Life’s Crucial 12: Updating and Enhancing the Life’s Essential 8 of Cardiovascular Health: A proposal from NHANES

Abstract Background Life’s Essential 8 (LE8) is a cardiovascular health (CVH) model but does not take into account mental health, an important cardiovascular risk factor, so we constructed Life’s Crucial 12 (LC12), a comprehensive cardiovascular care model that takes CVH into account, based on LE8, and hypothesized that it would be a more reliable index of CVH, despite the additional information needed to calculate LC12. Objective To construct an integrated cardiovascular care model LC12 based on LE8 that can take Psychological Health into account, and to report the association between LC12 and stroke. Design Population-based, cross-sectional study. Setting Various locations in the United States. Participants This study was a cross-sectional study based on data from the 2005-2008 National Health and Nutrition Examination Survey (NHANES), which included 4,478 U.S. adults (≥ 20 years old). Method The composite cardiovascular care model LC12 with scores (range 0-100) defining low (0-49), medium (50-79) and high (80-100) CVH. Determination of stroke status was obtained by questionnaire. Associations were assessed using multivariate logistic regression models and restricted cubic spline models. Result Among 4,478 participants, there were 2252 female and 2226 male participants (53.136% and 46.864%, respectively), and 250 participants (5.583%) were diagnosed with stroke. The mean values of LC12, Psychological Health, Health behaviors, and Health factors scores for participants with stroke were 68.953, 52.775, and 55.451, respectively, which were lower than those of Non-Stroke participants. After fully adjusting for confounders, the ORs for the LC 12, Psychological Health, Health Behaviors, and Health Factors moderate and high groups were 0.431 (0.226,0.822), 0.212 (0.060,0.755), 0.536 (0.297, 0.967), 0.357 (0.178,0.713), 0.759 (0.552, 1.043), 0.334 (0.179, 0.623), 0.565 (0.406, 0.786), 0.533 (0.286, 0.994), which were significantly associated with the risk of stroke ( P-trend < 0.05) and there was a linear trend between subgroups with different scores ( P-value < 0.001). However, no nonlinear dose relationship was observed ( P-Nonlinearity > 0.05). Limitation Because estimates are based on single measures, fluctuations over time could not be determined. Conclusion These findings suggest that Psychological Health is important in CVH. CVH status assessed by LC12 (Psychological Health, Health behaviors, Health factors) was significantly associated with the risk of developing stroke. When LC12 scores are maintained at high levels, it is beneficial to decrease the risk of stroke. Abstract Pictures