Life essential 8 associated with a lower risk of stroke: ideal cardiovascular health in the EPIC-NL prospective cohort study

Abstract Introduction The American Heart Association (AHA) introduced the concept of Life’s Essential 8 (LE8) to measure and monitor cardiovascular health (CVH) to prevent cardiovascular diseases. Purpose This study aims to identify the association between LE8 and the risk of incident total stroke, ischemic stroke, and haemorrhagic stroke. Methods We included 37,358 participants from the EPIC-NL (European Prospective Investigation Into Cancer and Nutrition- Netherlands) population-based cohort. The LE8 score was calculated according to the AHA’s definition using the LE8 metrics; diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipids, blood pressure, and blood glucose. The overall LE8 score (range 0-100) was categorised into low (0-49), moderate (50-79), and high (80-100) CVH. A Cox proportional hazard model adjusted for age, sex, educational levels, alcohol consumption and history of atrial fibrillation, was used to assess the association between LE8 and the risk of stroke. Results The mean age of participants was 49 years ± 12 years and 75% of participants were female. The mean LE8 score of the participants was 72 ± 11. During the median follow-up of 15.3 years (interquartile range: 14.1-16.5 years), 1323 (3.5%) total stroke, 873 (2.3%) ischemic stroke, and 247 (0.7%) haemorrhagic stroke cases occurred. Moderate and high CVH scores were associated with a lower risk of total stroke compared with low CVH scores: hazard ratio (HR) 0.52 95% confidence interval (95%CI) 0.41-0.65 for moderate and HR 0.33 95%CI 0.25-0.43 for high CVH). For ischemic stroke we observed similar associations (HR 0.46 95%CI 0.35-0.61 for moderate and HR 0.31 95%CI 0.23-0.44 for high CVH) as well as for haemorrhagic stroke (HR 0.68 95%CI 0.37-1.25 for moderate and HR 0.38 95%CI 0.19-0.75 for high CVH). Conclusions Our findings suggest an inverse graded relationship between LE8 and stroke. A higher baseline LE8 score was associated with an impressive lower risk of total stroke, ischemic stroke, and haemorrhagic stroke among Dutch adults. Improving the LE8 score could therefore potentially be a valuable tool to prevent the risk of stroke.