Associations of “Life’s Essential 8” cardiovascular health with dementia risk, cognition, and neuroimaging markers of brain health

Abstract Importance: The American Heart Association (AHA)’s Life’s Essential 8 (LE8) score, a recently updated metric for promoting cardiovascular health (CVH), has addressed the limitations of the original metrics (Life’s Simple 7) and is able to quantify CVH. Objective: To evaluate the associations of LE8 score with the risk of incident dementia and its subtypes, cognition, and neuroimaging outcomes and to determine whether these associations differ among apolipoprotein E (APOE)-ε4 genotypes. Design, Setting, and Participants: UK Biobank participants without prior cardiovascular disease nor dementia at baseline (2006–2010) were enrolled in this prospective cohort study. Data analysis was conducted from December 20, 2022, to February 15, 2023. Exposures: A modified version of the LE8 score was created (range: 0–100) and categorized into poor (0–49), intermediate (50–79), and optimal (80–100) CVH. Main Outcomes and Measures: The outcomes included incident dementia (all-cause, vascular [VaD], and Alzheimer’s disease ascertained through hospital inpatient and death records), cognitive test scores (fluid intelligence and numeric memory), and neuroimaging markers (total brain volume [BV], white matter hyperintensity [WMH], and hippocampal volume). Adjusted Cox proportional hazard and multivariable linear regression models were used. Results: A subsample of 316,669 participants (mean [SD] age, 56.3 [8.1] years) were included. Higher LE8 scores were associated with reduced risk of all-cause dementia and VaD, the adjusted hazard ratios (HRs) in the optimal CVH versus the poor CVH group were 0.56 (95% confidence interval [CI], 0.48–0.64) and 0.29 (95% CI, 0.22–0.38), respectively. A 10-point increment in LE8 was associated with higher fluid intelligence (β, 0.088; 95% CI, 0.073–0.102) and numeric memory (β, 0.054; 95% CI, 0.043–0.065), and was also associated with lower WMH volume (β, −0.673; 95% CI, from −0.751 to −0.596) and larger BV (β, 77.93; 95% CI, 62.03–93.84) and hippocampal volume (β, 0.197; 95% CI, 0.106–0.288). These associations were more evident in APOE-ε4 noncarriers. Conclusions and Relevance: Individuals with a higher LE8 score experienced less dementia events (driven especially by incident VaD) and were associated with better neurocognitive brain health profiles. CVH optimization may be beneficial to the maintenance of brain health.