Life's Essential 8 and risk of non-communicable chronic diseases: Outcome-wide analyses

Yuetian Yu; Ying Sun; Yuefeng Yu; Yuying Wang; Chi Chen; Xiao Tan; Yingli Lu; Ningjian Wang

doi:10.1097/CM9.0000000000002830

Life's Essential 8 and risk of non-communicable chronic diseases: Outcome-wide analyses

Chin Med J (Engl). 2023 Oct 10. doi: 10.1097/CM9.0000000000002830. Online ahead of print.

Authors

Yuetian Yu¹, Ying Sun¹, Yuefeng Yu¹, Yuying Wang¹, Chi Chen¹, Xiao Tan^{2

3}, Yingli Lu¹, Ningjian Wang¹

Affiliations

¹ Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China.
² School of Public Health, Zhejiang University, Hangzhou 310058, Zhejiang, China.
³ Department of Medical Sciences, Uppsala University, Uppsala 75185, Sweden.

PMID: 37821910
DOI: 10.1097/CM9.0000000000002830

Abstract

Background: Life's Simple 7, the former construct of cardiovascular health (CVH) has been used to evaluate adverse non-communicable chronic diseases (NCDs). However, some flaws have been recognized in recent years and Life's Essential 8 has been established. In this study, we aimed to analyze the association between CVH defined by Life's Essential 8 and risk of 44 common NCDs and further estimate the population attributable fractions (PAFs) of low-moderate CVH scores in the 44 NCDs.

Methods: In the UK Biobank, 170,726 participants free of 44 common NCDs at baseline were included. The Life's Essential 8 composite measure consists of four health behaviours (diet, physical activity, nicotine exposure, and sleep) and four health factors (body mass index, non-high density lipoprotein cholesterol, blood glucose, and blood pressure), and the maximum CVH score was 100 points. CVH score was categorized into low, moderate, and high groups. Participants were followed up for 44 NCDs diagnosis across 10 human system disorders according to the International Classification of Diseases 10th edition (ICD-10) code using linkage to national health records until 2022. Cox proportional hazard models were used in this study. The hazard ratios (HRs) and PAFs of 44 NCDs associated with CVH score were examined.

Results: During the median follow-up of 10.85 years, 58,889 incident NCD cases were documented. Significant linear dose-response associations were found between higher CVH score and lower risk of 25 (56.8%) of 44 NCDs. Low-moderate CVH (<80 points) score accounted for the largest proportion of incident cases in diabetes (PAF: 80.3%), followed by gout (59.6%), sleep disorder (55.6%), chronic liver disease (45.9%), chronic kidney disease (40.9%), ischemic heart disease (40.8%), chronic obstructive pulmonary disease (40.0%), endometrium cancer (35.8%), lung cancer (34.0%), and heart failure (34.0%) as the top 10. Among the eight modifiable factors, overweight/obesity explained the largest number of cases of incident NCDs in endocrine, nutritional, and metabolic diseases (35.4%), digestive system disorders (21.4%), mental and behavioral disorders (12.6%), and cancer (10.3%); however the PAF of ideal sleep duration ranked first in nervous system (27.5%) and neuropsychiatric disorders (9.9%).

Conclusions: Improving CVH score based on Life's Essential 8 may lower risk of 25 common NCDs. Among CVH metrics, normal weight may especially important to prevent new cases of metabolic diseases, NCDs in digestive system and mental and behavioral disorders, and cancer.