Influence of physical activity measurement on the association between Life's Essential 8 and incident cardiovascular disease in older women

Eric T Hyde; Steve Nguyen; Michael J LaMonte; Chongzhi Di; John Bellettiere; Lesley F Tinker; Randi E Foraker; Hilary A Tindle; Marcia L Stefanick; Andrea Z LaCroix

doi:10.1016/j.pmedr.2024.102904

Influence of physical activity measurement on the association between Life's Essential 8 and incident cardiovascular disease in older women

Prev Med Rep. 2024 Oct 12:47:102904. doi: 10.1016/j.pmedr.2024.102904. eCollection 2024 Nov.

Authors

Eric T Hyde^{1

2}, Steve Nguyen¹, Michael J LaMonte³, Chongzhi Di⁴, John Bellettiere¹, Lesley F Tinker⁴, Randi E Foraker⁵, Hilary A Tindle^{6

7}, Marcia L Stefanick⁸, Andrea Z LaCroix¹

Affiliations

¹ Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, United States.
² Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, United States.
³ Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo - SUNY, Buffalo, NY, United States.
⁴ Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, United States.
⁵ Division of General Medical Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, United States.
⁶ Vanderbilt University Medical Center, Nashville, TN, United States.
⁷ Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, United States.
⁸ Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States.

Abstract

Objective: The American Heart Association's Life's Essential 8 (LE8) metric includes self-reported physical activity as one of the metrics for assessing cardiovascular health. Self-reported physical activity is prone to misclassification, whereas accelerometer measures are less biased. We examined associations of LE8 and incident cardiovascular disease (CVD) using self-reported and accelerometer-measured physical activity.

Methods: Participants in the Women's Health Initiative (WHI) Objective Physical Activity and Cardiovascular Health Study (n = 4,243; mean age = 79 ± 7 years) with no CVD history completed the WHI physical activity questionnaire and the Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire prior to wearing a hip-worn accelerometer for up to seven days in 2012-2014. LE8 components (physical activity, diet, sleep, body mass index, smoking, blood pressure, non-HDL cholesterol, and glucose) were scored according to guidelines. Scores were created using five physical activity measures: WHI questionnaire (LE8_WHI), CHAMPS (LE8_CHAMPS), accelerometer-measured physical activity (LE8_A), and sample quantiles of accelerometer-measured physical activity (LE8_AQ) and daily steps (LE8_STEPS). Hazard ratios (HR) for physician-adjudicated CVD were estimated using Cox regression.

Results: 707 incident CVD events occurred over an average 7.5 years. Multivariable HRs (95 % CI) comparing women in the highest vs. lowest quartiles of LE8 scores were: LE8_WHI = 0.53 (0.43-0.67), LE8_CHAMPS = 0.47 (0.38-0.60), LE8_A = 0.44 (0.36-0.56), LE8_AQ = 0.44 (0.35-0.55), and LE8_STEPS = 0.45 (0.35-0.57).

Conclusions: The LE8-incident CVD association varies by physical activity measurement, however all methods showed reduced risk. Device-measures of physical activity may be more accurate in the LE8, but when impractical to implement, also support use of self-reported measures.

Keywords: Accelerometer; Cardiovascular health; Device; Questionnaire; Steps; Women’s health.