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Brain & Heart The relationship between LE8 score and ASCVD

Table 2. Distribution of ideal, intermediate, and poor CVH higher, following adjustments for potential confounding
across metrics among non‑Hispanic white adults (n=4,459) variables that included income relative to poverty level,
without ASCVD, NHANES 2017 – 2020 race/ethnicity, educational attainment, sex, age, and
marital status. LE8 is then used with a square and then
Metric Number of
participants a cubic polynomial specification with similar controls
(n [%]) (Table 3). The polynomial specification utilizes all data
Body mass index (kg/m ) in LE8, enabling systematic variation of the marginal
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<25 (ideal) 1,854 (41.58) impact on the probability of ASCVD with the level of
LE8. Finally, a linear probability model was constructed
25 – 29.9 (intermediate) 881 (19.76) by individually incorporating all eight components of
≥30 (poor) 1,724 (38.66) LE8, aiming to discern their distinct effects on ASCVD. In
Smoking addition, significant correlations at the 5% level between
Never or quit for >12 months (ideal) 3,228 (70.79) the components were considered.
Former smoker; quit for ≤12 months (intermediate) 710 (11.46) In Table 3, we demonstrated that the use of LE8
Current (poor) 622 (13.64) controls for poor and intermediate categories did not
Physical activity predict the prevalence of ASCVD. The coefficients on both
≥150 min/d moderate intensity; ≥75 min/d vigorous 4,109 (91.80) identification variables were not significantly different from
intensity; or≥150 min/d moderate and vigorous zero. The next column revealed that a quadratic function
intensity (ideal) of the LE8 metric predicted the incidence of ASCVD. The
1 – 149 min/d moderate intensity; 1 – 74 min/d 367 (8.20) fourth column illustrated that a cubic polynomial did not
vigorous intensity; or 1 – 149 min/d moderate and improve on the quadratic polynomial, as evidenced by the
vigorous intensities (intermediate)
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non-statistically significant difference of R and the cube of
None (poor) 17 (0.4) LE8 from zero, as its 95% confidence interval contains zero.
Healthy diet score* (healthy eating index [HEI]-2015) Furthermore, as indicated in Table 3, age categories
≥80 (ideal) 493 (11.33) predominantly predicted a higher ASCVD probability,
50 – 79 (intermediate) 2,406 (55.28) while being college-educated with a 4-year diploma
<49 (poor) 1,453 (33.39) reduced the prediction probability by 6%, or raised by
Total cholesterol (non-HDL cholesterol [mg/dL]) 4% if self-identified as male. The emergence of diverse
<130 (ideal) 1,883 (42.42) results across different age groups aligns with findings
131 – 220 (intermediate) 1,169 (26.33) from a prior study, where young adults with CVD tended
>220 (poor) 1,387 (31.25) to be older and had lower LS7 scores compared to their
CVD-free counterparts in the same age range. Potential
Blood pressure (mm Hg) explanations for these differences include factors associated
SBP<120; DBP<80 (ideal) 1,724 (38.56) with awareness, behavior, and socioeconomic status
SBP: 120 – 139; DBP: 80 – 89; or treated to a goal 914 (20.44) leopold. In addition, an elevated prevalence of ASCVD of
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(intermediate) almost 5% was observed among those who were widowed,
SBP≥140 or DBP ≥90 (poor) 1,833 (41.00) divorced, or separated, compared to married individuals,
Glycated hemoglobin A1c (%) as can be calculated by taking the difference between the
<5.7 (ideal) 4,236 (94.68) widowed/divorced/separated coefficient minus the married
5.7 – 6.4 (intermediate) 49 (1.10) coefficient in Table 3.
>6.4 (poor) 174 (4.22) 4. Discussion
Sleep health (h of sleep)
7 – 9 (ideal) 1,208 (30.25) The non-linear relationship between the new LE8 score
and ASCVD was investigated using a multivariate linear
4 – 9 or>10 (intermediate) 2,757 (69.05) probability model in a nationwide survey. Our findings
<4 (poor) 28 (0.70) indicate that higher LE8 scores are generally associated
Note: *HEI-2015, validated as a representative measure of diet quality with lower ASCVD prevalence. Our findings align with
in the population, was employed as a proxy for the American Heart prior studies indicating a decrease in the prevalence of
Association (AHA)’s healthy diet score. CVD associated with higher LE8 scores. Recent research
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Abbreviations: DBP: Diastolic blood pressure; SBP: Systolic blood pressure;
CVH: Cardiovascular health; ASCVD: Atherosclerotic cardiovascular conducted on a group of South Asian American adults
disease; NHANES: National Health and Nutrition Examination Survey. with suboptimal (poor) CVH, as evaluated by LE8 scores,

Volume 2 Issue 2 (2024) 5 doi: 10.36922/bh.2915