Abstract Body (Do not enter title and authors here): Background: Recent data show that inflammation leads to residual atherosclerotic cardiovascular disease (ASCVD) risk. The recently revised AHA’s Life’s Essential 8 (LE8) optimal cardiovascular health advisory does not include inflammation as a modifiable risk factor for optimal cardiovascular health. We investigated the role of inflammation as a ninth component of LE8.

Methods: Measures of cardiovascular health and inflammation biomarkers data were evaluated among 1,869 patients (age 59.0±7.45 years, 65.7% female, 41.9% self-identified as Black) enrolled in the Heart Strategies Concentrating on Risk Evaluation (Heart SCORE) study. Multivariable adjusted regression models were used to examine the association of LE8 quartiles with incident ASCVD events and all-cause mortality. We then tested the association of inflammatory markers (interleukin-6 [IL-6] and C-reactive protein [hs-CRP]).

Results: Over a median of ~12 years, ideal level of blood glucose was associated with significantly lower risk of ASCVD (HR 0.26, CI 95% [0.12-0.58]; p=0.001). A similar trend was seen for ideal BP (HR 0.45, [0.18-1.12]; p=0.086). For all-cause mortality, no smoking emerged as the main protective factor (HR 0.29 CI95% 0.16-0.53, p<0.001).
Overall, highest quartile of LE8 Score was significantly associated with lower risk of ASCVD events and all-cause mortality (HR 0.14, [0.04-0.48];p<0.01) (Table). In stratified analysis, age and IL-6 levels (HR 1.54 (1.05-2.25); p=0.03) were independently associated with a higher risk of ASCVD events despite higher LE8 scores.

Conclusion: Despite optimal health parameters, as identified by optimal Life’s Essential 8 scores, high IL-6 levels are independently associated with residual risk of ASCVD events. Utility of adding IL-6 as a ‘necessary ninth’ modifiable parameter needs to be explored further.