Abstract
Abstract
Background
Stroke poses a significant financial and medical burden as it is the primary cause of death and disability globally. The identification of modifiable risk factors is crucial in the prevention of stroke. Life’s Essential 8 (LE8) is the most recent indicator of cardiovascular health, but its association with stroke is unclear.
Methods
Using information from the National Health and Nutrition Examination Survey conducted in 2005–2018, we evaluated the relationship between the LE8 score and the self-reported incidence of stroke in adult US citizens aged 20 years or older on a cross-sectional basis. LE8 scores were classified as being high, moderate or low according to American Heart Association guidelines. The stroke status was ascertained through self-reporting, and the analysis was adjusted for potential confounders. In addition, restricted cubic spline (RCS) analyses were used to further analyse the potential non-linear correlation between the LE8 score and the risk of stroke.
Results
In our study, a total of 24 851 study participants were included, with 943 strokes and a male prevalence of 48.21%. After adjusting for all covariates, the odds of stroke were 2.17 (95% CI: 1.41 to 3.33) and 4.81 (95% CI: 3.07 to 7.56) in those with medium and low LE8 scores compared with those with a high LE8 score, respectively. Both the health behaviour score and the health factor score exhibit a significant association with stroke risk. RCS further confirmed that the association was linear. Finally, subgroup analysis has further confirmed the robustness of the observed associations.
Conclusions
Our observation suggests an important independent negative association between LE8 score and stroke risk. This study demonstrates the utility of LE8 as a public health tool for stroke risk stratification and emphasises the importance of cardiovascular health in stroke prevention.
Keywords: Cardiovascular Disease, Stroke, Risk Factors
STRENGTHS AND LIMITATIONS OF THIS STUDY.
The cross-sectional design prevents causal inference.
Some Life’s Essentials 8 components rely on self-reported data, introducing potential bias.
Unmeasured confounders may remain due to dataset limitations.
Prospective studies are needed to confirm these findings.
Introduction
Stroke imposes a substantial economic burden and remains a significant public health challenge worldwide, particularly in the USA. The WHO estimates that a staggering 15 million individuals worldwide are affected by strokes annually, which cause 5 million fatalities and 5 million permanent disabilities.1 2 In 2020, around 6.6 million people died because of stroke, which is considered to be the second-leading cause of death globally.3 Stroke not only poses a significant threat to human health. The estimated cost of stroke in the USA is around US$68 billion annually.4 Identifying and understanding the modifiable risk factors for stroke is of utmost importance for public health. While much attention has been paid to stroke mortality, non-fatal stroke events also contribute substantially to the overall burden of disease, leading to long-term disability and reduced quality of life.5
Life’s Simple 7 (LS7) is a concept that was defined by the American Heart Association (AHA) in 2010.6 It is used to evaluate cardiovascular health (CVH) and encourage a change in perspective from treating diseases exclusively to actively promoting and safeguarding health throughout a person’s or population’s life. The AHA modified LS7 in 2022 and proposed an enhanced total score called Life’s Essential 8 (LE8) for evaluating CVH.7 8 As opposed to LS7, the LE8 approach exhibits a higher level of thoroughness and sensitivity when it comes to detecting and accounting for interindividual differences, and it acknowledges the role sleep plays in avoiding heart disease and other cardiovascular disorders. Diet, exercise, exposure to nicotine, sleep quality, body mass index (BMI), lipids, blood sugar and blood pressure are all involved in LE8.
The LE8 CVH status assessment tool is a powerful tool for tracking both individual and societal health, and it provides evidence of the remarkable potential of early preventative techniques to enhance and prolong countless lives.7 One tool proposed for boosting brain health is the CVH score.9 Prior research has demonstrated a correlation between LS7 and stroke disability in the USA.10 However, a study quantifying the correlation between LE8 and stroke is still lacking. Thus, the purpose of this study was to examine the relationship between LE8 and non-fatal stroke in the US population using data from the 2005–2018 National Health and Nutrition Examination Survey (NHANES) in order to supplement existing knowledge and strengthen the case for a potential link between LE8 and non-fatal stroke.
