# Lifes essential 8 score and 10-year cardiovascular outcomes in atrial fibrillation: A UK biobank analysis with simulated lifestyle improvement

## TL;DR

This study shows that better lifestyle and health metrics in people with atrial fibrillation are linked to lower risks of death and heart problems.

## Contribution

The study introduces a novel analysis of the Life’s Essential 8 score in predicting cardiovascular outcomes in atrial fibrillation patients.

## Key findings

- Higher Life’s Essential 8 scores correlated with 39% lower all-cause mortality risk in atrial fibrillation patients.
- Simulated improvements in lifestyle metrics could reduce major adverse cardiovascular events by 7%.
- Diet, smoking, blood pressure, and BMI were the most impactful factors in reducing mortality and heart events.

## Abstract

Atrial fibrillation (AF) is associated with high risks of mortality and cardiovascular events, yet the prognostic value of comprehensive lifestyle and clinical health metrics remains uncertain.

To investigate whether cardiovascular health (CVH), as measured by the American Heart Association's Life’s Essential 8 (LE8) score, is associated with clinical outcomes in people with AF, and to estimate the impact of simulated improvement in CVH components.

Data were drawn from the UK Biobank, a prospective population-based cohort. Participants with AF were identified using ICD codes. CVH was assessed using a modified LE8 score (range 0–100), derived from smoking status, cholesterol, blood pressure, BMI, HbA1c, physical activity, diet, and sleep. Primary outcomes were all-cause mortality and major adverse cardiovascular events (MACE: ischaemic heart disease, myocardial infarction, stroke, and heart failure). Associations were analysed using Cox models with penalised splines, presented in Kaplan-Meier curves. Population attributable and potential impact fractions were estimated.

Among 23,758 individuals with AF and 10-year follow-up, higher CVH scores associated with lower risk of all-cause mortality and MACE in a non-linear, graded pattern. Compared with the lowest quartile, the highest CVH quartile had 39% lower risk of all-cause mortality (HR: 0.61, 95% CI: 0.56–0.67) and 38% lower risk of MACE (HR: 0.62, 95% CI: 0.58–0.67; both p < 0.001). Associations were modified by age and multimorbidity. Simulated improvements in CVH could reduce all-cause mortality by 10% and MACE by 7%, with diet, smoking, blood pressure, and BMI contributing most.

Higher LE8 scores were independently associated with lower all-cause mortality and MACE risk in people with AF, supporting the role of lifestyle-based secondary prevention in AF care.