Life’s essential 8 in relation to incident cardiovascular disease and mortality: the prospective study of Isfahan cohort study (2001–2013)

Abstract

Background: There is no evidence regarding the association between Life’s Essential 8 (LE8) and the risk of cardiovascular disease (CVD) and mortality among Iranians. Therefore, we aimed to investigate the relationship between LE8 and incident CVD and mortality in the population. Methods: In total, 5324 participants free of CVD at baseline were included. Participants were categorized into 3 groups of high (80 ≤ LE8 < 100), moderate (70 ≤ LE8 < 80), and low (LE8 < 70) LE8 score. Multivariable-adjusted Cox models were used to evaluate the association of LE8 with CVD, CVD subtypes (myocardial infarction (MI), stroke, and unstable angina (UA)), CVD mortality, and non-CVD mortality. Results: After a median follow-up of 11.25 years, 786 CVD cases and 172 CVD deaths were recorded. Participants in the highest category of the LE8 had lower risk of CVD (HR: 0.47; 95 CI: 0.30–0.72; P trend < 0.001), MI (HR: 0.30; 95 CI: 0.19–0.46; P trend < 0.001), stroke (HR: 0.45; 95 CI: 0.30–0.67; P trend < 0.001), UA (HR: 0.46; 95 CI: 0.35–0.60; P trend < 0.001), and CVD mortality (HR: 0.43; 95 CI: 0.29–0.33; P trend < 0.001) compared to individuals with the lowest score. In subgroup analysis, the inverse relationship between LE8 and CVD was stronger among females and younger participants. No significant link was observed between LE8 and non-CVD mortality risk after even adjustment for confounders. Conclusion: Our findings indicate an inverse association between LE8 and the risk of cardiovascular events among Iranians, which may be advantageous for CVD preventive risk management in the healthcare system. © The Author(s) 2026.