Correlation between cardiovascular health score based on eight life factors and prognosis of ischemic stroke and mediating effect of clinical test indicators: a multicenter prospective cohort study

doi:10.12122/j.issn.1673-4254.2026.02.01

Abstract

Abstract:

Objective To investigate the association between cardiovascular health scores (CVH) based on Life's Essential 8 (LE8) and 90-day functional prognosis of patients with acute ischemic stroke (AIS) and explore the mediating role of laboratory indicators to provide evidence for secondary stroke prevention. Methods This multicenter, prospective cohort study was conducted among 599 AIS patients within 72 h of onset. The clinical data of the patients were collected, and the cardiovascular health (CVH) scores were calculated according to LE8 criteria. Functional prognosis of the patients at 90 days were assessed by telephone follow-up using the modified Rankin scale score (mRS), whose correlation with the total LE8 score and each individual item score were analyzed using multiple linear regression. Lasso regression analysis was used to select laboratory markers associated with 90-day mRS, and their mediating role in the LE8-outcome relationship were assessed using the Bootstrap method. Results After adjusting for confounders, the total LE8 score was found to inversely correlate with 90-day mRS score of the patients (β=-0.05, 95% CI: -0.06‒-0.041; P<0.001). The scores of 7 LE8 components (exercise, diet quality, nicotine exposure, sleep, body mass index, cholesterol, and blood pressure) were inversely correlated with 90-day mRS scores (all P<0.05). Among the laboratory parameters, fibrinogen (FIB) was positively correlated (β=0.215, 95% CI: 0.068‒0.361; P=0.0041) while MCHC (β=-0.012, 95% CI: -0.022‒-0.002; P=0.0229) and HRR (β=-0.007, 95% CI: -0.013‒0.00; P=0.042) were negatively correlated with 90-day mRS scores. FIB significantly mediated the relationship between LE8 scores and 90-day mRS scores with an indirect effect of -0.0019 (95% CI: -0.00381‒0.00; P=0.006) and a mediation proportion of 3.778% (95% CI: 0.00869‒0.08). Conclusion The CVH scores assessed by LE8 are inversely correlated with 90-day functional prognosis of AIS patients, suggesting the importance of maintaining good CVH for improving stroke outcomes. FIB, MCHC and HRR levels are inversely correlated with the patient prognosis, and FIB partially mediates the impact of LE8 scores on stroke outcomes.

Key words: Life's Essential 8, cardiovascular health score, acute ischemic stroke, prognosis, mediating effect

Xiaoxiao LIANG, Huilin LUAN, Pengzhen MA, Wenzhu DENG, Jiaxin JIN, Chenyang QUAN, Tingting CHEN, Youcai YANG, Yingzhen XIE. Correlation between cardiovascular health score based on eight life factors and prognosis of ischemic stroke and mediating effect of clinical test indicators: a multicenter prospective cohort study[J]. Journal of Southern Medical University, 2026, 46(2): 239-246.

Figures/Tables 6

References 39

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Characteristics	LE8 quartile grouping
Characteristics	1 (n=152)	2 (n=152)	3 (n=155)	4 (n=140)	t/c²/Z	P
Age (year)	67 (59,73)^b	62 (54, 73)^a	64.26 (58, 72)	63.5 (58, 71)^a	8.826	0.032
Male [n (%)]	101 (66.4)	115 (75.7)	108 (69.7)	100 (71.4)	3.248	0.355
Drinking [n (%)]	69 (45.4)	72 (47.4)	67 (43.2)	71 (50.7)	1.786	0.618
Alcohol abuse [n (%)]	92 (60.5)	104 (68.4)	85 (54.8)	80 (57.1)	6.703	0.082
BMI [kg/m², Median (P₂₅, P₇₅)]	29 (25.53, 32.40)^b	26.95 (23.56, 30.90)^ac	25.70 (222.40, 29.20)^ab	24.49 (23.00, 27.18)^ab	66.077	<0.001
Hypertension [n (%)]	108 (71.1)	117 (77.0)	127 (81.9)	97 (69.3)^c	7.984	0.046
Diabetes [n (%)]	58 (38.2)	71 (46.7)	72 (46.5)	68 (48.6)	3.908	0.272
Hyperlipemia [n (%)]	64 (42.1)	57 (37.5)	73 (47.1)	48 (34.3)	5.775	0.123
Coronary heart disease [n (%)]	39 (25.7)	31 (20.4)	37 (23.9)	25 (17.9)	3.126	0.373
Atrial fibrillation [n (%)]	7 (4.6)	8 (5.3)	10 (6.5)	7 (5.0)	0.575	0.902
Stroke [n (%)]	55 (36.2)	47 (30.9)	48 (31.0)	41 (29.3)	1.854	0.603
NIHSS (score)	3 (1.87, 7)^c	3 (2, 5)^c	2 (1, 4)^ab	2 (1, 4)^ab	24.211	<0.001
mRS (score)	2.50 (1, 4)^b	1 (0, 2)^c	1 (0, 2)^ab	1 (0, 1)^ab	105.189	<0.001

