‘Life’s Essential 8’ cardiovascular health with premature cardiovascular disease and all-cause mortality in young adults: the Kailuan prospective cohort study

Abstract

Abstract Aims Whereas cardiovascular disease (CVD) metrics define risk in individuals aged over 40 years, the earliest lesions of CVD appear well before this age. Cardiovascular health (CVH) was proposed to improve cardiovascular risk factors and was updated recently. This study aimed to explore the associations of baseline and long-term CVH assessed by ‘Life’s Essential 8’ metrics with premature CVD and all-cause mortality in young Chinese adults. Methods and results A total of 16 011 CVD-free participants aged 18–40 years were enrolled from the Kailuan cohort study. The CVH score ranged from 0 to 100 and was categorized into low, moderate, and high. Cox regressions were used to assess the hazard ratios (HRs) for the associations of baseline, time-updated mean, and time-varying CVH with the risk of outcomes. During a median follow-up of 13 years, we identified 271 cases (1.7%) of CVD and 219 cases (1.4%) of all-cause mortality. A lower CVH was associated with a higher risk of CVD and all-cause mortality; the adjusted HR in the low CVH vs. the high CVH group was 7.34 [95% confidence interval (CI), 3.19–16.89] and 2.54 (95% CI, 1.27–5.06) for baseline CVH, 4.38 (95% CI, 2.14–8.97) and 1.99 (95% CI, 1.06–3.71) for time-updated CVH, and 8.19 (95% CI, 2.70–24.88) and 4.28 (95% CI, 1.70–10.81) for time-varying CVH, respectively. Conclusion We observed an inverse gradient association of baseline and long-term CVH with the risk of premature CVD and all-cause mortality in young adults, emphasizing the importance of keeping health behaviours and factors earlier in life. Lay Summary This longitudinal prospective cohort study showed an inverse gradient association of baseline and long-term cardiovascular health, as measured by the new updated Life’s Essential 8 metrics, with the risk of premature cardiovascular disease and all-cause mortality in Chinese young adults, emphasizing the importance of keeping health behaviours and factors earlier in life.Baseline and longitudinal low cardiovascular health (CVH) status (measured by time-updated mean and time-varying CVH score) was associated with a higher risk of cardiovascular disease (CVD) and all-cause mortality in young adults aged <40 years.Among the eight metrics of LE8, lower scores of health factors were associated with a higher risk of CVD and all-cause mortality in young adults, while the associations of health behaviours with CVD and all-cause mortality were non-significant.