Life's Essential 8 and 10-Year and Lifetime Risk of Atherosclerotic Cardiovascular Disease in China

Cheng Jin; Jianxin Li; Fangchao Liu; Xia Li; Ying Hui; Shouhua Chen; Furong Li; Gang Wang; Fengchao Liang; Xiangfeng Lu; Shouling Wu; Dongfeng Gu

doi:10.1016/j.amepre.2023.01.009

Life's Essential 8 and 10-Year and Lifetime Risk of Atherosclerotic Cardiovascular Disease in China

Am J Prev Med. 2023 Jun;64(6):927-935. doi: 10.1016/j.amepre.2023.01.009. Epub 2023 Feb 20.

Authors

Cheng Jin¹, Jianxin Li², Fangchao Liu², Xia Li³, Ying Hui⁴, Shouhua Chen⁵, Furong Li³, Gang Wang⁵, Fengchao Liang⁶, Xiangfeng Lu², Shouling Wu⁵, Dongfeng Gu⁷

Affiliations

¹ Shenzhen Key Laboratory of Cardiovascular Health and Precision Medicine, Southern University of Science and Technology, Shenzhen, China; Department of Cardiology, Kailuan General Hospital, Tangshan, China; School of Medicine, Southern University of Science and Technology, Shenzhen, China.
² Department of Epidemiology, Fu wai Hospital, National Center for Atherosclerotic cardiovascular diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
³ Shenzhen Key Laboratory of Cardiovascular Health and Precision Medicine, Southern University of Science and Technology, Shenzhen, China; Department of Epidemiology and Biostatistics, School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, China.
⁴ Department of Cardiology, Kailuan General Hospital, Tangshan, China; Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
⁵ Department of Cardiology, Kailuan General Hospital, Tangshan, China.
⁶ Department of Epidemiology and Biostatistics, School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, China.
⁷ Shenzhen Key Laboratory of Cardiovascular Health and Precision Medicine, Southern University of Science and Technology, Shenzhen, China; Department of Epidemiology, Fu wai Hospital, National Center for Atherosclerotic cardiovascular diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, China. Electronic address: gudongfeng@cashq.ac.cn.

PMID: 36813641
DOI: 10.1016/j.amepre.2023.01.009

Abstract

Introduction: Cardiovascular health level according to the American Heart Association's Life's Essential 8 (LE8) in China and its effectiveness on the 10-year and lifetime risk of atherosclerotic cardiovascular diseases is unclear.

Methods: This prospective study included 88,665 participants in the China-PAR cohort (data from 1998 to 2020) and 88,995 in the Kailuan cohort (data from 2006 to 2019). Analyses were conducted by November 2022. LE8 was measured according to the American Heart Association's LE8 algorithm, and a high cardiovascular health status was defined as a LE8 score ≥80 points. Participants were followed for the primary composite outcomes, including fatal and nonfatal acute myocardial infarction, ischemic stroke, and hemorrhagic stroke. The lifetime risk was estimated from the cumulative risk of atherosclerotic cardiovascular diseases through ages 20-85 years, the association of LE8 and LE8 change with atherosclerotic cardiovascular diseases was assessed with the Cox proportional-hazards model, and partial population-attributable risks evaluated the proportion of atherosclerotic cardiovascular diseases that could be averted.

Results: The mean LE8 score was 70.0 in the China-PAR cohort and 64.6 in the Kailuan cohort, with 23.3% and 8.0% of participants having a high cardiovascular health status, respectively. Participants in the highest quintile had about 60% lower 10-year and lifetime risk of atherosclerotic cardiovascular diseases in the China-PAR and Kailuan cohorts than participants with the lowest quintile LE8 score. If everyone maintained the highest quintile of LE8 score, approximately half of the atherosclerotic cardiovascular diseases could be prevented. The participant with LE8 score that increased from the lowest to the highest tertile during 2006-2012 had a 44% (hazard ratio=0.56; 95% CI=0.45, 0.69) lower observed risk and a 43% (hazard ratio=0.57; 95% CI=0.46, 0.70) lower lifetime risk of atherosclerotic cardiovascular diseases than those remaining in the lowest tertile in the Kailuan cohort.

Conclusions: The LE8 score was below optimal levels in Chinese adults. A high baseline LE8 score and an improving LE8 score were associated with decreased 10-year and lifetime risk of atherosclerotic cardiovascular diseases.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Atherosclerosis* / epidemiology
Cardiovascular Diseases* / epidemiology
Cardiovascular Diseases* / etiology
Cardiovascular Diseases* / prevention & control
China / epidemiology
Humans
Myocardial Infarction*
Prospective Studies
Risk Factors
United States