Materials and methods
Date sources and study population
The NHANES, conducted by the National Center for Health Statistics (NCHS), is designed to evaluate the health and nutritional status of adults and children in the USA. NHANES collects data across five sections: demographics, dietary, examination, laboratory and questionnaire, providing valuable opportunities for identifying risk factors. Using a stratified, multistage probability cluster sampling technique, each participant is assigned a sample weight to represent the US civilian non-institutionalised population. The study protocol was approved by the NCHS Research Ethics Review Board, and participants provided written informed consent on enrolment. The data used in this investigation came from the NHANES database, which may be accessed (www.cdc.gov/nchs/nhanes.com). The aim was to assess the health status of Americans who are 20 years of age or older. Within the USA, the data samples were collected from various states and counties. All NHANES participants (n=85 750) between 2005 and 2018 provided samples for this study. Participants under the age of 20 (n=36 769), those without demographic information (n=5196), those with missing stroke information (n=76), those who were pregnant (n=633) and those lacking LE8 information (n=18 225) were not included. There were (n=24 851) participants in the analysis sample overall. Figure 1 provides details about the screening procedure.
Figure 1. The flow chart of participant selection. LE8, Life’s Essential 8.
Patient and public involvement
This study was based on publicly available NHANES data. Patients and the public were not involved in the design, conduct, reporting or dissemination plans of this research.
Measurement of LE8
Recently, the AHA unveiled LE8, a tool for assessing CVH. CVH consists of two components: health factors (BMI, non-high density lipoprotein (HDL) cholesterol, blood glucose and blood pressure) and health behaviours (diet, physical activity, exposure to nicotine and sleep health). The average ratings for each of the eight indications were calculated, and grading on a scale ranging from 0 to 100 points was used to get the overall LE8 score. Those with an AHA LE8 score of 80 or higher were classified as having high CVH. People who scored less than 50 on the LE8 scale were classified as mild CVH, while those who scored between 50 and 79 were classified as moderate CVH.7
Assessment of stroke
The determination of a stroke was made using the patient’s self-reported history of diagnosis from a physician during a live interview. People answering in the positive when asked the question, “Have you ever been informed by a physician or healthcare provider that you experienced a stroke?” were classified as having experienced a stroke. Thus, this approach primarily captures symptomatic stroke events. However, it is possible that a small number of individuals with asymptomatic (covert) brain infarction, who were diagnosed by imaging and subsequently informed by their physicians, may also have been included. It is crucial to remember that using self-reported measurements could lead to memory bias, which could affect how the data are interpreted. Furthermore, even though the NHANES database does not include precise information about the kind of stroke, it is likely that the majority of participants who experienced a stroke during the study did so due to ischaemic strokes.
Covariates
We compiled a list of potential confounding variables that might influence the association between LE8 and stroke in our multivariable-adjusted model. In order to avoid model overfitting, fewer factors were changed in this study due to the huge number of projects in LE8.11 Age was one of the covariates in our study (20–39 years, 40–59 years and ≥60 years) along with gender, race (other Hispanic, Mexican American, non-Hispanic white, non-Hispanic black and other race), marital status (married or living with partner, never married, widowed, divorced or separated), education level (high school or less, some college, college graduate or higher) and poverty income ratio (PIR) (≤1.3, 1.4–3.5 and >3.5).
Statistical analysis
Initially, we separated the data into two categories: stroke and non-stroke. For categorical data, proportions with their corresponding 95% CI were used, while weighted means and SD were used to express continuous variables. Comorbidities are shown by frequency. For continuous variables, we employed independent sample t-tests to ascertain differences between the two groups, while χ2 tests were applied for categorical data. The means of each component were then determined, and the differences between non-stroke and stroke were examined. Third, two adjusted models (Model I and Model II) and one unadjusted model (Model I) were among the multivariate logistic regression models used to evaluate the relationship between LE8 and stroke. There is no covariate adjustment in an unadjusted model. Age and sex adjustments were made to the basic model I. Model II was a completely adjusted model that took into account factors including income, education level, race, sex, marital status and age. As was already indicated, we used an unweighted analysis to further examine the result. Furthermore, an interaction test was incorporated to examine the potential impact of variables on the correlation between the LE8 score and stroke.
R V.4.1.2 (The R Foundation) and Empower software (X&Y Solutions, Boston, Massachusetts, USA) were used for all analyses. At p values <0.05, statistical significance was taken into account.
Results
Baseline characteristics of participants
In the final study, we evaluated the association between LE8 score and stroke incidence in 24 851 participants aged 20 years or older, including 943 stroke cases (table 1). Significant disparities were observed between the stroke group and the non-stroke group for all clinical characteristics except for the Healthy Eating Index-2015 dietary score. In the stroke group, there was a predominance of participants older than 60 years, and a lower proportion of individuals aged 20–40 years. In addition, subjects who were women, Mexican American, had PIR ≤1.3, had high school education or less and divorced were over-represented in the stroke group. Not only that, but lower LE8 scores were also strongly associated with an increased incidence of stroke. Physical activity, sleep quality, BMI, exposure to nicotine, blood pressure and blood glucose are a few examples that also showed significant differences between the two groups, with all scores being higher in non-stroke participants.
