The following is a summary of “Life’s Essential 8 and Poor Brain Health Outcomes in Middle-Aged Adults,” published in the October 2024 issue of Neurology by Clocchiatti-Tuozzo et al.
Mounting evidence links cardiovascular risk in middle age with poor brain health later in life. The American Heart Association’s Life’s Essential 8 (LE8) identifies 8 modifiable cardiovascular risk factors that impact both heart and brain health.
Researchers conducted a prospective study to investigate whether worse profiles of LE8 were associated with a higher risk of poor brain health outcomes.
They conducted a 2-stage study using data from the UK Biobank (UKB) and All of Us (AoU) cohorts in the United Kingdom and the United States. The LE8 score includes 8 modifiable cardiovascular risk factors, blood pressure, glucose, cholesterol, body mass index, smoking, physical activity, diet, and sleep duration, categorized into 3 groups, optimal, intermediate, and poor cardiovascular health. The main outcome was a composite of stroke, dementia, or late-life depression. Associations were evaluated using multivariable Cox proportional HRs and CIs.
The results showed that the discovery stage included 316,127 participants of UKB (mean age 56, 52% female) with a mean (SD) follow-up of 4.9 (0.4) years. The unadjusted risk of the composite outcome (stroke, dementia, late-life depression) was 0.7% (95% CI 0.61–0.74) for optimal, 1.2% (95% CI 1.11–1.22) for intermediate, and 1.8% (95% CI 1.70–1.91) for poor cardiovascular health (P<0.001). This remained significant in multivariable Cox models, with HRs of 1.37 (95% CI 1.24–1.52) for intermediate vs. optimal and 2.11 (95% CI 1.88–2.36) for poor vs. optimal (P trend<0.001).In the replication stage, 68,407 AoU (mean age 56, 60% female) had a mean (SD) follow-up of 2.9 (1.41) years. The unadjusted risk of the composite outcome was 2.8% (95% CI 2.49–3.05) for optimal, 6% (95% CI 5.76–6.22) for intermediate, and 9.7% (95% CI 9.24–10.24) for poor cardiovascular health (P<0.001). In multivariable models, HRs were 1.35 (95% CI 1.21–1.51) for intermediate vs. optimal and 1.94 (95% CI 1.72–2.18) for poor vs. optimal (P trend<0.001).
They concluded that poor cardiovascular health, as measured by LE8, was associated with a significantly higher risk of stroke, dementia, or late-life depression, highlighting the importance of optimizing cardiovascular health to reduce the risk of poor brain health outcomes.
Source: neurology.org/doi/10.1212/WNL.0000000000209990
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