The Life’s Essential 8 cardiovascular health score and risk of premature death in people with and without type 2 diabetes

This prospective, multicentre cohort study was based on UK Biobank data from
309,789 participants (aged 37–73 years) and was designed to assess how
Life’s Essential 8 – the American Heart Association’s cardiovascular health (CVH) assessment score – is associated with premature death, especially in people with type 2 diabetes. The eight scores include four health behaviours (diet, physical activity, nicotine use and sleep) and four health factors (BMI, non-HDL cholesterol, blood glucose and blood pressure). Overall CVH scores were stratified as high (80–100), moderate (50–79) or low (0–49); premature death was defined as death at age <75 years.

Over a median of 12.7 years’ follow-up, 13,683 premature deaths were recorded. Life’s Essential 8 score was inversely associated with all-cause premature death risk: a 10-point increase in CVH score decreased premature death risk by 20% (HR for moderate- and high-CVH groups 0.59 and 0.42, respectively, compared with the low-CVH group). High CVH score appeared to counter even the impact of type 2 diabetes: people with diabetes and a high CVH score had a lower risk of premature death than those with no diabetes but a low CVH score (HR 0.53).

Men with high CVH score and type 2 diabetes had a significantly lower risk of dying prematurely than those without diabetes and, strikingly, women aged 50 years with high CVH score and type 2 diabetes had no excess risk of premature death at all, further highlighting the importance of CVH.

At the age of 50 years, compared with a low score, a high CVH score was associated with an increase of 9.79 life-years in men with type 2 diabetes and an increase of 5.58 life-years in those without the condition. In women, a high score was associated with 24.21 and 10.18 additional life-years in those with and without diabetes, respectively.

Moderate BMI and blood lipids in people with type 2 diabetes, and sleep and BMI in those without diabetes, were the top factors associated with improved outcomes.

The main limitations of this study are that the design only accounted for association (not causation) and that risk factors were only recorded at baseline. Nonetheless, the authors conclude that Life’s Essential 8 is significantly linked with premature death, especially for people with type 2 diabetes, who may decrease their premature death risk by up to 35% or even 58% by maintaining a moderate or ideal CVH score.

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