Clinical Scorecard: The beneficial role of Life's Essential 8 in reducing the risk of developing heart failure

At a Glance

Key Highlights

• Life's Essential 8 (LE8) includes four behavioural factors (diet, physical activity, smoking, sleep) and four metabolic factors (BMI, non-HDL cholesterol, fasting glucose, blood pressure).
• Higher and increasing LE8 scores over time are associated with significantly lower risk of incident heart failure.
• LE8 trajectory is a superior predictor of HF risk compared to single time-point LE8 status, especially in individuals younger than 55 years.

Guideline-Based Recommendations

Diagnosis

• Consider comprehensive cardiovascular health assessment using Life’s Essential 8 metrics.

Management

• Implement healthy lifestyle interventions including regular physical activity, maintaining normal weight, healthy diet, smoking cessation, and adequate sleep to reduce HF risk.
• Control metabolic risk factors such as blood pressure, blood glucose, and cholesterol.

Monitoring & Follow-up

• Track longitudinal changes in LE8 scores to better predict and manage HF risk.

Risks

• Higher burden of cardiovascular risk factors increases HF risk, particularly with aging and in males.
• Limited data on HF phenotypes (HFpEF vs HFrEF) and female populations may affect risk stratification.

Patient & Prescribing Data

35,896 Chinese adults from the Kailuan study with repeated LE8 assessments over 8 years

Sustained or increasing LE8 scores correlate with reduced incidence of HF; lifestyle and metabolic factor improvements are key preventive strategies.

Clinical Best Practices

• Encourage patients to adopt and maintain multiple healthy lifestyle behaviours simultaneously for maximal HF risk reduction.
• Use repeated LE8 measurements to monitor cardiovascular health trajectory rather than relying on single assessments.
• Focus preventive efforts especially on younger adults to maximize long-term benefits.
• Recognize limitations in HF phenotyping and gender representation when applying LE8 findings.

References

• Association between Life’s Essential 8 and risk of heart failure: findings from the Kailuan study
• 2022 American Heart Association/American College of Cardiology/Heart Failure Society of America HF guidelines