BACKGROUND AND OBJECTIVES Mounting evidence points to a strong connection between cardiovascular risk during middle age and brain health later in life. The American Heart Association's Life's Essential 8 (LE8) constitutes a research and public health construct capturing key determinants of cardiovascular health. However, the overall effect of the LE8 on global, clinically relevant metrics of brain health is still unknown. We tested the hypothesis that worse LE8 profiles are associated with higher composite risk of the most important clinical endpoints related to poor brain health. METHODS We conducted a two-stage (discovery and replication) prospective study using data from the UK Biobank (UKB) and All of Us (AoU), 2 large population studies in the United Kingdom and the United States, respectively. The primary exposure was the LE8 score, a validated tool that captures 8 modifiable cardiovascular risk factors (blood pressure, glucose, cholesterol, body mass index, smoking, physical activity, diet, and sleep duration), organized in 3 categories (optimal, intermediate, and poor). The primary outcome was a composite of stroke, dementia, or late-life depression. We evaluated associations using multivariable Cox proportional hazard models. RESULTS The discovery stage included 316,127 UKB participants (mean age 56, 52% female). Over a mean (SD) follow-up time of 4.9 (0.4) years, the unadjusted risk of the composite outcome was 0.7% (95% CI 0.61-0.74), 1.2% (95% CI 1.11-1.22), and 1.8% (95% CI 1.70-1.91) in participants with optimal, intermediate, and poor cardiovascular health, respectively (p < 0.001). This association remained significant in multivariable Cox models (intermediate vs optimal cardiovascular health hazard ratio [HR], 1.37; 95% CI 1.24-1.52, and poor vs optimal cardiovascular health HR, 2.11; 95% CI 1.88-2.36, p trend <0.001). The replication stage included 68,407 AoU participants (mean age 56, 60% female). Over a mean (SD) follow-up time of 2.9 (1.41) years, the unadjusted risk of the composite outcome was 2.8% (95% CI 2.49-3.05), 6% (95% CI 5.76-6.22), and 9.7% (95% CI 9.24-10.24) in participants with optimal, intermediate, and poor cardiovascular health, respectively (p < 0.001). This association remained significant in multivariable Cox models (intermediate vs optimal cardiovascular health, HR 1.35; 95% CI 1.21-1.51, and poor vs optimal cardiovascular health, HR 1.94; 95% CI 1.72-2.18; p trend <0.001). DISCUSSION Among middle-aged adults enrolled in 2 large population studies, poor cardiovascular health profiles were associated with two-fold higher risk of developing a composite outcome that captures the most important diseases related to poor brain health. Because the evaluated risk factors are all modifiable, our findings highlight the potential brain health benefits of using the Life's Essential 8 to guide cardiovascular health optimization.

中文翻译：

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Life's essential 8 和中年人的大脑健康不良结果。


背景和目标越来越多的证据表明，中年心血管风险与以后的大脑健康之间存在密切联系。美国心脏协会的 Life's Essential 8 （LE8） 构成了一个研究和公共卫生结构，捕捉心血管健康的关键决定因素。然而，LE8 对全球临床相关大脑健康指标的总体影响仍然未知。我们检验了这样一个假设，即较差的 LE8 概况与与大脑健康状况不佳相关的最重要临床终点的较高复合风险相关。方法 我们使用来自英国生物样本库 （UKB） 和 All of Us （AoU） 的数据进行了一项两阶段（发现和复制）前瞻性研究，这两项研究分别在英国和美国进行。主要暴露是 LE8 评分，这是一种经过验证的工具，可捕获 8 个可改变的心血管风险因素（血压、葡萄糖、胆固醇、体重指数、吸烟、身体活动、饮食和睡眠持续时间），分为 3 类（最佳、中等和差）。主要结局是中风、痴呆或晚年抑郁症的综合结局。我们使用多变量 Cox 比例风险模型评估关联。结果 发现阶段包括 316,127 名 UKB 参与者 （平均年龄 56,52% 为女性）。在 4.9 （0.4） 年的平均 （SD） 随访时间内，复合结局的未调整风险分别为 0.7% （95% CI 0.61-0.74）、1.2% （95% CI 1.11-1.22） 和 1.8% （95% CI 1.70-1.91） 心血管健康状况最佳、中等和较差的参与者 （p < 0.001）。这种关联在多变量 Cox 模型中仍然显著 （中间与最佳心血管健康风险比 [HR]，1.37;95% CI 1.24-1。52，差与最佳心血管健康 HR，2.11;95% CI 1.88-2.36，p 趋势 <0.001）。复制阶段包括 68,407 名 AoU 参与者 （平均年龄 56 岁，60% 为女性）。在 2.9 （1.41） 年的平均 （SD） 随访时间内，复合结局的未调整风险分别为 2.8% （95% CI 2.49-3.05）、6% （95% CI 5.76-6.22） 和 9.7% （95% CI 9.24-10.24） 心血管健康状况最佳、中等和较差的参与者 （p < 0.001）。这种关联在多变量 Cox 模型中仍然显著（中等与最佳心血管健康，HR 1.35;95% CI 1.21-1.51，不良与最佳心血管健康，HR 1.94;95% CI 1.72-2.18;p 趋势 <0.001）。讨论 在参加 2 项大型人群研究的中年人中，心血管健康状况不佳与发生复合结果的风险增加两倍相关，该结果捕捉了与大脑健康状况不佳相关的最重要疾病。由于评估的风险因素都是可改变的，因此我们的研究结果强调了使用 Life's Essential 8 指导心血管健康优化的潜在大脑健康益处。