Table 1. Clinical characteristics of study population.
| Variables | Overall(n=24 851) | Non-stroke(n=23 908) | Stroke(n=943) | P value |
|---|---|---|---|---|
| Age | 47.82 (47.32 to 48.32) | 47.34 (46.85 to 47.84) | 64.79 (63.51 to 66.07) | <0.0001 |
| Age, years % | <0.0001 | |||
| 20–39 years | 34.73 (33.06 to 36.39) | 35.58 (34.29 to 36.87) | 4.53 (2.68 to 6.38) | |
| 40–59 years | 38.86 (36.55 to 41.18) | 39.19 (38.12 to 40.27) | 27.12 (23.02 to 31.22) | |
| ≥60 years | 26.41 (24.59 to 28.23) | 25.23 (24.05 to 26.40) | 68.35 (64.33 to 72.37) | |
| Sex-male, % | 0.02 | |||
| Male | 48.21 (45.87 to 50.55) | 48.37 (47.73 to 49.01) | 42.58 (37.98 to 47.18) | |
| Female | 51.79 (49.32 to 54.26) | 51.63 (50.99 to 52.27) | 57.42 (52.82 to 62.02) | |
| Race, % | <0.0001 | |||
| Non-Hispanic white | 7.57 (6.47 to 8.68) | 7.67 (6.45 to 8.90) | 4.06 (2.87 to 5.24) | |
| Non-Hispanic black | 9.92 (8.91 to 10.93) | 9.81 (8.58 to 11.04) | 13.72 (11.29 to 16.15) | |
| Mexican American | 70.94 (65.56 to 76.32) | 70.88 (68.48 to 73.27) | 73.18 (68.94 to 77.43) | |
| Other Hispanic | 4.93 (4.20 to 5.66) | 4.99 (4.19 to 5.79) | 2.72 (1.73 to 3.71) | |
| Other | 6.64 (6.07 to 7.21) | 6.65 (6.02 to 7.27) | 6.32 (3.96 to 8.68) | |
| Poverty income ratio, % | <0.0001 | |||
| ≤1.3 | 19.56 (18.41 to 20.71) | 19.27 (18.10 to 20.44) | 29.70 (25.59 to 33.80) | |
| 1.4–3.5 | 35.93 (33.86 to 38.01) | 35.64 (34.31 to 36.97) | 46.13 (41.78 to 50.49) | |
| >3.5 | 44.51 (41.30 to 47.73) | 45.09 (43.13 to 47.04) | 24.17 (20.20 to 28.13) | |
| Education, % | <0.0001 | |||
| High school or less | 37.00 (34.64 to 39.36) | 36.51 (34.75 to 38.27) | 54.26 (49.85 to 58.67) | |
| Some college | 31.75 (30.11 to 33.39) | 31.88 (30.85 to 32.91) | 26.88 (23.45 to 30.31) | |
| College graduate or higher | 31.26 (28.69 to 33.83) | 31.61 (29.69 to 33.53) | 18.86 (15.35 to 22.38) | |
| Marital status, % | <0.0001 | |||
| Married | 65.02 (61.17 to 68.87) | 65.14 (63.87 to 66.42) | 60.60 (56.57 to 64.64) | |
| Never married | 16.89 (15.90 to 17.88) | 17.20 (16.08 to 18.32) | 5.93 (4.13 to 7.73) | |
| Divorced | 18.10 (17.08 to 19.11) | 17.66 (16.90 to 18.42) | 33.47 (29.60 to 37.33) | |
| LE8 | 68.32 (67.86 to 68.78) | 68.63 (68.17 to 69.09) | 57.32 (56.02 to 58.61) | <0.0001 |
| HEI-2015 diet score | 39.37 (38.49 to 40.25) | 39.42 (38.52 to 40.32) | 37.75 (35.32 to 40.19) | 0.21 |
| Physical activity score | 71.60 (70.69 to 72.51) | 72.28 (71.34 to 73.22) | 47.46 (43.18 to 51.75) | <0.0001 |
| Blood lipids score | 71.55 (70.60 to 72.51) | 71.74 (70.80 to 72.69) | 64.88 (61.69 to 68.07) | <0.0001 |
| Sleep health score | 83.47 (82.95 to 84.00) | 83.71 (83.19 to 84.23) | 75.27 (72.70 to 77.84) | <0.0001 |
| Body mass index score | 60.52 (59.71 to 61.32) | 60.70 (59.88 to 61.52) | 54.06 (50.91 to 57.21) | <0.001 |
| Nicotine exposure score | 64.35 (63.70 to 65.00) | 64.44 (63.77 to 65.10) | 61.26 (58.79 to 63.73) | 0.02 |
| Blood glucose score | 86.14 (85.68 to 86.60) | 86.62 (86.15 to 87.08) | 69.30 (66.73 to 71.87) | <0.0001 |
| Blood pressure score | 69.55 (68.88 to 70.22) | 70.15 (69.47 to 70.82) | 48.55 (45.87 to 51.24) | <0.0001 |
Continuous variables are presented as the mean (95% CI), and category variables are presented as proportions (95% CI).
