Associations of cardiovascular health with arterial health in adults free of cardiovascular disease.

Background: In adults without cardiovascular disease (CVD), there is limited understanding of the association between overall cardiovascular health (CVH) and arterial health. Methods: In 2330 Framingham Heart Study Offspring participants free of CVD (60±9 years; 57% women) with Life's Essential 8 (LE8) and applanation tonometry data (Exam 7), we calculated CVH scores per American Heart Association's LE8 guidelines. Multivariable-adjusted regression analyses examined the relations of LE8 with aortic stiffness and pressure pulsatility [negative inverse carotid-femoral pulse wave velocity (niCFPWV), central pulse pressure (CPP), respectively], and examined effect modification by age and sex. We also evaluated niCFPWV and CPP as mediators of the relation between LE8 and death outcomes (CVD, all-cause mortality). Results: Higher LE8 scores (better CVH) were associated with lower niCFPWV [standardized (std) β= -0.20±0.02, p<0.0001] and CPP (std β= -0.11±0.02, p<0.0001). While age- and sex- interactions were not significant, stratified analysis revealed stronger association of LE8 with arterial health in women (niCFPWV: std β= -0.11±0.02, p<0.0001 vs. std β= -0.06±0.03, p=0.04; CPP: std β= -0.13±0.03, p<0.001 vs. std β= -0.06±0.03, p=0.07 in women vs. men, respectively). niCFPWV and CPP mediated 19% and 10% of the association between LE8 and CVD mortality, respectively, and 17% and 15% of the association between LE8 and all-cause mortality, respectively. Conclusion: Better CVH measured by LE8 was associated with lower arterial stiffness and pressure pulsatility, both of which mediate a significant proportion of the associations between CVH and CVD/death outcomes. These findings underscore the importance of optimal cardiovascular health behaviors and factors in maintaining arterial health.