Abstract DP112: Sex-differences in Life’s Essential 8 and Ischemic Stroke Outcomes: the ARIC Cohort Study

Introduction: Ischemic stroke (IS) has notable sex differences in risk factors, presentation, treatment, and outcomes. Life’s Essential 8 (LE8) is a composite score (0-100) of cardiovascular health (CVH) developed by the American Heart Association, based on the unweighted average of 4 health behaviors and 4 health factors. High CVH score (80-100) is linked to lower cardiovascular and all-cause mortality, as well as reduced risks of incident IS and post-stroke cardiovascular complications. We aimed to evaluate whether the association between midlife LE8 score and IS outcomes at discharge differs by sex in the Atherosclerosis Risk in Communities (ARIC) study. Methods: Participants from the ARIC prospective cohort with a first-ever incident IS after ARIC visit 2 (1990-92) were included. LE8 components were measured at visit 2. Adjusted logistic and ordinal regression models assessed the association of LE8 categories (low 0-49/moderate 50-79/high 80-100) with primary (modified Rankin Scale (mRS) categories) and secondary outcomes (mRS 0-1 and favorable discharge disposition). Models for the whole population included gender, race, age at first IS, and stroke severity. Models for sex difference included the main effect and interaction of gender, race, age at first IS, and stroke severity. Results: Of a total of 1285 ARIC participants with IS (mean age 58±6 at visit 2), 615 (48%) were men and 670 (52%) women. The total LE8 score did not differ by sex; when considering single components, women had better scores for diet and nicotine exposure and men for physical activity and body mass index (Table 1). Women were older at time of first IS (75±9 vs 73±9, p <0.01), while stroke severity and outcomes did not differ between sexes. High LE8 score was significantly associated with lower odds of greater disability (mRS shift) in multivariable analysis (adjusted Odd Ratio (aOR)=0.53 [0.33,0.86]). Interaction model showed an association in women (aOR=0.35 [0.18,0.66]), but not in men (aOR=0.89 [0.45,1.78]), with a statistically significant LE8 x sex interaction ( P =0.04). Effect modification by sex was also observed for secondary outcomes (Table 2) and when considering LE8 as a continuous variable (Table 3). Conclusions: In ARIC participants, a high midlife CVH score was associated with better IS functional outcomes. Stratified analyses revealed a significant association in women but not in men, suggesting that the relationship between CVH and IS outcomes may be sex-dependent.