Life's Essential 8 and the risk of cardiovascular disease: a systematic review and meta-analysis

Abstract

Aims

The benefits of achieving optimal cardiovascular health (CVH) through Life's Simple 7 (LS7) are well-documented across diverse populations. In this study, we assess the updated metrics, Life's Essential 8 (LE8), and its association with long-term cardiovascular disease (CVD) outcomes and mortality.

Methods and results

We conducted a comprehensive systematic review, searching PubMed, Google Scholar, Cochrane Library, and ScienceDirect from January 2022 until June 2024, focusing on studies that specifically assessed the impact of LE8 on CVH. The statistical analysis used RevMan 5.4 and applied a random effects model to synthesize hazard ratios (HRs) for primary and secondary outcomes. This study is registered in PROSPERO (CRD42024558493). Our final analysis comprised 34 observational studies, encompassing 1 786 664 participants aged 18–80 years, with an average follow-up of approximately 11.6 years. Pooled analysis revealed a statistically significant decrease in the risk of CVD among individuals with higher LE8 scores compared with those with lower scores, with an HR of 0.47 (95% CI: 0.39–0.56, P < 0.00001). Higher LE8 scores were also associated with significant reductions in both all-cause mortality (HR: 0.54, 95% CI: 0.43–0.69, P < 0.00001) and CVD-related mortality (HR: 0.37, 95% CI: 0.26–0.52, P < 0.00001. Moreover, individuals with high LE8 scores have a 56% lower risk of coronary heart disease and a 48% lower risk of stroke.

Conclusion

LE8 has a strong inverse association with CVD risk and mortality, with higher LE8 scores corresponding to significantly lower risk levels.

Graphical Abstract

Lay Summary

The American Heart Association's newly introduced cardiovascular health metric, Life's Essential 8 (LE8), offers a more robust assessment of cardiovascular disease (CVD) and mortality risk compared with the older Life's Simple 7 score.

Key findings 

• Higher Life's Essential 8 (LE8) scores show a significant reduction in overall cardiovascular disease (CVD) events, including coronary heart disease and stroke.

• Increased LE8 scores are consistently associated with lower rates of both all-cause mortality and cardiovascular disease-specific mortality.

Life’s Essential 8, Cardiovascular health, CVD, Mortality, Sleep health