Abstract
BACKGROUND: Atrial fibrillation (AF) burden can be reduced by targeting modifiable risk factors. Limited data exist on the association between American Heart Association's Life's Essential 8 (LE8) score (higher scores healthier) and AF incidence. METHODS: We studied AF-free Framingham Heart Study Offspring and Omni 1 participants aged ≥45 years who attended ≥1 index exam in which LE8 components were assessed. LE8 scores were calculated incorporating body mass index, blood pressure, non-HDL cholesterol, glucose, smoking, physical activity, diet, and sleep. Fine-Gray hazards models, accounting for the competing risk of death, were used to calculate subdistribution hazards ratios (sHR) for the association of LE8 score and its components with 10-year AF incidence. RESULTS: We included 3161 unique participants (n = 4628 index exams, 57 % women, mean age 65±9 years). Participants were classified as having "ideal" (LE8≥80; 16 % [n = 763 exam cycles]), "intermediate" (LE8 50-79; 76 % [n = 3519]), or "poor"(LE8<50; 7 % [n = 346]) cardiovascular health. There were 410 incident AF events (10.4/1000 person-years). Compared with "ideal", a "poor" LE8 score was associated with higher AF risk (sHR,1.78; 95 %CI, 1.20-2.64; p = 0.004); we did not observe a statistically significant association comparing participants with "intermediate" LE8 scores to those with "low" LE8 scores with regards to AF risk. Higher LE8 scores (healthier; continuous) were associated with lower AF risk (sHR per 1-SD increase increment of LE8 score, 0.80; 95 %CI, 0.72-0.90; p < 0.0001). CONCLUSIONS: Lower LE8 scores were associated with greater risk of developing AF. Future studies of the role of LE8 in reducing AF burden in the overall population are warranted.