See article vol. 31: 368-381
Risk factors, such as high blood pressure, high cholesterol, obesity, smoking, and lack of exercise accelerate arteriosclerosis progression. When these factors are present simultaneously, their effects are synergistically amplified, causing damage to the arterial wall and progressive inflammation, as well as the deterioration of vascular endothelial function; this accelerates the progression of atherosclerosis, thereby increasing the risk of cardiovascular disease and death 1) . Appropriately controlling risk factors at an early stage is important to prevent the development of cardiovascular disease. If individuals continue to grow old with uncontrolled risk factors, they must assume a high risk of developing cardiovascular disease throughout their lifetime. Thus, it is necessary to determine the degree of cardiovascular risk and consider measures to deal with it.
The Suita score, which includes a composite of risk factors, has been used to assess the risk of future cardiovascular disease in the Japanese population 2) . The Suita score is an assessment tool used to predict the 10-year risk of developing cardiovascular heart disease (CHD) 3) ; the cutoff values of brachial–ankle vascular index (baPWV) are shown separately for age and gender using the Suita score 4) . However, in 2022, a new score predicting a 10-year risk of atherosclerotic cardiovascular diseases in Japanese adults was reported in the Hisayama study 5) . The Suita score uses the development of coronary artery disease as its endpoint, whereas the endpoint of the score in the Hisayama study is coronary heart disease or atherothrombotic brain infarction. These scores are useful in predicting the risk of future disease development; however, they do not include determinants of healthy living, such as diet and exercise habits.
In 2010, the American Heart Association defined the new concept of cardiovascular health (CVH) to promote a paradigm shift from focusing solely on disease treatment to active health promotion and maintenance across populations and individual life courses. The first definition of CVH included seven components called “Life’s Simple 7”: diet quality, participation in physical activity, exposure to smoking, body mass index, fasting blood glucose, total cholesterol, and BP 6) . Several studies have shown that CVH scores are associated with prognosis 7) . Moreover, Life’s Essential (LE) 8, proposed by American Herat Association in 2022, assesses CVH with eight items, consisting of seven components from Life’s Simple 7 and a sleep component 7) . It is an excellent tool for the comprehensive assessment of CVH. High LE 8 is inversely associated with carotid plaque 8) and independently associated with a reduced risk of all-cause and cardiovascular mortality 9) . LE 8 is a new concept and only a few reports exist on its relevance in the context of atherosclerosis. In this issue of the Journal of Atherosclerosis and Thrombosis, Li et al. demonstrated that changes in LE 8 over time were associated with the exacerbation of baPWV 10) . The present study is the first to show that LE 8 is significantly associated with arterial stiffness as assessed by baPWV and that multiple risk factors should be evaluated over time and appropriately treated. However, evidence of LE 8 in Asians, including Japanese, is insufficient, and its usefulness remains unclear. Therefore, this study is valuable, and further research is required.
Prevention of atherosclerotic cerebrovascular disease requires early and comprehensive management of the risk factors. Especially, patients with multiple risk factors require a more comprehensive approach, including more rigorous monitoring and treatment planning, than those with a single risk factor. LE 8 or assessment tools, such as the Suita score and score from the Hisayama study, are used to assess risk. Using those assessment tools to evaluate the risk of developing cardiovascular disease, lifestyle modifications, drug therapy, and regular health checkups are important in the management of patients with combined risk factors as the goal is to improve the health of all individuals throughout their lives.
Conflict of Interest
None.
References
- 1).Nakamura Y, Yamamoto T, Okamura T, Kadowaki T, Hayakawa T, Kita Y, Saitoh S, Okayama A, Ueshima H. Combined cardiovascular risk factors and outcome: NIPPON DATA80, 1980-1994. Circ J, 2006; 70: 960-964 [DOI] [PubMed] [Google Scholar]
- 2).Hirai H, Asahi K, Yamaguchi S, Mori H, Satoh H, Iseki K, Moriyama T, Yamagata K, Tsuruya K, Fujimoto S, Narita I, Konta T, Kondo M, Shibagaki Y, Kasahara M, Watanabe T, Shimabukuro M. New risk prediction model of coronary heart disease in participants with and without diabetes: Assessments of the Framingham risk and Suita scores in 3-year longitudinal database in a Japanese population. Sci Rep, 2019; 9: 2813 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3).Nishimura K, Okamura T, Watanabe M, Nakai M, Takegami M, Higashiyama A, Kokubo Y, Okayama A, Miyamoto Y. Predicting coronary heart disease using risk factor categories for a Japanese urban population, and comparison with the framingham risk score: the Suita study. J Atheroscler Thromb, 2014; 21: 784-798 [DOI] [PubMed] [Google Scholar]
- 4).Mori R, Miyata M, Kubozono T, Inadome N, Kawasoe S, Ojima S, Kawabata T, Salim AA, Miyahara H, Tokushige K, Ohishi M. Cutoff values of brachial-ankle pulse wave velocity for atherosclerotic risks by age and sex in the Japanese general population. J Atheroscler Thromb, 2023; 30: 481-490 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5).Honda T, Chen S, Hata J, Yoshida D, Hirakawa Y, Furuta Y, Shibata M, Sakata S, Kitazono T, Ninomiya T. Development and Validation of a Risk Prediction Model for Atherosclerotic Cardiovascular Disease in Japanese Adults: The Hisayama Study. J Atheroscler Thromb, 2022; 29: 345-361 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6).Lloyd-Jones DM, Hong Y, Labarthe D, Mozaffarian D, Appel LJ, Van Horn L, Greenlund K, Daniels S, Nichol G, Tomaselli GF, Arnett DK, Fonarow GC, Ho PM, Lauer MS, Masoudi FA, Robertson RM, Roger V, Schwamm LH, Sorlie P, Yancy CW, Rosamond WD; American Heart Association Strategic Planning Task Force and Statistics Committee. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic Impact Goal through 2020 and beyond. Circulation, 2010; 121: 586-613 [DOI] [PubMed] [Google Scholar]
- 7).Lloyd-Jones DM, Allen NB, Anderson CAM, Black T, Brewer LC, Foraker RE, Grandner MA, Lavretsky H, Perak AM, Sharma G, Rosamond W; American Heart Association. Life’s Essential 8: Updating and Enhancing the American Heart Association’s Construct of Cardiovascular Health: A Presidential Advisory From the American Heart Association. Circulation, 2022; 146: e18-e43 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8).Herraiz-Adillo Á, Ahlqvist VH, Higueras-Fresnillo S, Berglind D, Wennberg P, Lenander C, Daka B, Ekstedt M, Sundström J, Ortega FB, Östgren CJ, Rådholm K, Henriksson P. Life’s Essential 8 and carotid artery plaques: the Swedish cardiopulmonary bioimage study. Front Cardiovasc Med, 2023; 10: 1173550 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9).Yi J, Wang L, Guo X, Ren X. Association of Life’s Essential 8 with all-cause and cardiovascular mortality among US adults: A prospective cohort study from the NHANES 2005-2014. Nutr Metab Cardiovasc Dis, 2023; 33: 1134-1143 [DOI] [PubMed] [Google Scholar]
- 10).Li L, Zhang J, Zhang X, Huo Z, Jiang J, Wu Y, Zhu C, Chen S, Du X, Li H, Wei X, Ji C, Wu S, Huang Z. Association of Cumulative Exposure to Cardiovascular Health Behaviors and Factors with the Onset and Progression of Arterial Stiffness. J Atheroscler Thromb, 2024; 31: 368-381 [DOI] [PMC free article] [PubMed] [Google Scholar]