Life’s Essential 8, genetic predisposition, and risk of incident adult-onset asthma: a prospective cohort study

Adult-onset asthma (AOA) and cardiovascular diseases shared common risk factors and similar pathophysiologic resemblances. The American Heart Association (AHA) unveiled the life's essential 8 (LE8) to promote cardiovascular health (CVH). This study aimed to assess the overall impact of LE8 implementation on AOA prevention. According to the guideline of AHA's Construct of CVH in 2022, LE8 score was calculated from 8 health status concerning diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipids, blood glucose, and blood pressure. Cox proportional-hazards models were used to estimate effect sizes of associations between CVH, asthma genetic risk, and risk of incident AOA in participants selected from the UK Biobank study. A total of 6180 incident AOA cases occurred in 249,713 participants during an average of 11.60 y' follow-up. A higher LE8 score was associated with a lower risk of incident AOA with a significant linear trend (P < 0.0001). Every standard deviation increment of LE8 was associated with a 17% (HR: 0.83; 95% CI: 0.81, 0.85) lower risk of incident AOA. Compared with participants with low-CVH score, participants with moderate (HR: 0.72; 95% CI: 0.67, 0.78) and high CVH scores (HR: 0.52; 95% CI: 0.47, 0.58) were associated with a lower risk of incident AOA (P-trend < 0.0001). No significant multiplicative or additive interaction was found between LE8 score and genetic risks. Stratified analysis showed a consistent association between CVH and risk of incident AOA across different asthma polygenic risk score (PRS) levels. Compared with participants with high PRS and low CVH, participants with low PRS and high CVH experienced the lowest risk (HR: 0.28; 95% CI: 0.23, 0.34) of incident AOA. Our findings suggest that maintaining optimal CVH should be recommended as a preventive strategy for AOA, regardless of their asthma genetic risks.