Feasibility of implementing life essential 8 cardiovascular health metrics to assess cardiovascular health in malaysian children

Abstract Background Cardiovascular health (CVH) declines throughout the life course, from early childhood. Understanding CVH trajectories is essential for policy and practice to prevent cardiovascular disease (CVD). In 2022 the American Heart Association introduced Life’s Essential 8 (LE8), a set of 8 metrics to define and operationalize CVH. CVH assessment in epidemiological research and clinical practice is seriously lacking in low- and middle-income countries (LMICs) despite their major CVD burden. Feasible methods of CVH assessment beginning in childhood must be established. Purpose To study feasibility of fully assessing CVH of children in primary care settings in Malaysia. Methods We assessed CVH in 60 children aged 2-11 years at 2 primary care clinics. Each CVH metric (diet, physical activity, nicotine exposure, sleep, body mass index, cholesterol, blood glucose) was assessed by trained observers under a standard protocol as adapted to Malaysian culture and language. Each metric was scored from 0-100 and the composite CVH score calculated and ranked (low, intermediate, or high) by LE8 methods. Participant experience was evaluated by an exit survey regarding recruitment, acceptability, and time required. Results Volunteer participants were recruited in clinic waiting areas and by healthcare provider (HCP) referrals, snowballing, and advertisement in WhatsApp groups. Early engagement with clinic heads facilitated acceptance by HCPs, ensuring access to facilities. Of 68 participants approached, 88.2% participated. Reasons for non-participation: parental time constraints, lack of interest, and fear of needles (though only capillary blood was collected). LE8 assessments took 30-45 minutes. Challenges: difficulty in dietary recall (particularly school meals), length of the diet questionnaire, capillary blood samples for cholesterol testing, and requirement of 3 blood pressure measurements. However, parents found the assessment acceptable and beneficial for raising awareness of healthy lifestyle. Point-of-care capillary blood testing was well-accepted by children. Among 60 participants, the mean age was 6.38±2.63 years. Mean composite CVH score was 76.17± 8.81 - 36.7% (n=22) high, 63.3% (n=38) intermediate, and 0 low - consistent with expectation from studies elsewhere. Conclusion Complete assessment of each CVH metric by trained observers under a standard protocol was feasible in this setting, laying the foundation for epidemiologic studies of CVH in Malaysian children aged 2-11. Refinement of methods and procedures for this and other settings will increase efficiency and support clinical assessment of CVH as standard of care.