Life's Essential 8 and carotid artery plaques: the Swedish cardiopulmonary bioimage study

Ángel Herraiz-Adillo; Viktor H Ahlqvist; Sara Higueras-Fresnillo; Daniel Berglind; Patrik Wennberg; Cecilia Lenander; Bledar Daka; Mattias Ekstedt; Johan Sundström; Francisco B Ortega; Carl Johan Östgren; Karin Rådholm; Pontus Henriksson

doi:10.3389/fcvm.2023.1173550

Life's Essential 8 and carotid artery plaques: the Swedish cardiopulmonary bioimage study

Front Cardiovasc Med. 2023 Jun 22:10:1173550. doi: 10.3389/fcvm.2023.1173550. eCollection 2023.

Authors

Ángel Herraiz-Adillo¹, Viktor H Ahlqvist², Sara Higueras-Fresnillo^{1

3}, Daniel Berglind^{2

4}, Patrik Wennberg⁵, Cecilia Lenander⁶, Bledar Daka⁷, Mattias Ekstedt^{1

8}, Johan Sundström^{9

10}, Francisco B Ortega^{11

12}, Carl Johan Östgren^{1

8}, Karin Rådholm^{1

10}, Pontus Henriksson¹

Affiliations

¹ Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
² Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
³ Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Madrid, Spain.
⁴ Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden.
⁵ Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden.
⁶ Department of Clinical Sciences in Malmö, Centre for Primary Health Care Research, Lund University, Lund, Sweden.
⁷ School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁸ Centre of Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.
⁹ Clinical Epidemiology Unit, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
¹⁰ The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
¹¹ Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health, University Research Institute (iMUDS), University of Granada; CIBERobn Physiopathology of Obesity and Nutrition, Granada, Spain.
¹² Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.

Abstract

Background: To quantify cardiovascular health (CVH), the American Heart Association (AHA) recently launched an updated construct of the "Life's Simple 7" (LS7) score, the "Life's Essential 8" (LE8) score. This study aims to analyse the association between both CVH scores and carotid artery plaques and to compare the predictive capacity of such scores for carotid plaques.

Methods: Randomly recruited participants aged 50-64 years from the Swedish CArdioPulmonary bioImage Study (SCAPIS) were analysed. According to the AHA definitions, two CVH scores were calculated: i) the LE8 score (0, worst CVH; 100, best CVH) and two different versions of the LS7 score [(0-7) and (0-14), 0 indicating the worst CVH]. Ultrasound-diagnosed carotid plaques were classified as no plaque, unilateral, and bilateral plaques. Associations were studied by adjusted multinomial logistic regression models and adjusted (marginal) prevalences, while comparison between LE8 and LS7 scores was performed through receiver operating characteristic (ROC) curves.

Results: After exclusions, 28,870 participants remained for analysis (50.3% women). The odds for bilateral carotid plaques were almost five times higher in the lowest LE8 (<50 points) group [OR: 4.93, (95% CI: 4.19-5.79); adjusted prevalence 40.5%, (95% CI: 37.9-43.2)] compared to the highest LE8 (≥80 points) group [adjusted prevalence 17.2%, (95% CI: 16.2-18.1)]. Also, the odds for unilateral carotid plaques were more than two times higher in the lowest LE8 group [OR: 2.14, (95% CI: 1.82-2.51); adjusted prevalence 31.5%, (95% CI: 28.9-34.2)] compared to the highest LE8 group [adjusted prevalence 29.4%, (95% CI: 28.3-30.5)]. The areas under ROC curves were similar between LE8 and LS7 (0-14) scores: for bilateral carotid plaques, 0.622 (95% CI: 0.614-0.630) vs. 0.621 (95% CI: 0.613-0.628), P = 0.578, respectively; and for any carotid plaque, 0.602 (95% CI: 0.596-0.609) vs. 0.600 (95% CI: 0.593-0.607), P = 0.194, respectively.

Conclusion: The new LE8 score showed inverse and dose-response associations with carotid plaques, particularly bilateral plaques. The LE8 did not outperform the conventional LS7 score, which showed similar ability to predict carotid plaques, especially when scored as 0-14 points. We conclude that both the LE8 and LS7 may be useful in clinical practice for monitoring CVH status in the adult population.

Keywords: Doppler ultrasound; SCAPIS project; carotid atherosclerosis; health promotion; healthy lifestyle; population-based.

Grants and funding

The main funding body of The Swedish CArdioPulmonary bioImage Study (SCAPIS) is the Swedish Heart-Lung Foundation. The study is also funded by the Knut and Alice Wallenberg Foundation, the Swedish Research Council and VINNOVA (Sweden`s Innovation Agency), the University of Gothenburg and Sahlgrenska University Hospital, Karolinska Institutet and Stockholm County council, Linköping University and University Hospital, Lund University and Skåne University Hospital, Umeå University and University Hospital, Uppsala University and University Hospital. Funding was received from the CircM strategic research network at Linköping University. SH-F is supported by a Margarita Salas grant from the Autonomous University of Madrid. FBO research activity on this topic is supported by the Grant PID2020-120249RB-I00 funded by MCIN/AEI/10.13039/501100011033 and by the Andalusian Government (Junta de Andalucía, Plan Andaluz de Investigación, ref. P20_00124).