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Available online 5 June 2024
Adherence to Life's Essential 8 is associated with delayed biological aging: a population-based cross-sectional study
La adherencia al Life's Essential 8 se asocia con un retraso en el envejecimiento biológico: un estudio transversal poblacional
Hongyu Chena,, Haoxian Tanga,b,, Xuan Zhangb,c, Jingtao Huangb,d, Nan Luob,e, Qingqian Guoa, Xin Wanga,
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Corresponding author.
a Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
b Department of Clinical Medicine, Shantou University Medical College, Shantou, China
c Department of Bone & Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, China
d Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, Shenzhen, China
e Department of Psychiatry, Shantou University Mental Health Center, Shantou, China
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Table 1. Characteristics of participants stratified by cardiovascular health level
Table 2. Association between Life's Essential 8 and KDM biological age/phenotypic age
Table 3. Association between Life's Essential 8 and KDM biological age/phenotypic age acceleration
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Introduction and objectives

The aim of this study was to explore the potential of adhering to the American Heart Association's updated Life's Essential 8 (LE8) scores in delaying biological aging amid growing concerns about aging populations and related diseases.


A total of 18 261 adults (≥ 20 years old) were examined using National Health and Nutrition Examination Survey data from 2005-2010 and 2015-2018. The LE8 includes 8 components, covering health behaviors and factors. Acceleration of biological aging was defined as an excess of biological/phenotypic age over chronological age, assessed by using clinical biomarkers. The association between LE8 score and biological aging was explored through regression analyses.


Each 10-point increase in LE8 scores was associated with a 1.19-year decrease in biological age and a 1.63-year decrease in phenotypic age. Individuals with high cardiovascular health (CVH) had a 90% reduction in their risk of accelerated aging based on biological age and an 81% reduction based on phenotypic age compared with individuals with low CVH. Bootstrap-based model estimates and weighted quantile sum regression suggested that health factors, particularly blood glucose, had strong impact on delaying aging. The association between smoking and biological aging seemed to differ depending on the definition of aging used. Among all subgroups, LE8 consistently correlated negatively with biological aging, despite observed interactions. Three sensitivity analyses confirmed the robustness of our conclusions.


A higher CVH is associated with a lower risk of biological aging. Maintaining elevated LE8 levels across demographics, regardless of cardiovascular history, is recommended to delay aging and promote healthy aging, with significant implications for primary health care.

Cardiovascular system
Heart disease risk factors
Healthy aging
Cardiovascular health
Life's Essential 8
Biological aging
Introducción y objetivos

El objetivo de este estudio es explorar el potencial de adherirse a los índices Life's Essential 8 (LE8) actualizados por la American Heart Association para retrasar el envejecimiento biológico en medio de crecientes preocupaciones sobre poblaciones envejecidas y enfermedades relacionadas.


Se examinó a un total de 18.261 adultos (edad ≥ 20 años) utilizando datos del National Health and Nutrition Examination Survey (NHANES) entre 2005-2010 y 2015-2018. El LE8 incluye 8 componentes que abarcan conductas y factores en salud. La aceleración del envejecimiento biológico se definió como el exceso de edad biológica/fenotípica sobre la edad cronológica evaluada mediante biomarcadores clínicos. Los análisis de regresión exploraron la asociación entre la puntuación del LE8 y el envejecimiento biológico.


Cada aumento de 10 puntos en el LE8 se asoció con una disminución de 1,19 años en la edad biológica y una disminución de 1,63 años en la edad fenotípica. Las personas con buena salud cardiovascular (SCV) tuvieron una reducción del 90% en el riesgo de envejecimiento acelerado con base en la edad biológica y una reducción del 81% con base en la edad fenotípica, en comparación con las personas con una SCV baja. Las comparaciones de estimaciones de modelos basadas en bootstrap y la regresión de la suma ponderada de cuantiles indicaron que los factores de salud, particularmente la glucemia, tuvieron un mayor impacto en retrasar el envejecimiento. La asociación entre fumar y el envejecimiento biológico pareció diferir dependiendo de la definición de envejecimiento empleada. En todos los subgrupos, la correlación negativa del LE8 con el envejecimiento biológico fue constante, a pesar de las interacciones observadas. Tres análisis de sensibilidad confirmaron la solidez de nuestras conclusiones.


Una SCV alta se asocia con un menor riesgo de envejecimiento biológico. Se recomienda mantener altos valores de LE8 en diversas demografías, independientemente de la historia cardiovascular, para retrasar el envejecimiento y promover un envejecimiento saludable, con implicaciones significativas para la atención primaria.

Palabras clave:
Sistema cardiovascular
Factores de riesgo de enfermedades cardiacas
Envejecimiento saludable
Salud cardiovascular
Life's Essential 8
Envejecimiento biológico


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