Association of American Heart Association's Life's Essential 8 and mortality among US adults with and without cardiovascular disease

Background: Differences in the American Heart Association's Life's Essential 8 (LE8) score and its association with mortality based on the presence of clinically prevalent cardiovascular disease (CVD) has not been assessed previously. Methods: Data from the National Health and Nutrition Examination Survey 2009–2018 were utilized to calculate LE8 scores among adult patients, stratified by the presence of existing CVD. Health metrics were further divided into health behaviors and health factors. Scores were also evaluated based on sex, age, race/ethnicity, and socioeconomic status. Cox proportional hazard models were used to evaluate the association between the levels of cardiovascular health (CVH), estimated using LE8 score, and risk of all-cause and cardiovascular mortality. Results: 25,359 patients were included in the analysis, of which 10.2 % had CVD. Individuals with known CVD had lower overall CVH (55.9 vs. 65.8, p < 0.001), health behaviors (60.6 vs. 67.9, p < 0.001), and health factors (51.3 vs. 63.8, p < 0.001) scores. The lower CVH scores in those with prior CVD persisted after stratification by sex, age, race/ethnicity, and socioeconomic status. When assessing the association of CVH metrics with mortality, for every 10-point increase in LE8 score, there was a significant reduction (17 %–27 %) in all-cause and CV mortality in those with and without CVD. Conclusions: Individuals with known CVD have lower CVH metric scores. Overall, the LE8 score is able to predict future CV outcomes in both individuals with and without CVD and highlights the importance of effective implementation strategies that target health factors and behaviors in primary and secondary prevention populations.