Abstract Body (Do not enter title and authors here): Background
Cardiovascular health (CVH) predicts heart failure (HF) risk, but its association with the subclinical HF stage of pre-HF is less understood. We evaluated associations of CVH, measured by AHA’s Life’s Essential 8 (LE8), with prevalent and incident pre-HF in the Hispanic/Latino population.

Methods
We analyzed serial echocardiograms from 1643 adults from ECHO-SOL, obtained ~4.3 years apart, to identify pre-HF. Prevalent pre-HF (visit 1, 2011-2014) was defined by ≥1 abnormality: LVEF <50%, global longitudinal strain > -15%, diastolic dysfunction ≥ grade 1, left ventricular mass index >115 in men/>95 in women, relative wall thickness >0.42. Incident pre-HF was assessed at visit 2 (2015-2018) among those free of pre-HF at visit 1, n=486. CVH metrics (diet, physical activity, sleep health, nicotine use, body mass index [BMI], lipids, blood pressure, and glucose) were assessed at baseline cohort visit (2008–2011), and LE8 scores [AHA scoring algorithm, range: 0-100] were categorized as low (0–<50), moderate (50–80), or high (>80–100). Age-and-sex-adjusted logistic regression and splines models evaluated associations of LE8 (total and components) with pre-HF. All analyses accounted for complex survey design.

Results
In ECHO-SOL (mean age 55 years, 55% female), only 3.5% had high CVH; 71.5% had moderate and 25.1% had low CVH. Participants with (vs. without) prevalent pre-HF had significantly lower total LE8, diet, physical activity, BMI, glucose and blood pressure scores (p<.0001). Similarly, those with (vs. without) incident pre-HF had significantly lower total LE8, BMI, and glucose scores, Table 1. Compared to high CVH, moderate CVH associated with nearly 3-fold higher adjusted odds of prevalent and incident pre-HF, with even greater odds for low CVH, Figure 1A. Each 10-point increase in LE8 score associated with 41% lower odds of prevalent pre-HF (OR 0.59, 95% CI 0.53–0.67), but not with incident pre-HF, Figure 1B. In splines, LE8 scores >60 were protective for prevalent pre-HF (OR 0.69, 95% 0.64, 0.76), with no association observed for incident pre-HF, Figure 1C-D. Among LE8 metrics, higher diet, blood pressure, and glucose scores were associated with lower odds of prevalent pre-HF, while only higher glucose scores were linked to incident pre-HF (all p<.05), Figure 1B.

Conclusion
Increasing CVH is associated with less prevalent and incident pre-HF. As HF burden grows in diverse groups, optimizing LE8 scores may help stem future HF at the population level.