Higher Life’s Essential 8 Scores Associated With Reduced COPD Risk

Higher Life’s Essential 8 (LE8) scores are associated with a reduced risk of chronic obstructive pulmonary disease (COPD) in a nonlinear trend, with the association primarily driven by LE8's nicotine exposure metric.¹

Authors of the BMC Public Health study noted that patients with COPD are at an elevated risk of developing cardiovascular disease (CVD), with cardiovascular mortality being higher in those with reduced pulmonary function. To assess and promote cardiovascular health (CVH), the American Heart Association established LE8 in 2022, a novel and measurable indicator based on Life’s Simple 7 (LS7).²

LE8 consists of 4 health factors (body mass index [BMI], blood pressure [BP], blood glucose, and total cholesterol) and 4 health behaviors (diet, nicotine exposure, sleep health, and physical activity [PA]).¹ Unlike LS7, LE8 added the sleep health metric and is more sensitive to differences between each patient. A higher LE8 score indicates healthier behavior, with one study linking it to a reduced risk of all-cause and CVD-specific mortality.³

Despite the established relationship between COPD and CVD, the researchers noted that the association between LE8 scores and COPD remains unclear.¹ Consequently, they investigated this association with data from the National Health and Nutrition Examination Survey (NHANES).

Higher Life’s Essential 8 (LE8) scores, especially those reflecting lower nicotine exposure and better sleep health, are inversely associated with chronic obstructive pulmonary disease (COPD) risk. | Image Credit: Syda Productions - stock.adobe.com

The researchers described the CDC's NHANES as an ongoing cross-sectional survey investigating US civilians' health behaviors, nutritional status, and physical examination results. Self-reported questionnaires collected information on participants’ nicotine exposure, PA, and sleeping duration, while professional staff measured their BP, height, and weight. Also, NHANES researchers collected blood samples to determine blood lipids, hemoglobin A1c, and plasma glucose.

Additionally, each LE8 metric score ranged from 0 to 100 points, with the overall score calculated as the unweighted average of the 8 metric scores. Those with a total LE8 score between 80 and 100, 79 and 50, and 0 and 49 were categorized as having high, moderate, or low CVH, respectively.

The researchers used multivariate logistic regression models to examine the association between LE8 and COPD. They also employed a restricted cubic spline regression model to explore the dose-response relationship between LE8 scores and COPD. Lastly, the researchers performed subgroup and sensitivity analyses to assess the robustness of their results.

Using data from the 6 consecutive NAHNES cycles (2007-2018), they enrolled 19,774 participants, representing 145.2 million US civilians aged 20 or older. Most were female (51.5%; n = 10,094), and the weighted mean (standard error [SE]) age was 47.77 (0.27) years. Also, the mean (SE) LE8 score was 68.76 (0.26). There were 2438 (9.8%), 13,222 (65.4%), and 4084 (24.8%) participants with low, moderate, and high CVH levels, respectively.

The overall age-adjusted COPD prevalence was 4.5% (SE, 0.20). The researchers observed a higher COPD prevalence among older participants with lower poverty-income ratios (PIRs), as well as among those with CVD (all P values < .05). Compared with participants with COPD, those without COPD had significantly higher scores in nicotine exposure, sleep health, blood lipids, blood glucose, BP, and PA.

The researchers observed a lower age-adjusted COPD prevalence COPD among those with a higher LE8 score. After adjusting for potential covariates, those with a lower COPD adjusted odds ratio (aOR) were significantly associated with moderate (aOR, 0.477; 95% CI, 0.394-0.578) and high (aOR, 0.169; 95% CI, 0.115-0.249) CVH levels.

Therefore, the researchers noted that the total LE8 score and COPD OR exhibited an inverse nonlinear dose-response relationship (P < .05). They observed similar trends in participants with higher LE8 component scores for nicotine exposure (aOR, 0.164; 95% CI, 0.123-0.218) and sleep health (aOR, 0.670; 95% CI, 0.525-0.855).

A lower age-adjusted COPD prevalence was also observed among those with higher health behavior and health factor scores. After adjusting for potential covariates, the COPD aOR was significantly lower in participants with moderate (aOR, 0.419; 95% CI, 0.337-0.521; P < .001) and high (aOR, 0.300; 95% CI, 0.223-0.404; P < .001) health behavior scores. Similarly, after adjusting for potential covariates, the COPD aOR was significantly lower in participants with moderate (aOR, 0.850; 95% CI, 0.645-0.1.120; P = .245) and high (aOR, 0.603; 95% CI, 0.426-0.852; P < .05) health factor scores.

Overall, the researchers observed an inverse linear dose-response relationship between health behavior scores and COPD, as well as an inverse nonlinear dose-response relationship between health factor scores and COPD. Subgroup analyses revealed that these inverse associations were more pronounced among middle-aged and male participants.

Lastly, the researchers acknowledged their study's limitations, including its cross-sectional design. Consequently, they cannot determine the causality or temporality of LE8 and COPD. Despite their limitations, the researchers expressed confidence in their findings and suggested that patients with COPD adhere to LE8 guidelines.

“Adhering to LE8 guidelines, especially smoking cessation, to sustain optimal CVH levels may be beneficial to alleviate the burden of COPD,” the authors concluded.

References

1. Liu Y, Li W, Tang J, Gao S. Association of life's essential 8 with chronic obstructive pulmonary disease: a population-based analysis of NHANES 2007-2018. BMC Public Health. 2024;24(1):3144. doi:10.1186/s12889-024-20534-5
2. Life’s Essential 8. American Heart Association. Accessed November 20, 2024. https://www.heart.org/en/healthy-living/healthy-lifestyle/lifes-essential-8
3. Sun J, Li Y, Zhao M, et al. Association of the American Heart Association's new "Life's Essential 8" with all-cause and cardiovascular disease-specific mortality: prospective cohort study. BMC Med. 2023;21(1):116. doi:10.1186/s12916-023-02824-8