Life’s Essential 8 Linked to More Years Free of Chronic Disease

People whose lifestyles better reflect cardiovascular health can reap gains in life expectancy free from major chronic disease, a new analysis of UK Biobank data suggests.

Researchers quantified CV health using the American Heart Association (AHA)’s Life’s Essential 8, a list that captures diet quality, sleep quality, physical activity, exposure to cigarette smoking, body mass index, and levels of fasting blood glucose, total cholesterol, blood pressure.

The results, published online this week in JAMA Internal Medicine, are being presented this Thursday at the AHA’s EPI|Lifestyle Scientific Sessions 2023 in Boston, MA.

“The average life expectancy has increased substantially in the past few decades in most industrialized countries,” but not all of that added time is lived in optimal health, Xuan Wang, MD, PhD (Tulane University, New Orleans, LA), and colleagues note in their paper. The situation is only expected to worsen—they point out that “two-thirds of UK adults are expected to be living with multiple chronic conditions by 2035,” with consequences for quality of life, years lived, and healthcare costs.

Attention to cardiovascular risk factors could have a wide impact, Wang et al stress. “[Our] results indicate that a high CV health may not only prolong life span, but also improve the quality (disease free) of aging. Because total life expectancy cannot be extended indefinitely, these findings are of important implications for improvement of healthy aging.”

Donald Lloyd-Jones, MD (Northwestern University Feinberg School of Medicine, Chicago, IL), immediate past president of the AHA, chaired the writing group behind Life’s Essential 8 in 2022 and led the effort to delineate the metrics behind its predecessor, Life’s Simple 7, in 2010.

“The concept of cardiovascular health really, I think, does represent the fountain of youth,” he told TCTMD. This study “amplifies and expands some prior findings that show it doesn’t only help you live longer, it helps you live healthier and longer. And you avoid not just cardiovascular disease, but other things that people really care about: cancer, dementia, all the things that can rob us of [our] quality of life.”

Many of these factors that further CV health are, of course, already on clinicians’ minds, Lloyd-Jones noted. For patients, the AHA offers many tools they can use to assess their own health and decide on which areas to address first. “It’s hard for people to focus on three, four, five things at a time, but the data show us that just improving one of these things—and it doesn’t matter which one—will actually be very beneficial for your health in the long run. So pick that thing that you’re ready to work on, really understand what you need to do, and do it,” he advised. “I think that’s a hopeful and empowering message.”

Longer, Better Lives

For the cohort study, Wang and colleagues analyzed data from the UK Biobank on 135,199 adults (mean age 55.4 years; 44.7% men) who started out free from major chronic disease and also had details recorded for the Life’s Essential 8 metrics.

The investigators used aspects of these metrics to calculate baseline CV health as low (< 50), moderate (≥ 50 to < 80), and high (≥ 80). Among men, 7.8% fell into the low health category, 81.0% into moderate, and 11.2% into high. For women, the distribution of CV health was more favorable, with 4.9% low, 69.8% moderate, and 25.3% high.

People whose scores reflected better CV health were more likely to be younger, white, and have higher education level. They were more likely to be socioeconomically stable (as defined by an index based on employment, car and home ownership, lack of household crowding) and less likely to be diagnosed with depression.

Total life expectancy after age 50 was longer in people with higher CV health scores—amounting to 39.3 years for men in the high group compared with 37.2 and 34.5 years, respectively, in the low and moderate groups. Women in the high CV health group could expect to live 42.0 years beyond age 50, compared with 36.0 and 40.2 years in the low and moderate groups, respectively.

For both men and women, having better CV health was linked to longer life expectancy free from four major chronic diseases (CVD, diabetes, cancer, and dementia) past the age of 50. For example, men in the high category lived 6.9 years longer, on average, without these diseases than men in the low category. Women with the best CV health lived 9.4 years longer free of disease than those with the worst CV health. Beyond this, the healthiest individuals lived a greater percentage of their years disease-free.

Disease-Free Years Remaining at Age 50 by CV Health Level

Lower socioeconomic status was linked to fewer years living without the burden of chronic disease. But importantly, in the highest CV health stratum, disease-free life span did not differ by socioeconomic status for either men or women, suggesting that successful efforts to improve CV health might narrow health inequalities, the researchers said.

“Once you achieve high cardiovascular health or maintain it from early in life, it really does trump some of those other social determinants, particularly things like education [and] income,” Lloyd-Jones agreed.

Lloyd-Jones highlighted the fact that Life’s Simple 7 has, in the years since its creation, inspired over 2,500 scientific papers. He predicted key areas of interest going forward will be social determinants, whether as barriers or facilitators, that affect CV health, as well as the role of stress. In time, this research may tease out the mechanisms by which CV health has such wide-ranging and lifelong effects.