September 13, 2025JACC Advances2 citationsOpen Access
Comparing Life’s Simple 7 and Life’s Essential 8 With Risk of Heart Failure
Key Result
Participants with high cardiovascular health according to Life's Essential 8 had an 82% lower risk of developing heart failure compared to those with low cardiovascular health (HR 0.18).
Study Design
Type
Cohort (n=37,803)
Structured PICO
Does higher cardiovascular health as measured by Life's Essential 8 reduce the risk of incident heart failure in a general population cohort?
P
Population
37,803 adults aged 20 to 70 years from the Netherlands, predominantly female and free of prevalent heart failure, followed for a median of 15.3 years.
E
Exposure
Cardiovascular health quantified by Life's Essential 8 (LE8) score, categorized into low (0-49), moderate (50-79), and high (80-100) cardiovascular health.
C
Comparator
Low cardiovascular health (LE8 score 0-49) and Life's Simple 7 (LS7) score classification.
O
Outcome
Incident heart failure (first event of heart failure from hospitalization or death).hard clinical
Higher cardiovascular health quantified by Life's Essential 8 is strongly and non-linearly associated with a lower risk of incident heart failure, though it categorizes many more individuals as having moderate health compared to Life's Simple 7.
Main Result
Hazard Ratio: 0.18 (95% CI 0.12–0.26)
Limitations
- Information on sleep was not collected at baseline but at later follow-up.
- Sleep duration and physical activity were self-reported, which may introduce bias due to underreporting or overreporting.
- No information on nicotine delivery system use was collected.
- The sample was largely of European ancestry (>95%), which may affect generalizability to non-European populations.
Abstract
BACKGROUND: Better cardiovascular health (CVH) lowers risk of heart failure (HF). CVH can be quantified using Life's Essential 8 (LE8), a score consisting of 8 health factors and behaviors. OBJECTIVES: The authors assessed the association between LE8 and risk for HF, and compared LE8 with its predecessor, Life's Simple 7 (LS7). METHODS: We included 37,803 participants from the EPIC-NL (European Prospective Investigation into Cancer and Nutrition-Netherlands) cohort. The LE8 score ranged from 0 to 100 and was categorized into low (0-49), moderate (50-79), and high (80-100) CVH. CVH classification was compared between LS7 and LE8 scoring. Adjusted Cox proportional hazard models were used to assess LE8 score with risk of HF, and CVH reclassification from LS7 to LE8. RESULTS: Participants were predominantly female (74%), with a median age of 52 years (Q1-Q3: 42-58). Compared to low CVH (4%), those with high CVH (21%) had an 82% lower risk of developing HF (HR: 0.18; 95% CI: 0.12-0.26). CVH classification differed substantially between LE8 and LS7, with 75% vs 36% having moderate CVH, respectively, which could be attributed to an upward shift (90%) of participants from LS7 low CVH to LE8 moderate CVH. A graded, nonlinear association with risk for HF was observed for LE8, especially for moderate CVH scores. CONCLUSIONS: LS7 and LE8 differ in scoring and CVH classification. While a strong inverse association exists between LE8 score classification and HF risk, the association is graded over the whole LE8 range, suggesting that nuances may be overlooked when using the proposed CVH classification for exploring HF risk.