Objective  To explore the potential differences of the association between cardiovascular health (CVH) scores, which was evaluated by the life’s essential 8 (LE8) metrics, and the incidence of cardiovascular disease (CVD) across different genders and age groups.

Methods  A prospective cohort study was conducted. The Kailuan study population who participated in the 2006 health examination was selected as the research subjects. After excluding those with incomplete LE8 data or a prior history of CVD at the time of the 2006 health examination, 92 230 individuals were included in the analysis. The revised CVH scores, which encompassed eight key metrics−dietary status, physical activity, nicotine exposure, sleep duration, body mass index (BMI), lipids, blood glucose, and blood pressure−were categorized into three groups: low CVH, moderate CVH, and high CVH. Kaplan-Meier method was used to calculate the cumulative incidence of CVD of these CVH subgroups, and Log-rank test was used to compare the difference of the cumulative incidence of CVD among groups. To evaluate the independent association between CVH scores and CVD, a multifactorial Cox regression analysis was performed. Additionally, stratified analyses by sex and age were conducted to investigate potential interactions.

Results  Among 92 230 participants from the Kailuan community, 79.37% were male. Over an average follow-up period of (14.36±3.71) years, 11 377 cases of CVD were identified. Multifactor Cox regression analysis showed that after adjusting for confounding factors such as alcohol consumption, education level, marital status, income level, family history of CVD, and triglyceride levels, in subjects ＜45 years of age, each standard deviation increase in CVH score was associated with a 48% reduction in the risk of CVD among women (HR=0.52, 95%CI 0.46–0.60, P＜0.001), and a 40% reduction in the risk of CVD among men (HR=0.60, 95%CI 0.57–0.64, P＜0.001); in subjects ＞65 years of age, each standard deviation increase in CVH score was associated with a 29% reduction in CVD risk among women (HR=0.71, 95%CI 0.64–0.80, P＜0.001), and a 18% reduction risk in CVD risk among men (HR=0.82, 95%CI 0.79–0.86, P＜0.001).

Conclusion  The inverse relationship between CVH scores, as evaluated by the LE8 framework, and the risk of CVD is notably stronger among women and younger demographic groups.