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Vol. 77. Issue 5.
Pages 372-380 (May 2024)
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Vol. 77. Issue 5.
Pages 372-380 (May 2024)
Original article
Cardiovascular health in Spain based on the Life's Essential 8 and its association with all-cause and cardiovascular mortality: the ENRICA cohort
Salud cardiovascular en España basada en el Life's Essential 8 y su asociación con mortalidad general y cardiovascular: la cohorte ENRICA
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Alba Hernández-Martíneza,b,
Corresponding author
albaherzm@ual.es

Corresponding authors.
, Miguel Angelo Duarte-Juniorc, Mercedes Sotos-Prietoc,d,e,f, Rosario Ortolác,d, José R. Banegasc,d, Fernando Rodríguez-Artalejoc,d,e, Alberto Soriano-Maldonadoa,b,,
Corresponding author
asoriano@ual.es

Corresponding authors.
, David Martínez-Gómezc,d,e,
a Departamento de Educación, Facultad de Ciencias de la Educación, Universidad de Almería, Almería, Spain
b SPORT Research Group (CTS-1024), CIBIS (Centro de Investigación para el Bienestar y la Inclusión Social) Research Center, University of Almería, Almería, Spain
c Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
d Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
e Instituto Madrileño de Estudios Avanzados - Alimentación (IMDEA-Food Institute), Campus de Excelencia Internacional de la Universidad Autónoma de Madrid y del Consejo Superior de Investigaciones Científicas (CEI UAM+CSIC), Madrid, Spain
f Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
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Tables (2)
Table 1. Baseline characteristics of the participants in the ENRICA total cohort and by Life's Essential 8 (LE8) quartiles
Table 2. Association of Life's Essential 8 score quartiles with all-cause and cardiovascular mortality in the ENRICA cohort
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Additional material (1)
Abstract
Introduction and objectives

The American Heart Association has recently developed the Life's Essential 8 (LE8) score to encourage prevention of cardiovascular disease (CVD). This study assessed the distribution of LE8 in the Spanish adult population and its association with all-cause and CVD death.

Methods

We used data from 11 616 individuals aged 18 years and older (50.5% women) from the ENRICA study, recruited between 2008 and 2010 and followed up until 2020 to 2022. The LE8 score includes 8 metrics (diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipids and glucose, and blood pressure) and ranges from 0 to 100. The association of LE8 score with mortality was summarized with hazard ratios (HR), obtained from Cox regression.

Results

In total, 13.2% of participants (range, 6.1%-16.9% across regions) had low cardiovascular health (LE8 ≤ 49). During a median follow-up of 12.9 years, 908 total deaths occurred, and, during a median follow-up of 11.8 years, 207 CVD deaths were ascertained. After adjustment for the main potential confounders and compared with being in the least healthy (lowest) quartile of LE8, the HR (95%CI) of all-cause mortality for the second, third and fourth quartiles were 0.68 (0.56-0.83), 0.63 (0.51-0.78), and 0.53 (0.39-0.72), respectively. The corresponding figures for CVD mortality, after accounting for competing mortality risks, were 0.62 (0.39-0.97), 0.55 (0.32-0.93), and 0.38 (0.16-0.89).

Conclusions

A substantial proportion of the Spanish population showed low cardiovascular health. A higher LE8 score, starting from the second quartile, was associated with lower all-cause and CVD mortality.

Keywords:
Cardiovascular health
Cardiovascular diseases
American Heart Association
Risk factors
Healthy lifestyle
Primordial prevention
Cohort studies
Life's Essential 8
Abbreviations:
CVD
CVH
LE8
LS7
Resumen
Introducción y objetivos

La American Heart Association ha desarrollado el índice Life's Essential 8 (LE8) para promover la prevención de la enfermedad cardiovascular (ECV). Este estudio examinó la distribución del LE8 en la población adulta española y su asociación con la mortalidad general y por ECV.

Métodos

Se analizaron datos de 11.616 personas de edad ≥ 18 años (el 50,5% mujeres) del estudio ENRICA, reclutadas en 2008-2010 y seguidas hasta 2020-2022. El LE8 incluye 8 parámetros (dieta, actividad física, exposición a la nicotina, sueño, índice de masa corporal, lípidos y glucosa en sangre y presión arterial) y se puntúa de 0 a 100. La asociación entre LE8 y mortalidad se resumió mediante hazard ratio obtenidas de modelos de Cox.

Resultados

El 13,2% de los participantes (del 6,1 al 16,9% según la comunidad autónoma) mostraron mala salud cardiovascular (LE8 ≤ 49). Tras una mediana de 12,9 años de seguimiento, ocurrieron 908 muertes totales y, durante una mediana de 11,8 años de seguimiento, 207 muertes por ECV. Tras ajustar por los principales factores de confusión y comparados con el cuartil más bajo (menos saludable) de LE8, los HR (IC 95%) de mortalidad general en el segundo, el tercer y el cuarto cuartil fueron, respectivamente, 0,68 (0,56-0,83), 0,63 (0,51-0,78) y 0,53 (0,39-0,72). Los resultados correspondientes a la mortalidad cardiovascular, considerando riesgos competitivos de muerte, fueron 0,62 (0,39-0,97), 0,55 (0,32-0,93) y 0,38 (0,16-0,89).

Conclusiones

Una proporción sustancial de los españoles mostraron mala salud cardiovascular. Una mayor puntación de LE8, desde el segundo cuartil, se asocia con menores mortalidad general y cardiovascular.

Palabras clave:
Salud cardiovascular
Enfermedades cardiovasculares
American Heart Association
Factores de riesgo cardiovascular
Hábitos saludables
Prevención primordial
Estudios de cohortes
Life's Essential 8

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