Association of Cardiovascular Health With Life Expectancy Free of Cardiovascular Disease, Diabetes, Cancer, and Dementia in UK Adults

“The concept of cardiovascular health (CVH) was proposed by the American Heart Association (AHA) in 2010 and is composed of both lifestyle factors and biological metrics. The original algorithm for evaluating CVH was the Life’s Simple 7 (LS7) score. In 2022, the AHA published the new algorithm for evaluating CVH, the Life’s Essential 8 (LE8) score, on the basis of feedback on the LS7 score and new evidence. The LE8 score adopts a new scoring algorithm and incorporates sleep health into CVH.8 Intriguingly, previous studies have shown that having a higher CVH level was not only associated with a lower risk of CVD, but also associated with lower risks of other diseases, such as diabetes, cancer, and dementia, as well as risk of all-cause mortality. Currently, studies assessing the relations between CVH defined by LE8 and the overall health in humans are lacking. [..]

Cardiovascular health was evaluated by LE8 score. Eight components were used to create the LE8 score, including (1) diet, (2) physical activity, (3) tobacco/nicotine exposure, (4) sleep, (5) body mass index, (6) non–high-density lipoprotein (non-HDL) cholesterol, (7) blood glucose, and (8) blood pressure. Diet within LE8 was estimated by calculating the Dietary Approaches to Stop Hypertension diet score. The information on physical activity (minutes of moderate or vigorous physical activity per week), tobacco/nicotine exposure (combustible tobacco use and secondhand smoke exposure), sleep (sleep duration), and medication use were self-reported and collected during the interview process. [..] Blood pressure was measured twice by trained nurse. Average levels of systolic and diastolic blood pressure were used in this study, and automated measurements were preferred; if the automated one was not available, manual measurement was used instead. [..] The individual CVH metric ranges from 0 to 100 points. The overall CVH score was calculated by summing the scores for the 8 metrics and dividing by 8 and also ranges from 0 to 100 points. Higher score represents healthier CVH. According to the AHA’s recommendations, we categorized overall CVH into low (LE8 score <50), moderate (LE8 score ≥50 but <80), and high (LE8 score ≥80) levels. [..]

Of 60 415 men, 7.8%, 81.0%, and 11.2% had low (LE8 score <50), moderate (LE8 score ≥50 but <80), and high (LE8 score ≥80) CVH levels, respectively. Of 74 784 women, 4.9%, 69.8%, and 25.3% had low, moderate, and high CVH levels, respectively. In both men and women, participants with higher levels of CVH were more likely to be younger, to be White, to have a higher level of educational attainment, to have a lower Townsend Deprivation Index, and to have a lower prevalence of depression. [..]

Higher levels of CVH were associated with both longer total life expectancy and greater percentage of life expectancy free of major chronic diseases (CVD, diabetes, cancer, and dementia) in men and women. At age 50 years, the estimated total life expectancy was 34.5 (95% CI, 33.3-35.6), 37.2 (95% CI, 37.0-37.3), and 39.3 (95% CI, 38.2-40.3) years for men with low, moderate, and high CVH levels, respectively. The corresponding estimated total life expectancy at age 50 years for women was 36.0 (95% CI, 34.6-37.3), 40.2 (95% CI, 40.1-40.4), and 42.0 (95% CI, 41.3-42.6) years. Notably, the percentage of life expectancy free of diseases out of total life expectancy was greater along with higher levels of CVH, which were 62.4% (95% CI, 60.8%-64.3%), 68.6% (95% CI, 68.3%-68.8%), and 72.4% (95% CI, 70.8%-74.2%) among men with low, moderate, and high CVH levels, respectively, and were 67.2% (95% CI, 65.2%-69.3%), 75.8% (95% CI, 75.5%-76.1%), and 79.9% (95% CI, 78.9%-80.9%) for women, respectively.

