular trends in CVH, as assessed by the LE8, in US adults from 2005 to 2018. Methods Using cross-sectional data from the National Health and Nutrition Examination Survey between 2005-2006 and 2017-2018, we calculated the age-standardized mean scores of overall CVH and each of the LE8 components, where a higher score (range 0-100 points) means a better health status. A total of 21,667 adults aged 20-79 years were included in this analysis. Results The overall CVH did not significantly change between 2005-2006 and 2017-2018 (65.5, 95% CI 63.9-67.1 to 65.0, 95% CI 62.8-67.1; P=.82). The individual metrics did not significantly change for diet (41.0, 95% CI 38.0-43.9 to 41.5, 95% CI 36.5-46.6; P=.94), physical activity (57.5, 95% CI 53.0-61.9 to 53.0, 95% CI 48.7-57.3; P=.26), and blood pressure (68.4, 95% CI 65.2-71.5 to 68.6, 95% CI 65.3-71.9, P=.35), improved for nicotine exposure (64.7, 95% CI 61.1-68.4 to 71.9, 95% CI 67.7-76.2; P<.001), sleep health (83.7, 95% CI 81.6-85.7 to 84.1, 95% CI 81.2-87.1; P=.006), and blood lipids (61.6, 95% CI 59.1-64.0 to 67.0, 95% CI 63.5-70.4; P<.001), and worsened for BMI (63.4, 95% CI 59.7-67.1 to 56.2, 95% CI 52.5-59.9; P<.001) and blood glucose (83.9, 95% CI 82.4-85.4 to 77.4, 95% CI 74.5-80.3; P<.001). Conclusions According to the LE8, the overall CVH did not change among US adults from 2005 to 2018, as well as 3 components (diet, physical activity, and blood pressure). Other metrics such as nicotine exposure, blood lipids, and sleep health improved, while BMI and blood glucose deteriorated over time.

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