Abstract Body: Background:
Life’s Essential 8 (LE8) is a cardiovascular health (CVH) metric proposed by the American Heart Association (AHA) that includes blood glucose, blood pressure, lipid levels, diet, physical activity, nicotine exposure, body mass index, and sleep duration. LE8 is used as a tool to assess and improve CVH outcomes. Little is known about the association between LE8 and mortality after stroke.

Methods:
We included data from participants aged 20 and older with self-reported stroke who participated in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018. Data was linked with National Death Index mortality data through 2019. The association between poor and ideal LE8 scores and all-cause mortality and CV mortality rates after stroke were determined in 3 models: (1) unadjusted; (2) adjusted for sociodemographic factors (age, sex, race/ethnicity, poverty income ratio (PIR)) and (3) further adjusted for comorbidities (Charlson Comorbidity Index).

Results:
During the study period, 1,019 out of 26,670 individuals reported a prior stroke. When assessing mortality in those with poor CVH, although the direction of the hazard ratios (HR) suggested an increased risk of CV mortality with higher numbers of poor LS8 metrics, the associations were not significant in any of the models. However, for all-cause mortality, the risk increased with a higher number of poor CVH metrics. Possessing at least 4 poor CVH metrics was associated with a higher risk of all-cause mortality (Model 1 HR 1.69, 95%CI 1.13-2.52; Model 2 HR 2.25, 1.51-3.35; Model 3 HR 2.10, 1.39-3.20). Conversely, possessing at least 4 ideal metrics was associated with lower CV mortality in the unadjusted model, (HR 0.35, 0.15-0.85) but this association was no longer significant in Models 2 and 3. Possessing at least 4 ideal CVH characteristics was associated with lower all-cause mortality in all 3 models (Model 1 HR 0.50, 0.29-0.85; Model 2 HR 0.54, 0.31-0.92; Model 3 HR 0.56, 0.33-0.96). Higher LE8 scores were associated with lower CV mortality in Model 2 (HR per point LE8 score 0.98, 0.96-0.99) and Model 3 (0.98, 0.96-0.99) and all-cause mortality in Model 2 (0.98, 0.97-0.99) and Model 3 (0.98, 0.97-0.99).

Conclusion:
A higher LE8 score correlates with an increased risk of both CV and all-cause mortality in stroke survivors. Possession of at least 4 ideal CVH metrics is associated with a nearly two-thirds risk reduction in CV mortality and 50% risk reduction in all-cause mortality.