The estimated disease-free years at age 50 years was 21.5 (95% CI, 21.0-22.0), 25.5 (95% CI, 25.4-25.6), and 28.4 (95% CI, 27.8-29.0) years for men with low, moderate, and high CVH levels, respectively. The corresponding estimated disease-free years at age 50 years for women was 24.2 (95% CI, 23.5-24.8), 30.5 (95% CI, 30.4-30.6), and 33.6 (95% CI, 33.1-34.0) years. Equivalently, men with moderate or high CVH levels lived on average 4.0 (95% CI, 3.4-4.5) or 6.9 (95% CI, 6.1-7.7) years longer free of chronic disease at age 50 years, respectively, compared with men with low CVH levels. The corresponding longer years lived free of disease for women at age 50 years was 6.3 (95% CI, 5.6-7.0) or 9.4 (95% CI, 8.5-10.2) years. The differences in years lived free of major chronic diseases between CVH levels were less pronounced at older index ages (eg, at age 60 or 70 years). However, until age 70 years, the estimated disease-free life expectancy remained significantly higher in the high CVH group than in the low CVH group in men (5.2 years; 95% CI, 4.6-5.8 years) and women (7.5 years; 95% CI, 6.8-8.1 years). Moreover, life expectancy in the presence of major chronic diseases was shorter along with higher levels of CVH, despite the increase in total life expectancy across CVH levels. Similar results were observed if multiple imputation was used to impute data for missing covariates. [..]

Men and women with low socioeconomic status had on average 0.6 to 1.4 and 0.4 to 1.6 shorter years of life expectancy free of diseases, respectively, at age 50 years compared with their counterparts with other socioeconomic status. In joint analysis of the association of CVH and socioeconomic status with estimated life expectancy free of diseases, longer life expectancy free of diseases at age 50 years was associated with higher CVH level in both low and other socioeconomic status. Notably, for participants who had high CVH levels, the life expectancies free of diseases between participants with low and other socioeconomic status were not statistically significantly different in both men (difference: 0.6 [95% CI, −1.1 to 2.5] years for education; 0.3 [95% CI, −1.6 to 0.9] years for Townsend Deprivation Index; and 0.9 [95% CI, −0.4 to 2.2] years for income) and women (difference: −0.9 [95% CI, −2.0 to 0.3] years for education; 0.3 years [95% CI, −0.7 to 1.2] years for Townsend Deprivation Index, and 0.6 [95% CI, −0.4 to 1.7] years for income). [..]

Intriguingly, we observed that the life expectancy in the presence of major chronic disease was shorter along with the higher levels of CVH, despite extended total life expectancy. The present data indicate that higher-level CVH extended more disease-free life span, thereby occupying the space for periods with diseases, leading to a compression of years of life lived with disease. These findings were directly supported by the results from the Chicago Heart Association Detection Project in Industry study, which showed that participants who had a high level of CVH in early middle age not only lived a longer life, but also a healthier life with a greater proportion of life span free of morbidity compared with counterparts with a low level of CVH. Taken together, these results indicate that a high CVH may not only prolong life span, but also improve the quality (disease free) of aging. Because total life expectancy cannot be extended indefinitely, these findings are of important implications for improvement of healthy aging.

Moreover, given the important role of socioeconomic status in optimizing and preserving CVH, we performed joint analyses of several relevant and well-established socioeconomic indicators and CVH in relation to the estimated life expectancies. Consistent with previous studies, we found that a lower socioeconomic status was associated with a shorter life expectancy. Of interest, the joint analyses showed that disparities in disease-free life expectancy due to low socioeconomic status might be considerably offset by a high CVH level. Indeed, we observed similar life expectancy free of diseases at age 50 years between participants with a high CVH level and low socioeconomic status and those with a high CVH level and relative higher socioeconomic status. These results did not change even when we used stricter cutoff points to define low socioeconomic status. These findings indicate that the gap in life expectancy between low socioeconomic status and others might be narrowed by improving CVH and, therefore, could contribute to reducing health inequalities.”

Full article, X Wang, H Ma, X Li et al. JAMA Internal Medicine 2023.2.27