Abstract Body: Introduction
The American Heart Association’s new Life’s Essential-8 (LE8) metrics is considered a comprehensive framework for pursuing optimal cardiovascular health (CVH). However, its relationship with carotid atherosclerotic plaque is inadequately studied globally and not clarified in Asians.

Hypothesis
We assessed the hypothesis that LE8 CVH is associated with carotid intima-media thickness (CIMT) and carotid plaque among Japanese men.

Methods
We cross-sectionally analyzed data from 938 randomly selected asymptomatic men aged 40-79 years participating in the Shiga Epidemiological Study of Subclinical Atherosclerosis (SESSA), Kusatsu, Shiga, during 2006-2008. Utilizing diet, physical activity, nicotine exposure, sleep, body mass index, blood lipids, blood glucose, and blood pressure metrics, we quantified and categorized LE8 CVH (high, 80-100 points; moderate, 50-79 points; and low, 0-49 points) as the exposure. Ultrasonography-derived intima-media thickness (IMT) and plaque numbers were quantified from the right and left common carotid artery (CCA) to the internal carotid artery via the carotid bifurcation. The average of these segment-specific IMT values was calculated and defined as the mean CIMT. The prevalence of increased CIMT (mean IMT >1 mm), increased IMT in CCA (mean IMT in CCA >1 mm), and carotid plaque (plaque count ≥1), and the plaque burden (total count) were evaluated as the outcomes. Multivariable (adjusted for age and family history of cardiovascular disease) modified Poisson regression and negative binomial regression analyses were used.

Results
Participants (mean [SD] age, 63.7 [10.0] years) had a prevalence of high, moderate, and low CVH of 16.7%, 77.6% and 5.6%, respectively. The prevalences of increased CIMT, increased IMT in CCA, and carotid plaque were 15.0%, 12.6%, and 77.5%, respectively. Compared to individuals with high CVH, those with moderate and low CVH had a higher risk (risk ratio [95% confidence interval]) of increased CIMT (2.06 [1.23-3.43] and 3.04 [1.53-6.05], respectively), increased IMT in CCA (2.01 [1.14-3.56] and 2.87 [1.28-6.46], respectively), and carotid plaque (1.09 [0.99-1.20] and 1.17 [1.01-1.36], respectively), and had a relative increase in the expected plaque counts (1.34 [1.14-1.59] and 1.65 [1.24-2.18], respectively).

Conclusions
Lower LE8 CVH is associated with a higher risk of CIMT and carotid plaque in Japanese men. Healthy lifestyle practices may reduce the risk of subclinical carotid atherosclerosis.