Life’s Essential 8 and risks of mortality and cardiovascular morbidity in individuals with PRISm and its associations with transition trajectories of PRISm

BACKGROUND: Although morbidity and mortality are reportedly increased in individuals with preserved ratio impaired spirometry (PRISm), little is known about how to optimise PRISm-related health. AIMS: Is Life's Essential 8 (LE8) associated with mortality and cardiovascular morbidity in individuals with PRISm and with PRISm transition trajectories? METHODS: Participants with PRISm (n=31 943) with complete data on LE8 and 23 179 individuals with two spirometry measurements were included from the UK Biobank. Eight health components were used to create the LE8 score (0-100). Cox proportional hazards models were used to assess associations of LE8 with cardiovascular morbidity and all-cause, cardiovascular and respiratory mortality. Multinomial logistic regression models were conducted to assess associations between LE8 and transition trajectories of PRISm. RESULTS: Among participants with PRISm, 3113 (9.75%), 25 254 (79.06%) and 3576 (11.19%) were categorised as high (LE8≥80), moderate (50≤LE8<80) and low LE8 (LE8<50) score groups, respectively. Compared with the high LE8 group, the low LE8 group demonstrated higher risks of cardiovascular disease (HR: 2.702, 95% CI 2.391 to 3.054) and all-cause (2.496, 2.082 to 2.993), cardiovascular (4.165, 2.672 to 6.493) and respiratory mortality (4.103, 1.866 to 9.020). Individuals with low LE8 score (vs high LE8) had higher odds to transition from normal spirometry to PRISm (OR: 2.238, 95% CI 1.638 to 3.057) and lower odds to transition from PRISm to normal spirometry (OR: 0.506, 95% CI 0.339 to 0.757). CONCLUSION: A lower LE8 score was associated with increased risks of cardiovascular morbidity and all-cause, cardiovascular and respiratory mortality in PRISm. A lower LE8 score was related to higher likelihood of developing PRISm and lower likelihood of PRISm recovery.