Association Between Cardiovascular Health by Life’s Essential 8 and Subsequent Coronary Artery Calcium Score: The Cardiovascular and Metabolic Diseases Etiology Research Center cohort

Abstract

Introduction: Although "Life’s Essential 8" (LE8) is a key metric for cardiovascular health (CVH), its longitudinal association with subclinical atherosclerosis in Koreans remains unclear. We examined the association between baseline LE8 scores and the presence of coronary artery calcium (CAC). Methods: Data were obtained from the Cardiovascular and Metabolic Diseases Etiology Research Center cohort study, a prospective cohort (baseline: 2013–2018; follow-up: 2022–2024). Baseline CVH scores, comprising 8 metrics (diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipids, blood glucose, and blood pressure), were categorized as low (0–<50), moderate (50–<80), and high (80–100). The main outcome was the presence of CAC at the follow-up. Multivariable logistic regression was used for statistical analysis. Results: During a mean follow-up of 7.3 years, among 1,746 participants (mean age: 52.3 years, 65.2% female), the overall prevalence of CAC was 41.4%, which decreased with increasing CVH scores (low: 64.6%, moderate: 41.5%, and high: 30.4%). Compared to the low CVH group, the fully adjusted odds ratios (95% confidence intervals) for the presence of CAC were 0.34 (0.23–0.51) in the moderate and 0.25 (0.15–0.39) in the high CVH group. Higher baseline CVH scores were log-linearly associated with lower odds of CAC presence, demonstrating a linear and dose-dependent relationship in the restricted cubic spline plot (p=0.102). The association between CVH and CAC was consistently observed across subgroups and sensitivity analyses. Conclusion: Our study showed that higher baseline CVH scores were associated with a lower risk of subsequent CAC, highlighting the importance of promoting ideal CVH early to reduce the burden of cardiovascular disease.