Importance of Life's Essential 8 in predicting short- and long-term incidence of cardiovascular disease: The atherosclerosis risk in communities study.

Background: As is acknowledged that there is a strong negative association between Life's Essential 8 (LE8) and the major adverse cardiovascular events (MACE). However, from the perspective of primary prevention of cardiovascular diseases (CVD), it is more valuable to discover the factors to predict the incidence of CVD. We intend to explore the predictive value of LE8 for the short-term and long-term incidence of CVD in the population without CVD at baseline. Methods: Participants in the ARIC (Atherosclerosis Risk in Communities) study were studied. Logistic regression models estimated the relationship between LE8 and CVD, including coronary heart disease (CHD), atrial fibrillation (AF) and stroke. Cox proportional hazards regression models were employed to assess whether an increase in the LE8 score could reduce the short-term and long-term incidence of CVD. Results: Among the 8083 participants studied at V2, 332 (4.1%) were diagnosed with CHD, 98 (1.8%) with stroke, and 24 (0.3%) with AF. LE8 was negatively associated with the prevalence of CHD, stroke, but without statistically significant association with AF. After adjusting for other cardiovascular-related risk factors, LE8 was still negatively associated with stroke (OR:0.959; 95%CI, 0.943-0.976; P<0.001). During the short-term follow-up, for each 1-point increase in the LE8 score, the risks of CHD, stroke, and AF decreased by 6.5%, 5.4%, and 5.1% respectively (the hazard ratio values were 0.935, 0.946, and 0.949). Whether LE8 was used as a continuous variable or a categorical variable, the higher the score, the lower the likelihood of developing CHD at the long-term follow-up. Using the ROC curve, the area under the curve (AUC) of LE8 for predicting the 5-year, 15-year, and 25-year incidence of CHD was 0.77, 0.696, and 0.644, respectively. Conclusions: A higher LE8 score is consistently associated with a lower probability of the incidence of CHD during both short-term and long-term follow-up periods.