HEI, Healthy Eating Index; LE8, Life’s Essential 8.
Relationship between LE8 score and stroke
In table 2, we explored the association between LE8 score and stroke by weighted logistic regression analysis. Our findings revealed a negative correlation between the LE8 score and the risk of stroke, specifically a heightened risk of stroke in participants with moderate and low LE8 score compared with the reference group with a high LE8 score by a factor of 2.17 (95% CI: 1.41 to 3.33, p<0.001) and 4.81 (95% CI: 3.07 to 7.56, p<0.001) after adjusting for covariates in Model II. In addition, both health behaviour scores and health factor scores exhibited significant correlations with the risk of stroke, with a stroke OR of 1.63 (95% CI: 1.32 to 2.02, p<0.001) and 3.00 (95% CI: 2.34 to 3.85, p<0.001). In the moderate and low scoring groups, respectively, OR were 1.22 (95% CI: 0.90 to 1.65, p<0.001) and 1.93 (95% CI: 1.38 to 2.71, p<0.001).
Table 2. Weighted logistic regression analysis on the association between LE8 score and stroke.
| Non-adjusted model | P value | Model I | P value | Model II | P value | |
|---|---|---|---|---|---|---|
| OR (95% CI) | OR (95% CI) | OR (95% CI) | ||||
| LE8 score | ||||||
| High (≥80) | Reference | – | Reference | – | Reference | – |
| Moderate (50–79) | 3.88 (2.54 to 5.92) | <0.001 | 2.55 (1.67 to 3.89) | <0.001 | 2.17 (1.41 to 3.33) | <0.001 |
| Low (LE8 <50) | 12.3 (7.89 to 19.1) | <0.001 | 6.69 (4.30 to 10.4) | <0.001 | 4.81 (3.07 to 7.56) | <0.001 |
| Health behaviours score | ||||||
| High (≥80) | Reference | – | Reference | – | Reference | – |
| Moderate (50–79) | 1.77 (1.44 to 2.19) | <0.001 | 1.85 (1.50 to 2.28) | <0.001 | 1.63 (1.32 to 2.02) | <0.001 |
| Low (LE8 <50) | 3.69 (2.91 to 4.69) | <0.001 | 3.94 (3.12 to 4.99) | <0.001 | 3.00 (2.34 to 3.85) | <0.001 |
| Health factors score | ||||||
| High (≥80) | Reference | – | Reference | – | Reference | – |
| Moderate (50–79) | 2.52 (1.89 to 3.36) | <0.001 | 1.30 (0.97 to 1.76) | 0.08 | 1.22 (0.90 to 1.65) | 0.02 |
| Low (LE8 <50) | 5.64 (4.12 to 7.70) | <0.001 | 2.31 (1.67 to 3.19) | <0.001 | 1.93 (1.38 to 2.71) | <0.001 |
Model I: adjusted for age and gender.
Model II: additionally adjusted for race/ethnicity, education, marital status, family income ratio.
LE8, Life’s Essential 8.
Restricted cubic spline analysis
In figure 2, we conducted a more in-depth analysis of the relationship between the LE8 score, its constituent health behaviours score, and health factors score, with the risk of stroke, using the restricted cubic spline method. We discovered a significant correlation between the LE8 score and the risk of stroke, specifically a notable negative linear relationship between the LE8 score and stroke risk (overall p value <0.001). As the LE8 score increased, the risk of stroke gradually decreased. No non-linear association was detected across the entire range of the LE8 score (non-linear p value = 0.612). In addition, the health behaviour score and the health factor score similarly demonstrated significant negative linear relationships with stroke risk (overall p value <0.001).