Characteristics	LE8 quartile grouping
Characteristics	1 (n=152)	2 (n=152)	3 (n=155)	4 (n=140)	t/c²/Z	P
Age (year)	67 (59,73)^b	62 (54, 73)^a	64.26 (58, 72)	63.5 (58, 71)^a	8.826	0.032
Male [n (%)]	101 (66.4)	115 (75.7)	108 (69.7)	100 (71.4)	3.248	0.355
Drinking [n (%)]	69 (45.4)	72 (47.4)	67 (43.2)	71 (50.7)	1.786	0.618
Alcohol abuse [n (%)]	92 (60.5)	104 (68.4)	85 (54.8)	80 (57.1)	6.703	0.082
BMI [kg/m², Median (P₂₅, P₇₅)]	29 (25.53, 32.40)^b	26.95 (23.56, 30.90)^ac	25.70 (222.40, 29.20)^ab	24.49 (23.00, 27.18)^ab	66.077	<0.001
Hypertension [n (%)]	108 (71.1)	117 (77.0)	127 (81.9)	97 (69.3)^c	7.984	0.046
Diabetes [n (%)]	58 (38.2)	71 (46.7)	72 (46.5)	68 (48.6)	3.908	0.272
Hyperlipemia [n (%)]	64 (42.1)	57 (37.5)	73 (47.1)	48 (34.3)	5.775	0.123
Coronary heart disease [n (%)]	39 (25.7)	31 (20.4)	37 (23.9)	25 (17.9)	3.126	0.373
Atrial fibrillation [n (%)]	7 (4.6)	8 (5.3)	10 (6.5)	7 (5.0)	0.575	0.902
Stroke [n (%)]	55 (36.2)	47 (30.9)	48 (31.0)	41 (29.3)	1.854	0.603
NIHSS (score)	3 (1.87, 7)^c	3 (2, 5)^c	2 (1, 4)^ab	2 (1, 4)^ab	24.211	<0.001
mRS (score)	2.50 (1, 4)^b	1 (0, 2)^c	1 (0, 2)^ab	1 (0, 1)^ab	105.189	<0.001

Variable	Model 1			Model 2			Model 3
Variable	β	95%CI	P	β	95% CI	P	β	95% CI	P
Physical activity score	-0.011	-0.015, -0.008	<0.001	-0.01	-0.013,-0.007	<0.001	-0.009	-0.012, -0.005	<0.001
Dash diet score	-0.017	-0.022, -0.012	<0.001	-0.016	-0.02,-0.011	<0.001	-0.014	-0.019, -0.009	<0.001
Nicotine exposure score	-0.004	-0.007, 0.00	0.0429	-0.006	-0.01,-0.002	<0.001	-0.005	-0.008, -0.001	0.0057
Sleep health score	-0.016	-0.019, -0.012	<0.001	-0.015	-0.019, -0.012	<0.001	-0.014	-0.017, -0.01	<0.001
Body mass index score	-0.005	-0.009, -0.001	0.0115	-0.005	-0.008, -0.001	0.0122	-0.006	-0.009, -0.002	0.0012
Blood lipid score	-0.009	-0.013, -0.005	<0.001	-0.009	-0.013, -0.005	<0.001	-0.007	-0.011, -0.003	<0.001
Blood glucose score	-0.003	-0.006, 0.001	0.1543	-0.002	-0.005,0.002	0.3338	0.000	-0.004, 0.003	0.924
Blood pressure score	-0.009	-0.013, -0.004	<0.001	-0.009	-0.013, -0.004	<0.001	-0.007	-0.012, -0.003	<0.001

