Life’s Essential 8 and progression of cardiometabolic multimorbidity trajectory: a prospective study of UK Biobank

Abstract Aims To evaluate the impact of Life's Essential 8 (LE8) on the onset and progression trajectory of cardiometabolic multimorbidity (CMM). Methods and results This prospective study included 240,346 participants (median age, 57 years) free of CMDs at baseline from the UK Biobank. LE8 scores were divided into low, moderate, and high cardiovascular health (CVH) groups at baseline, with higher LE8 scores representing better CVH. CMM was defined as the coexistence of two or three cardiometabolic diseases, including type 2 diabetes (T2D), ischemic heart disease, and stroke. Multi-state model was applied to explore the role of LE8 level in each transition stage of CMM trajectory. During a median follow-up of 14.01 years, 29,551 participants developed first cardiometabolic disease (FCMD), 3,183 developed CMM, and 15,763 died. LE8 scores were significantly associated with an increased risk of transition from health to FCMD or to death, with adjusted HRs (CIs) for high CVH levels of 0.22 (0.20-0.23) and 0.23 (0.21-0.25), respectively. Similar associations were observed in the transitions from FCMD to CMM (HRs: 0.41; 95% CIs: 0.34-0.50) and from FCMD to death (HRs: 0.82; 95% CIs: 0.68-0.98). CVH levels had an impact on disease-specific transitions except from stroke and T2D to death and from CMM to death. Conclusions This study revealed that LE8 may influence the progression of CMM trajectory. Our results highlight that managing behavior and health factors of LE8 is an important way to mitigate the progression of CMM trajectory.