In a recent study published in the journal BMC Public Health, researchers investigated the association between cardiovascular health (CVH), defined by Life’s Essential 8 (LE8), and mortality in people with hypertension.

Globally, around 1.13 billion people suffer from hypertension, which is the leading cause of cardiovascular events/mortality, significantly contributing to morbidity and mortality worldwide. While there has been considerable progress in the development of pharmacological interventions, effective management of hypertension requires a multifaceted approach, including non-pharmacological interventions.

The American Heart Association’s LE7 is a suite of modifiable lifestyle factors widely used in clinical practice. Sleep health was recently integrated into this initiative for its role in CVH and well-being, leading to LE8. Evidence suggests associations between CVH, defined by LE8, and improved quality of life, survival, and longevity. Nevertheless, fewer studies have explored associations between LE8 and mortality in people with hypertension.

Study: Association between new Life’s Essential 8 and the risk of all-cause and cardiovascular mortality in patients with hypertension: a cohort study. Image Credit: Chinnapong / Shutterstock

About the study

In the present study, researchers investigated the associations between LE8 and cardiovascular and all-cause mortality in hypertensive individuals. They used data from five successive National Health and Nutrition Examination Survey (NHANES) cycles between 2007 and 2016 in the United States (US). Pregnant individuals, people under 20, individuals without hypertension, and those with missing data of LE8 components were excluded.

Each LE8 component was scored between 0 and 100, and an average of all eight components was calculated. A trained examiner recorded blood pressure (BP). Average systolic (SBP) and diastolic BP (DBP) were estimated from three consecutive measurements. Hypertension was defined as the use of anti-hypertensive medicines, self-reported hypertension, average SBP ≥ 140 mmHg, or DBP ≥ 90 mmHg.

Incidence of age-adjusted all-cause mortality among hypertensive patients across various levels of Life’s Essential 8 scores

Covariates included age, sex, race/ethnicity, education, poverty income ratio, waist circumference, marital status, smoking status, body mass index (BMI), and history of cancer, cardiovascular diseases (CVDs), or diabetes, among others. Information on mortality and cause was obtained from the National Death Index. Baseline parameters were stratified by CVH categories (low, moderate, and high).

Age-standardized estimates of mortality and corresponding 95% confidence intervals were calculated for each CVH category. Multivariable Cox proportional hazards regression models estimated hazard ratios and 95% CIs for cardiovascular and all-cause mortality. One model was unadjusted; the second was adjusted for sociodemographic and lifestyle factors, and the final was adjusted for all covariates.

Findings

The study included 8,448 individuals aged 57.5, on average; 51.2% were female. The average LE8 score was 60.13. There were substantial differences in baseline clinical and demographic characteristics among participants across the three CVH categories. Subjects with high CVH (LE8 score ≥ 80-100) had a lower prevalence of all-cause mortality than those with low (score ≤ 49) or moderate CVH (score ≥ 50–79).

During a mean of 7.41 years of follow-up, 1,482 deaths occurred; 472 were attributed to CVDs. Individuals with a low CVH had the highest mortality risk. After multivariable adjustment, the high and moderate CVH groups had a lower mortality risk than the low CVH group. Each 10-point increment in the LE8 score reduced the risk of all-cause mortality by 8%. Subjects with high or moderate CVH also had a lower risk of CVD mortality.

Further, the risk of CVD mortality decreased by 18% with every 10-point increase in the LE8 score. A linear dose-response relationship was observed between CVH scores and all-cause and cardiovascular mortality. Subgroup analyses revealed consistent findings regardless of the differences in age, race, BMI, sex, smoking status, marital status, education, history of CVD, diabetes, or CVDs. Likewise, the results remained consistent in various sensitivity analyses.

Conclusions

The study illustrated associations between LE8 and cardiovascular and all-cause mortality in hypertensive individuals. Participants with higher LE8 scores had lower mortality risks. Thus, comprehensive lifestyle modifications could benefit hypertensive subjects. Together, the findings reinforce the significance of a healthy lifestyle in improving population health and suggest that initiatives to improve CVH could have implications for reducing mortality rates.