| Title: | Lifes essential 8 score and 10-year cardiovascular outcomes in atrial fibrillation: A UK biobank analysis with simulated lifestyle improvement |
| Journal: | American Journal of Preventive Cardiology |
| Published: | 29 Dec 2025 |
| Pubmed: | https://pubmed.ncbi.nlm.nih.gov/41624502/ |
| DOI: | https://doi.org/10.1016/j.ajpc.2025.101399 |
Publication 17166
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Abstract
Background: Atrial fibrillation (AF) is associated with high risks of mortality and cardiovascular events, yet the prognostic value of comprehensive lifestyle and clinical health metrics remains uncertain.</p>
Objective: To investigate whether cardiovascular health (CVH), as measured by the American Heart Association's Life's Essential 8 (LE8) score, is associated with clinical outcomes in people with AF, and to estimate the impact of simulated improvement in CVH components.</p>
Methods: Data were drawn from the UK Biobank, a prospective population-based cohort. Participants with AF were identified using ICD codes. CVH was assessed using a modified LE8 score (range 0-100), derived from smoking status, cholesterol, blood pressure, BMI, HbA1c, physical activity, diet, and sleep. Primary outcomes were all-cause mortality and major adverse cardiovascular events (MACE: ischaemic heart disease, myocardial infarction, stroke, and heart failure). Associations were analysed using Cox models with penalised splines, presented in Kaplan-Meier curves. Population attributable and potential impact fractions were estimated.</p>
Results: Among 23,758 individuals with AF and 10-year follow-up, higher CVH scores associated with lower risk of all-cause mortality and MACE in a non-linear, graded pattern. Compared with the lowest quartile, the highest CVH quartile had 39% lower risk of all-cause mortality (HR: 0.61, 95% CI: 0.56-0.67) and 38% lower risk of MACE (HR: 0.62, 95% CI: 0.58-0.67; both p < 0.001). Associations were modified by age and multimorbidity. Simulated improvements in CVH could reduce all-cause mortality by 10% and MACE by 7%, with diet, smoking, blood pressure, and BMI contributing most.</p>
Conclusion: Higher LE8 scores were independently associated with lower all-cause mortality and MACE risk in people with AF, supporting the role of lifestyle-based secondary prevention in AF care.</p>
4 Authors
- Charlotte J. Fitzhugh
- Helen Jones
- Lawrence Foweather
- Benjamin J.R. Buckley
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