Figure 2. (A) Restricted spline curves of LE8 score for stroke. (B) Health behaviour score for stroke. (C) Health factor score for stroke. LE8, Life’s Essential 8.
Subgroup analysis
In figure 3, we show the association between LE8 score and stroke risk in different subgroups through a forest plot. Subgroup analyses revealed generally consistent negative associations between LE8 score and stroke risk across subgroups of age, sex, race, PIR, education level and marital status, which were also considered in our analysis. In addition, the calculation of interaction p values showed that no significant interaction was found for the association between LE8 score and stroke risk across all compared subgroups.
Figure 3. Subgroup analysis of multivariable adjusted association of LE8 score with the risk of stroke. LE8, Life’s Essential 8.
Sensitivity analysis
To ensure the robustness and reliability of our primary findings, we performed additional analyses in which we used unweighted data to assess the association between LE8 score and stroke in table 3. In the unweighted sensitivity analysis, the negative association between LE8 score and stroke risk remained significant. Specifically, the OR of moderate LE8 score versus high score to stroke risk was 2.21 (95% CI: 1.62 to 3.12, p<0.001) and 4.60 (95% CI: 3.30 to 6.57, p<0.001), respectively. We validated the health behaviour score and the health factor score from the unweighted analyses, showing a significant negative correlation.
Table 3. Unweighted logistic regression analysis on the association between LE8 score and stroke in sensitive analysis.
| Non-adjusted model | P value | Model I | P value | Model II | P value | |
|---|---|---|---|---|---|---|
| OR (95% CI) | OR (95% CI) | OR (95% CI) | ||||
| LE8 score | ||||||
| High (≥80) | Reference | – | Reference | – | Reference | – |
| Moderate (50–79) | 4.31 (3.81 to 6.01) | <0.001 | 2.64 (1.94 to 3.70) | <0.001 | 2.21 (1.62 to 3.12) | <0.001 |
| Low (LE8 <50) | 12.1 (8.79 to 17.0) | <0.001 | 6.28 (4.55 to 8.89) | <0.001 | 4.60 (3.30 to 6.57) | <0.001 |
| Health behaviours score | ||||||
| High (≥80) | Reference | – | Reference | – | Reference | – |
| Moderate (50–79) | 1.79 (1.48 to 2.18) | <0.001 | 1.82 (1.49 to 2.22) | <0.001 | 1.61 (1.32 to 1.97) | <0.001 |
| Low (LE8 <50) | 3.65 (2.99 to 4.48) | <0.001 | 3.78 (3.08 to 4.65) | <0.001 | 2.93 (2.37 to 3.64) | <0.001 |
| Health factors score | ||||||
| High (≥80) | Reference | – | Reference | – | Reference | – |
| Moderate (50–79) | 2.86 (2.33 to 3.53) | <0.001 | 1.41 (1.15 to 1.76) | 0.02 | 1.35 (1.09 to 1.68) | 0.006 |
| Low (LE8 <50) | 5.60 (4.51 to 6.99) | <0.001 | 2.29 (1.83 to 2.88) | <0.001 | 2.02 (1.61 to 2.55) | <0.001 |
Model I: adjusted for age and gender.
Model II: additionally adjusted for race/ethnicity, education, marital status and family income ratio.
LE8, Life’s Essential 8.
Discussion
To our knowledge, this represents the initial study to explore the relationship between LE8 score and stroke risk using a large, nationally representative sample. Our findings confirm a significant and independent inverse association between LE8 score and the risk of stroke, which remains consistent across various subgroups defined by age, sex, race, PIR, education level and marital status. Additionally, both health behaviour score and health factor score demonstrated a negative relationship with stroke risk. These results underscore the potential value of improving lifestyle and health management to reduce the risk of stroke.
