Adults in the United States with lower Life’s Essential 8 cardiovascular health scores had significantly greater odds of experiencing a stroke compared with those who had higher scores, based on a cross-sectional analysis of a nationally representative cohort.
Life’s Essential 8 (LE8) is a cardiovascular health metric developed by the American Heart Association that scores 8 components—diet, physical activity, nicotine exposure, sleep, body mass index (BMI), blood pressure, blood glucose, and nonhigh-density lipoprotein (HDL) cholesterol—on a scale of 0 to 100. The average score categorizes patients into high (at least 80), moderate (50 to 79), or low (less than 50) cardiovascular health groups. In fully adjusted models that controlled for demographic and socioeconomic factors, participants in the low LE8 group had 4.81 times higher odds of stroke compared with those in the high-score group. Those in the moderate group had 2.17 times higher odds. The average LE8 score among participants with stroke was 57.32, compared with 68.63 among those without stroke.
Lead author Zhenyu Shi, of Zhejiang Chinese Medical University in Hangzhou, China, and colleagues observed significant LE8 score differences between stroke and nonstroke groups in physical activity (47.46 vs 72.28), blood pressure (48.55 vs 70.15), sleep health (75.27 vs 83.71), BMI (54.06 vs 60.70), and blood glucose (69.30 vs 86.62). Diet scores were similar between the two groups. Low scores in LE8 health behavior components—diet, activity, nicotine exposure, and sleep—were associated with 3 times higher odds of stroke compared with high scores. Low health factor scores—BMI, blood pressure, glucose, and lipids—were associated with 1.93 times higher odds of stroke.
The researchers also observed a dose-response relationship: As LE8 scores increased, stroke risk steadily declined. They confirmed this linear association through restricted cubic spline analysis. Sensitivity analyses using unweighted models showed consistent findings—low and moderate LE8 scores corresponded to 4.60 and 2.21 times higher stroke odds, respectively. Subgroup analysis demonstrated that the association between LE8 score and stroke risk remained consistent across categories of age, sex, race/ethnicity, marital status, education, and income. No significant interactions were detected.
The researchers analyzed data from 24,851 adults aged 20 years or older from the National Health and Nutrition Examination Survey between 2005 and 2018. Among them, 943 participants reported a history of stroke. Stroke cases were identified based on self-reported physician diagnosis, and some LE8 components, such as diet and physical activity, were self-reported, which may be subject to bias. Asymptomatic strokes diagnosed by imaging may not have been reported. The cross-sectional design limits the ability to determine causality. Finally, the authors noted, reverse causation bias may have been possible because some health behaviors may have been influenced by stroke.
“The LE8 score may complement established risk models by providing additional information on CVH and prevention, particularly in cross-sectional analyses examining associations with prevalent stroke,” they added. "The enhancement of LE8 scores may contribute to the reduction of individual stroke risk, which could assist medical professionals and public health experts in identifying high-risk populations for stroke and providing targeted preventive strategies.
The authors reported no conflicts of interest.
Source: BMJ Open