Variable	Model 1			Model 2			Model 3
Variable	β	95%CI	P	β	95% CI	P	β	95% CI	P
Physical activity score	-0.011	-0.015, -0.008	<0.001	-0.01	-0.013,-0.007	<0.001	-0.009	-0.012, -0.005	<0.001
Dash diet score	-0.017	-0.022, -0.012	<0.001	-0.016	-0.02,-0.011	<0.001	-0.014	-0.019, -0.009	<0.001
Nicotine exposure score	-0.004	-0.007, 0.00	0.0429	-0.006	-0.01,-0.002	<0.001	-0.005	-0.008, -0.001	0.0057
Sleep health score	-0.016	-0.019, -0.012	<0.001	-0.015	-0.019, -0.012	<0.001	-0.014	-0.017, -0.01	<0.001
Body mass index score	-0.005	-0.009, -0.001	0.0115	-0.005	-0.008, -0.001	0.0122	-0.006	-0.009, -0.002	0.0012
Blood lipid score	-0.009	-0.013, -0.005	<0.001	-0.009	-0.013, -0.005	<0.001	-0.007	-0.011, -0.003	<0.001
Blood glucose score	-0.003	-0.006, 0.001	0.1543	-0.002	-0.005,0.002	0.3338	0.000	-0.004, 0.003	0.924
Blood pressure score	-0.009	-0.013, -0.004	<0.001	-0.009	-0.013, -0.004	<0.001	-0.007	-0.012, -0.003	<0.001

Variable	Univariate analysis			Multivariate analysis
Variable	β	95% CI	P	β	95% CI	P
WBC (×10⁹/L)	0.023	-0.022, 0.067	0.3152
RBC (×10¹²/L)	-0.04	-0.113, 0.033	0.2847
MCHC (g/L)	-0.02	-0.031, -0.009	<0.001	-0.012	-0.022, -0.002	0.0229
MCH (pg)	-0.051	-0.105, 0.003	0.063
HGB (g/L)	-0.014	-0.02, -0.008	<0.001
RDW (%)	0.019	-0.02, 0.057	0.3385
NE% (%)	0.031	0.019, 0.043	<0.001	0.007	-0.023, 0.036	0.6578
NE# (×10⁹/L)	0.078	0.027, 0.129	0.0028
LY% (%)	-0.036	-0.05, -0.022	<0.001	-0.01	-0.044, 0.023	0.5555
LY# (×10⁹/L)	-0.271	-0.413, -0.129	<0.001
MO% (%)	-0.038	-0.097, 0.02	0.1959
MO# (×10⁹/L)	0.053	-0.385, 0.491	0.812
PLT (×10⁹/L)	0.000	-0.002, 0.002	0.8917
NLR	0.063	0.028, 0.098	<0.001
HRR (g/dL)	-0.015	-0.021, -0.009	<0.001	-0.007	-0.013, 0	0.042
K (mmol/L)	-0.062	-0.39, 0.265	0.7087
NA (mmol/L)	0.00	-0.041, 0.04	0.9869
CL (mmol/L)	0.00	-0.035, 0.034	0.998
UREA (mmol/L)	0.076	0.014, 0.138	0.0166
Cr (μmol/L)	0.007	0.002, 0.011	0.0074
UA (μmol/L)	-0.001	-0.002, 0.001	0.3646
TP (g/L)	0.004	-0.001, 0.009	0.1576
ALB (g/L)	-0.067	-0.093, -0.041	<0.001	-0.02	-0.047, 0.007	0.1469
Glb (g/L)	0.006	-0.019, 0.031	0.6243
A/G	-0.588	-0.977, -0.20	0.0031
AST (U/L)	-0.003	-0.012, 0.006	0.5436
ALT (U/L)	-0.002	-0.01, 0.005	0.5344
GGT (U/L)	-0.002	-0.005, 0.001	0.2419
ALP (U/L)	0.004	-0.002, 0.01	0.1965
TBIL (μmol/L)	-0.005	-0.021, 0.011	0.5389
DBIL (μmol/L)	0.013	-0.038, 0.065	0.6095
IBIL (μmol/L)	-0.01	-0.03, 0.01	0.3184
TC (mmol/L)	0.022	-0.09, 0.134	0.6954
TG (mmol/L)	-0.145	-0.273, -0.016	0.0273
HDL-C (mmol/L)	-0.057	-0.531, 0.418	0.8151
LDL-C (mmol/L)	0.051	-0.092, 0.194	0.4821
HCY (μmol/L)	0.009	0.001, 0.018	0.0297
FBG (mmol/L)	0.015	-0.02, 0.049	0.4078
TyG	-0.152	-0.332, 0.029	0.1005
Non-HDL-C (mmol/L)	0.027	-0.095, 0.149	0.6686
PTA (%)	0.001	-0.007, 0.01	0.7792
D-D (μg/L)	0.00	0.00, 0.00	0.0759
PT (s)	0.032	-0.052, 0.116	0.4544
INR	0.303	-0.883, 1.489	0.6161
APTT (s)	-0.023	-0.05, 0.004	0.0997
FIB (g/L)	0.441	0.292, 0.591	<0.001	0.215	0.068, 0.361	0.0041
TT (s)	-0.005	-0.023, 0.013	0.6089