Comparison of the associations between Life's Essential 8 and Life's Simple 7 with stroke: NHANES 1999-2018

Objective: This study aims to explore the association between Life's Essential 8 (LE8) and stroke and all-cause mortality, and compare whether it has an advantage over Life's Simple 7 (LS7).

Methods: This study investigated data from NHANES spanning from 1999 to 2018. The LE8 was categorized as low, moderate and high cardiovascular health (CVH). LS7 score was categorized as inadequate, average, or optimal. Weighted logistic regression and restricted cubic spline (RCS) were used to examin correlations. Receiver operating characteristic (ROC) curves were employed to detect the accuracy in predicting stroke. The stratified and sensitivity analyses were conducted along with mediation analysis. In addition, a longitudinal cohort was constructed by combining the mortality data, and Cox regression models were utilized to determine the association between CVH and the mortality rate.

Results: For LE8, compared to low CVH, moderate CVH was associated with a 41% lower risk of stroke, and high CVH was associated with a 71% lower prevalence of stroke. For LS7, compared to inadequate CVH, average CVH was associated with a 24% lower prevalence of stroke, and optimal CVH was associated with a 39% lower prevalence of stroke. RCS showed inverse dose-response relationships of both LE8 and LS7 with stroke. In unweighted ROC, LE8 (AUC=0.702, 95% CI: 0.685-0.718, P<0.001) has a stronger ability to discriminate stroke than LS7 (0.677, 95% CI: 0.658-0.696, P<0.001) (P_DeLong=0.046). Sensitivity analyses demonstrated robustness of LE8 in predicting stroke. GGT and WBC mediated 4.92% and 4.58% of the association, respectively. Cox regression showed neither LE8 nor LS7 were predictive of mortality risk among stroke survivor.

Conclusions: LE8 outperformed LS7 in classifying stroke. Oxidative stress and inflammation mediated the association between LE8 and stroke.