Cardiovascular health across adulthood may influence long-term outcomes beyond a single risk assessment. A cohort study published in JACC: Advances evaluated whether cumulative cardiovascular health, measured using the American Heart Association Life’s Essential 8 (LE8) score, was associated with future cardiovascular disease (CVD), specific CVD subtypes, and death.

The analysis used data from Framingham Offspring Study participants with a mean age of 55 years, including 53% women. LE8 scores from examinations 1 through 5 (1971-1995) were used to calculate cumulative exposure as area under the curve (AUC) in point-years. Cox regression models evaluated associations after adjustment for age at examination 5, sex, education, and either LE8 score at examination 5 or LE8 slope over time.

During a median follow-up of 28 years, 935 CVD events, 343 coronary heart disease events, 412 congestive heart failure events, 381 stroke events, and 1,484 deaths occurred. Participants with higher cumulative LE8 values had lower risk across all outcomes.

Compared with the lowest quartile, the highest quartile had hazard ratios (HRs) ranging from 0.16 to 0.45. Each 1 standard deviation increase in cumulative LE8 exposure (215 point-years) was also associated with lower risk of all measured outcomes, with HRs ranging from 0.55 to 0.86.

The findings suggest that sustained cardiovascular health during middle age was associated with lower long-term risk of cardiovascular events and death. Routine LE8 assessment may help identify opportunities to improve cardiovascular health over time.