Life’s Essential 8 for carotid artery stenosis prevention: stratified risk reduction by family cardiovascular history in the UK Biobank

Background To quantify cardiovascular health (CVH), the American Heart Association (AHA) recently launched an updated version of the “Life’s Simple 7” (LS7) score, now known as the “Life’s Essential 8” (LE8) score. Our study aimed to investigate the associations among the LE8 score, family history of cardiovascular diseases (including heart disease, stroke, hypertension, and diabetes in first-degree relatives), and carotid artery stenosis (CAS) via prospective data from the UK Biobank while evaluating the value of the LE8 score in reducing CAS risk across populations with distinct family history profiles. Methods After exclusion, 270,695 participants in the UK Biobank who were free of CAS at recruitment remained for analysis (55.2% women). According to the AHA definitions, CVH levels were categorized as low (0–49), moderate (50–79), or high (80–100) on the basis of the LE8 score. Cox proportional hazard models were used to estimate HRs between the LE8 score and CAS. A family risk score was developed to quantify the aggregated risk of CAS on the basis of family history of heart disease, stroke, high blood pressure, and diabetes, including data from fathers, mothers, and siblings, via univariate logistic regression. Results During a median follow-up of 13.3 years, 1158 incident cases of CAS were identified. Compared with participants with low-CVH, participants with moderate-CVH had a 36% lower risk of CAS, and those with high-CVH had a 60% lower risk of CAS incidence after adjustment for covariates. Compared to low-CVH, high-CVH showed progressively stronger CAS risk reduction: 40% lower risk in low-risk, 59% in medium-risk, and 67% in high-risk groups. The behavior and biological subscales contributed 31.9% and 27.9%, respectively, to the population attributable risk (PAR), with the total LE8 PAR reaching 57.6%. Conclusion High-CVH, as defined by the LE8 score, is significantly associated with a lower risk of CAS, and its protective effect is particularly significant in individuals whose parents or siblings have two or more conditions, including heart disease, stroke, high blood pressure, and diabetes.