The LE8 score, proposed by the AHA, is a comprehensive metric reflecting overall CVH by incorporating both behavioural and biological factors.7 In contrast, established cardiovascular risk models such as the Framingham Risk Score and SCORE2 primarily focus on predicting the 10-year risk of clinical cardiovascular events using a limited set of clinical variables, including age, blood pressure, cholesterol and smoking status.12 13 While these traditional models are widely used for risk stratification and clinical decision-making, the LE8 score offers a broader assessment by capturing modifiable lifestyle factors that contribute to cardiovascular risk but are not included in most risk prediction equations. Recent studies have shown that higher LE8 or its predecessor LS7 scores are associated with a lower risk of cardiovascular diseases, including stroke, independent of traditional risk models. Therefore, the LE8 score may complement established risk models by providing additional information on CVH and prevention, particularly in cross-sectional analyses examining associations with prevalent stroke. The LE8 score encompasses two main categories: health behaviours and health factors, covering eight aspects including diet, physical activity, nicotine exposure, sleep health, BMI, non-HDL cholesterol, blood glucose and blood pressure.7 Numerous studies have established an inseparable link between the components of LE8 and the incidence of stroke. A review of eight global cohort studies confirmed that a higher intake of dietary fibre is associated with a lower risk of first-time stroke.14 Furthermore, a longitudinal study from the UK, with a median follow-up of 7.7 years, found that physical activity, including vigorous exercise, household chores and walking, was associated with a reduced risk of stroke to varying degrees.15 Additionally, smoking, sleep, BMI and HDL have all been confirmed in studies to be associated with stroke risk.16,19
Moreover, previous research has revealed that LE8 has a positive association with the reduced incidence of various diseases, including chronic kidney disease and cognitive and psychological impairments.20 21 A study by Shen et al, surveying depression among 21 942 participants in the USA, found a significant inverse and non-linear relationship between LE8 scores and depression, which was sex-dependent.21 Another study by Chen et al, conducted in a population with a 50.48% prevalence of periodontitis, found a negative correlation between LE8 scores and the likelihood of suffering from periodontitis.22 In our study, the inverse relationship between LE8 scores and stroke further reinforces this notion, highlighting the importance of LE8 as a functional and utilitarian composite indicator for assessing and maintaining a healthy lifestyle. Healthier diet, reduced nicotine exposure, improved sleep health and optimisation of metabolic syndrome indicators can mitigate vascular inflammation.23 24 Vascular inflammation induces the migration of inflammatory cells to the vascular wall and increases vascular permeability, leading to endothelial dysfunction, platelet aggregation and thrombus formation, which may explain the association between LE8 and stroke.
Furthermore, we also explored the association between health behaviour scores and health factor scores with stroke, finding a similar negative correlation. In subgroup analyses, we identified no factors that could influence this negative correlation, and sensitivity analyses further confirmed the robustness of our findings.
While our cohort is relatively young, this age profile may have important implications for the interpretation and generalisability of our findings. Younger participants typically have a lower baseline risk of stroke and may have had less cumulative exposure to risk factors, which could attenuate the observed associations between LE8 and prevalent stroke. Additionally, age-related physiological changes and comorbidities that influence stroke risk might not be fully captured in a younger population. As a result, our findings may not be directly generalisable to older adults, in whom the burden of stroke—and the impact of cardiovascular risk factors—may be greater. Future studies in older or more diverse populations are warranted to validate and extend our findings.
Although our study used survey data representative of the entire US population, it does have some limitations. First, due to the cross-sectional nature of the NHANES data, we cannot establish a causal relationship between LE8 scores and stroke. Future studies should employ prospective cohort study designs to further validate these findings. Second, some indicators in the LE8 score, such as diet and physical activity, are based on self-reported data, which may be subject to reporting bias. Additionally, due to the limitations of the NHANES dataset, there may be potential confounding factors that we did not account for in our study, which should be considered when applying our conclusions. Last but not least, health behaviours may have been influenced by a history of stroke and should be considered as reverse causation bias.
Conclusions
In summary, our study results underscore an independent inverse correlation between LE8 scores and the risk of stroke. The enhancement of LE8 scores may contribute to the reduction of individual stroke risk, which could assist medical professionals and public health experts in identifying high-risk populations for stroke and providing targeted preventive strategies.
Footnotes
Funding: Supported by the Traditional Chinese Medicine Science and Technology Program of Zhejiang Province (no.2023ZL351) and Key Discipline of Rehabilitation Medicine in Tongde Hospital of Zhejiang Province (no.2D02208).
Prepublication history for this paper is available online. To view these files, please visit the journal online (https://doi.org/10.1136/bmjopen-2024-093362).
Data availability free text: The data sets generated during the current study are available in NHANES database (URL: https://www.cdc.gov/nchs/nhanes/).
Patient consent for publication: Not applicable.
Ethics approval: Not applicable.
Provenance and peer review: Not commissioned; externally peer reviewed.
Patient and public involvement: Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.
Data availability statement
Data are available in a public, open access repository.
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