Evaluating the Attenuation of Black-White Disparities in Cardiovascular Disease Incidence and Total Mortality by Life’s Essential 8

BACKGROUND: Higher cardiovascular health, as measured by the Life's Essential 8 (LE8) score, is associated with better health outcomes. We sought to examine whether higher cardiovascular health may attenuate racial disparities in cardiovascular disease (CVD) and total mortality. METHODS: In this cross-sectional analysis, we used data from Black and White participants aged 20 to 59 years in the Cardiovascular Lifetime Risk Pooling Project, based in the United States including data from 1985 to 2022, for whom LE8 scores (0-100 points, higher is better) could be calculated. We compared incidence rates and hazard ratios (adjusted for age, sex, and education) for CVD and mortality between Black and White participants. We estimated the quantitative reduction in Black-White hazards without versus with adjustment for LE8 score by examining proportional changes in beta coefficients. RESULTS: Among 20 618 participants (28.6% Black; 54.8% women; mean age 45.9±11.6 years) followed for 499 000 person-years, 4316 developed CVD and 5660 died. The mean LE8 score was 61.5±14.7 for Black and 66.4±14.3 for White participants. Among Black participants, 1384 (23.4%) had a CVD event and 1870 (31.7%) died, compared with 2932 (19.9%) and 3790 (25.8%) of White participants, respectively. Black adults had higher hazards for incident CVD (adjusted hazard ratio, 1.55 [95% CI, 1.45-1.66]), which decreased to 1.20 (95% CI, 1.12-1.29) with LE8 adjustment, representing a 58.1% reduction in the beta estimate. Blood pressure score was the LE8 component associated with the greatest reduction in the beta estimate (47.7%). Findings were similar for mortality analyses (adjusted hazard ratio, 1.59 [95% CI, 1.50-1.68]). CONCLUSIONS: In young and middle-aged adults, adjustment for LE8 score partially attenuated Black-White disparities in CVD events and mortality. Improving cardiovascular health from young adulthood could be an important strategy for reducing racial disparities.