Background The prevalence of atrial fibrillation (AF) has continued to rise globally in recent years, and AF increases the risk of stroke, heart failure, myocardial infarction, chronic kidney disease, and other diseases. Studies have identified hypertension, diabetes, smoking, obstructive sleep apnea, obesity and sedentary lifestyle as risk factors for AF. And most of these factors are within the scope of the "Life's Essential 8" (LE8) proposed by the American Heart Association.
Objective To investigate the relationship between cardiovascular health (CVH) score based on the LE8 and AF.
Methods A study was conducted in which 91 131 employees of Kailuan Group in Tangshan, Hebei Province were selected for physical examination from June 2006 to October 2007, and the LE8 score was evaluated according to the algorithm developed by the American Heart Association, and combined with the actual situation of the Kailuan study to form the Kailuan study version of LE8, including 4 health behaviors (diet, physical activity, tobacco exposure, and sleep) and 4 health factors (BMI, blood lipids, blood glucose, and blood pressure). The study subjects were divided into the three groups of the low CVH group (n=8 407) with a LE8 score less than 50, the medium CVH group (n=73 493) with a LE8 score of 50 or more but less than 80, and the high CVH group (n=9 231) with a LE8 score of 80 or more. The follow-up visit was performed per year with the time of the study subject's first Kailuan physical examination as the starting point, the occurrence of AF as the endpoint event, the end of AF and follow-up (2020-12-31) as the endpoint time. Kaplan Meier survival curve was used to analyze the cumulative incidence of new-onset AF in different groups, and log rank test was used to compare the differences between groups; Cox proportional hazards regression analysis was used to investigate the impact of different LE8 score groups and single factor scores on the risk of new-onset AF.
Results There were significant differences in age, gender, education level, monthly per capita household income, history of alcohol consumption, and LE8 scores among the three groups of subjects (P<0.001). During follow-up, 1 088 cases of new-onset AF were identified, including 133 cases (1.58%) in the low CVH group, 883 cases (1.20%) in the medium CVH group, and 72 cases (0.78%) in the high CVH group. The median follow-up time was 15.0 (14.7, 15.2) years; there was statistically significant difference in the comparison of cumulative incidence rate of new-onset AF in the three groups (P<0.000 1). Cox proportional hazards regression analysis after adjusting for age, gender, education level, monthly per capita household income, and history of alcohol consumption showed that, compared with the low CVH group, both the medium CVH group (HR=0.697, 95%CI=0.579-0.841, P<0.001) and the high CVH group (HR=0.609, 95%CI=0.454-0.816, P=0.001) reduced the risk of new-onset AF. An increase in LE8 score could reduce the risk of new-onset AF (HR=0.859, 95%CI=0.804-0.918, P<0.001). The individual factors of LE8, including BMI score (HR=0.762, 95%CI=0.717-0.809, P<0.001) and blood pressure score (HR=0.824, 95%CI=0.776-0.876, P<0.001), were negatively correlated with the risk of new-onset AF.
Conclusion The LE8 score of CVH is negatively correlated with the risk of new-onset AF, and the individual factors of LE8, including BMI score and blood pressure score, are negatively correlated with the risk of new-onset AF.
