Despite universal healthcare access, most French adults have sub-optimal heart health—but new research shows that even modest improvements in lifestyle could dramatically cut cardiovascular risk.

Study: Life’s Essential 8 cardiovascular health status of 18-69-year-old individuals in France. Image Credit: Good dreams – Studio / Shutterstock

Despite substantial advancements in medicine, cardiovascular disease remains a leading cause of mortality worldwide. A recent study published in the American Journal of Preventive Cardiology found that only 13% of French adults aged 18 to 69 living in metropolitan regions have optimal cardiovascular health. This research assessed cardiovascular health using the American Heart Association’s updated ‘Life’s Essential 8’ (LE8) score (replacing the earlier LS7), revealing that a significant majority of the French population falls short of ideal cardiovascular well-being.

Assessing cardiovascular health

Cardiovascular diseases (CVDs) remain a major global health challenge, despite progress in primary prevention and public health initiatives like smoking bans. In 2019, CVDs accounted for one-third of all deaths worldwide and continue to be a leading cause of disability. In the European Union, the economic burden of managing cardiovascular diseases (CVDs) reached €282 billion in 2021, with only a small fraction of this expenditure allocated to primary prevention.

This situation highlights the urgent need for more effective preventive strategies. The American Heart Association developed the LE8 score, a tool used to assess and monitor cardiovascular health in populations. Higher LE8 scores are associated with a decreased incidence of cardiovascular disease (CVD), lower mortality rates, and improved overall health. However, ideal scores remain uncommon, and there is limited data on the factors that determine LE8 scores, especially outside of the United States.

The current study

In the present study, a team of scientists in France analyzed data from the CONSTANCES cohort, a large-scale French study that recruited participants aged 18 to 69 years from various regions in metropolitan France between 2012 and 2019. The participants were randomly selected from the French National Social Security database.

The researchers applied design weights to ensure that the sample accurately represented the French population in terms of age, sex, socioeconomic status, and geographical distribution. They then assessed the participants’ cardiovascular health using the LE8 score, which comprises eight components: diet, body mass index (BMI), physical activity levels, nicotine exposure, sleep health (a new addition to the AHA’s metrics), blood lipids, blood glucose levels, and blood pressure.

Diet was evaluated using a food frequency questionnaire, while physical activity and sleep duration were self-reported by the participants. Nicotine exposure was determined from self-reported smoking status, and BMI was calculated from measurements taken at health examination centers. Additionally, blood pressure, lipid levels, and blood glucose were measured through standardized tests (except for HbA1c, which was self-reported by 99% of participants and measured in only 1%). The LE8 score for each of the eight components ranged from 0 to 100, with the overall LE8 score being the average of these components.

The study also considered various covariates, including sex, age, rural or urban residence, socio-professional status, educational levels, cohabitation status (partner/no partner), alcohol use, depressive symptoms, socioeconomic deprivation, and family history of CVD.

Results

The study found that the average LE8 score for French adults was 66.11, with females scoring higher than males (68.92 vs. 62.79). Only 13.21% of the participants achieved a high LE8 score (equal to or greater than 80 points). The majority (76.81%) had moderate scores (50–79 points), and 9.43% had low scores (below 50 points).

Among the individual components of the LE8 score, diet had the lowest average score (41.50), and blood glucose had the highest (95.50). These scores highlighted a significant disparity in achieving optimal cardiovascular health, with dietary habits being a particularly critical area for improvement.

Several factors were identified as predictors of higher LE8 scores, including younger age, female sex, higher education, self-employment, fewer depressive symptoms, not living with a partner, lower alcohol consumption, residence in rural areas, lower socioeconomic deprivation, and no family history of cardiovascular disease (CVD). These findings suggested that both individual behaviors and socioeconomic conditions play a crucial role in cardiovascular health.

Notably, women were nearly three times as likely as men to achieve a high LE8 score (18.3% vs. 7.2%). The study also discussed how biological, psychosocial, and healthcare access factors—such as education, depression, and alcohol use—may contribute to this disparity.

The researchers also observed that LE8 scores tended to decline with age, particularly from young adulthood to midlife, after which they plateaued, highlighting the need for lifelong, age-adapted preventive strategies.

The study also estimated that a significant proportion of cardiovascular events could be prevented by improving the LE8 scores across the population. If all participants achieved a high LE8 score, 81% of CVD events could potentially be avoided assuming comparable CVD incidence rates across populations. Even a modest improvement in LE8 scores could prevent 68% of events. Moreover, the researchers estimated that increasing the percentage of the population with high LE8 scores from 13% to 20% could avert approximately 14% of cardiovascular events.

The researchers acknowledged several limitations, including the incompleteness of the diet metric due to missing data on dietary fiber and sodium levels, self-reported HbA1c data, and the potential for bias in self-reported data. They also noted that the study excluded individuals from France’s overseas territories, limiting generalizability. Despite these limitations, the study provided valuable insights into the cardiovascular health status of French adults.

Conclusions

In summary, the study showed that despite universal healthcare access in metropolitan France, only a small fraction of the adult population in the country has optimal cardiovascular health. Only 13% of the adult population had optimal LE8 scores, and the majority had sub-optimal levels of cardiovascular health.

However, the results suggested that even modest lifestyle and dietary changes could bring about significant improvements. The findings emphasized the need for not only personalized and context-specific prevention strategies but also the implementation of primordial prevention approaches that aim to prevent the development of risk factors in the first place. These insights support the development of integrated, multidisciplinary public health policies tailored to population subgroups and life stages.