Life’s Essential 8: A Potent Predictor for Short- and Long-Term Cardiovascular Risk, AJPC Study December 2025

Cardiovascular diseases (CVD) remain the leading cause of global death and disability, with risk strongly influenced by lifestyle factors such as smoking, unhealthy diet, and physical inactivity. To better quantify cardiovascular health (CVH), the American Heart Association (AHA) introduced Life’s Simple 7 (LS7) in 2010, and later updated it to Life’s Essential 8 (LE8) in 2022 by adding sleep duration due to its proven cardiovascular relevance.

LE8 includes four health behaviors (diet, physical activity, tobacco exposure, and sleep) and four health factors (body weight, blood lipids, blood glucose, and blood pressure). Although prior research has shown an inverse association between LE8 scores and major adverse cardiovascular events (MACE), this study aimed to evaluate the prognostic value of LE8 for both short-term and long-term incidences of specific CVD outcomes in individuals initially free of disease.

About the Study

This study analyzed data from the ARIC (Atherosclerosis Risk in Communities) cohort, which enrolled adults aged 45–64 years from 1987 to 1989. For cross-sectional analysis, 8,083 participants from Visit 2 (1990–1992) were included, while the predictive cohort comprised 7,624 individuals free of cardiovascular disease (CHD, stroke, or AF) at baseline.

Cardiovascular health was assessed using the overall Life’s Essential 8 (LE8) score—the average of eight components (0–100)—classified as high (80–100), moderate (50–79), or low (<50). Two follow-up periods were evaluated: short-term (Visit 2–3, ~3 years) and long-term (Visit 2–7, ~27.2 years). Logistic regression examined associations between LE8 and prevalent CVD, while Cox proportional hazards models evaluated whether higher LE8 scores predicted lower short- and long-term incidence of CHD, stroke, and AF.

Key Study Findings

Among the 8,083 participants studied at V2, the prevalence rates were 4.1% for CHD, 1.2% for stroke, and 0.3% for AF.

Association with Prevalent CVD: LE8 was negatively associated with the existing prevalence of CHD and stroke. The negative association with stroke remained statistically significant even after adjusting for risk factors. Importantly, among the eight components, the sleep-related factor was found to have the most significant association with prevalent CVD. No statistically significant association was found between the LE8 score and the prevalent risk of AF at baseline.

Predictive Value for Incident CVD:

• Short-term (3 years): In the multivariate model, 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 relationship between the LE8 score and CHD incidence was found to adhere to a linear pattern.

• Long-term (27.2 years): In the multivariate model, for each 1-point increase in the LE8 score, the risk of CHD decreased by 4.1%.

• Subgroup Findings: Regardless of disparities in gender and race, a higher LE8 score was consistently associated with a decreased likelihood of developing CHD. However, the protective association between the LE8 score and CVD was more pronounced in females.

Clinical Ramifications

This research underscores the substantial value of the LE8 score as a clinically relevant predictor of CHD risk across varying time horizons. The finding that the LE8 score demonstrated a substantially higher short-term predictive value (C-index: 0.785 for short-term vs. 0.69 for long-term prediction of CHD) is highly relevant for clinical practice. It implies that due to the modifiable nature of the behavioral factors, timely modulation of lifestyle to augment the LE8 score can rapidly impact and mitigate the short-term risk of CHD.

For practicing cardiologists, these results emphasize the critical need to periodically evaluate the LE8 score in all patients to early identify those at risk. Furthermore, given that the sleep factor was the most significantly associated component with prevalent CVD, clinicians should actively prioritize and integrate sleep-related health into patient management plans.

The LE8 score may likely serve as a sensitive, dynamic metric that reflects immediate changes in patient risk, functioning like a "diagnostic barometer" for cardiovascular health, allowing clinicians to make timely, impactful interventions.

Reference: Zou R, Wen Z, Zhang C, Huang Z, Zhuang X, Wu Z. Importance of Life's Essential 8 in predicting short- and long-term incidence of cardiovascular disease: The atherosclerosis risk in communities study. Am J Prev Cardiol. 2025 Oct 3;24:101315. doi: 10.1016/j.ajpc.2025.101315. PMID: 41127579; PMCID: PMC12539268.

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