High baseline Life’s Essential 8 (LE8) status and maintaining a high LE8 status over an extended time may be related to a decreased risk for stroke, and improvement in LE8 even with low initial levels may attenuate or even reverse risk for stroke, according to study findings published in Stroke.

Compared with other countries, China has the highest lifetime risk for stroke, with the incidence, frequency, and mortality rate of stroke rising every year from 1990 to 2019.

Investigators in China assessed 10-year trajectories of LE8 and characterized their association with risk for stroke.

The investigators in the current study used deidentified data from the Kailuan study, a population-based study dedicated to finding health-contributing factors in the Kailuan community in Tangshan, Republic of China. The Kailuan study was a prospective cohort study from 2006 to 2020 recruiting 26,719 participants in a workplace setting (average age, 46.02 [SD, 11.27] years; 73.73% men) with no history of stroke. Participants completed 6 surveys from 2006 to 2016 to gage LE8 scores (unweighted average of 8 component scores ranging from 0-100 with higher scores indicating better overall cardiovascular health). Stroke cases from 2016 to 2020 were identified from medical records.

Despite the initial low level of LE8, improvement in LE8 attenuates or even reverses the risk of stroke.

In the current study, the investigators noted 5 LE8 trajectory patterns including low-stable (10.46% of the participants), moderate-increasing (15.00%), moderate-decreasing (22.78%), moderate-stable (38.46%), and high-stable (13.30%).

Across the study period, the investigators noted 498 incident strokes (91.97% ischemic, 11.04% hemorrhagic). Compared with the moderate-decreasing trajectory, hazard ratios (HRs) after adjusting for covariates showed the association between low-stable trajectory (HR, 1.42; 95% CI, 1.11-1.84), moderate-increasing trajectory (HR, 0.73; 95% CI, 0.56-0.96), moderate-stable trajectory (HR, 0.49; 95% CI, 0.39-0.62), high-stable trajectory (HR, 0.19; 95% CI, 0.11-0.32) and incident stroke.

Significantly reduced risk for stroke was found among individuals with high LE8 status (LE8≥80) compared with those with low LE8 status (LE8≤49; Ptrend <.001). Lower risk for stroke was linked with faster annual growth in LE8. The investigators noted that, despite lower LE8 values in the moderate-increasing group in 2006 compared with the moderate-decreasing group, the increasing group still showed a lower risk for stroke.

Study limitations include the Kiluan cohort is predominantly men from 1 specific community, which limits generalizability. There is also the possibility of unmeasured confounders inherent in observational studies, and only about 30% of the cohort were included in the final analyses due to exclusions, possibly invalidating the association between LE8 and stroke (excluded individuals were older with higher levels of systemic inflammation and lower socioeconomic status).

“Maintaining high LE8 over an extended period and high baseline LE8 status were related to a decreased risk of stroke,” the investigators concluded. “Despite the initial low level of LE8, improvement in LE8 attenuates or even reverses the risk of stroke.”

This article originally appeared on The Cardiology Advisor