Prospective associations of American Heart Association Life's Essential 8 with subclinical measures of vascular health, cardiovascular disease events, and all-cause mortality in women traversing menopause: The Study of Women's Health Across the Nation study.

Objectives: We aimed to characterize cardiovascular health status as measured by Life's Essential 8 (LE8) in midlife women and to test the associations between baseline and change since baseline in LE8 with subclinical measures of vascular health, cardiovascular disease (CVD) events, and all-cause mortality.

Methods: Baseline and follow-up LE8 metrics (diet, physical activity, nicotine exposure, sleep, body mass index, lipids, glucose, and blood pressure) were calculated as total and component scores. Changes in LE8 were calculated as differences between follow-up and baseline scores. Subclinical measures of vascular health included carotid intima-media thickness, pulse wave velocity, and carotid plaque presence. CVD events (n = 213) included myocardial infarction, stroke, heart failure, and revascularization. Deaths (n = 161) were recorded from death certificates/family reports. Linear, logistic, and Cox proportional hazards regression models were used.

Results: Among 2,924 midlife women (mean age: 46 ± 3 y), 21% consistently showed ideal total LE8 scores (≥80) across visits. Higher baseline and greater increases in total LE8 scores were associated with more favorable measures of all outcomes. Among the components, more favorable baseline/greater increases in glucose, blood pressure, and nicotine exposure scores were generally associated with lower risks for all outcomes. Sleep quality was associated with events; with more favorable baseline and/or greater increases in sleep score associated with lower risks of CVD events and/or mortality.

Conclusions: The prevalence of ideal total LE8 scores remained below 25% among midlife women. Glucose, blood pressure, and nicotine exposure are critical components of associated risks with lower LE8 scores. Midlife sleep quality may uniquely contribute to future event risk.