Life’s Essential 8 Score and 10-year Cardiovascular Outcomes in People with Atrial Fibrillation: A UK Biobank Analysis with Simulated Lifestyle Improvement

Fitzhugh, CJ, Jones, H ORCID: 0000-0001-8282-1459, Foweather, L ORCID: 0000-0001-9851-5421 and Buckley, BJR ORCID: 0000-0002-1479-8872 (2025) Life’s Essential 8 Score and 10-year Cardiovascular Outcomes in People with Atrial Fibrillation: A UK Biobank Analysis with Simulated Lifestyle Improvement. American Journal of Preventive Cardiology. p. 101399. ISSN 2666-6677

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Abstract

Background
Atrial fibrillation (AF) is associated with high risks of mortality and cardiovascular events, yet the prognostic value of comprehensive lifestyle and clinical health metrics remains uncertain.

Objective
To investigate whether cardiovascular health (CVH), as measured by the American Heart Association's Life’s Essential 8 (LE8) score, is associated with clinical outcomes in people with AF, and to estimate the impact of simulated improvement in CVH components.

Methods
Data were drawn from the UK Biobank, a prospective population-based cohort. Participants with AF were identified using ICD codes. CVH was assessed using a modified LE8 score (range 0–100), derived from smoking status, cholesterol, blood pressure, BMI, HbA1c, physical activity, diet, and sleep. Primary outcomes were all-cause mortality and major adverse cardiovascular events (MACE: ischaemic heart disease, myocardial infarction, stroke, and heart failure). Associations were analysed using Cox models with penalised splines, presented in Kaplan-Meier curves. Population attributable and potential impact fractions were estimated.

Results
Among 23,758 individuals with AF and 10-year follow-up, higher CVH scores associated with lower risk of all-cause mortality and MACE in a non-linear, graded pattern. Compared with the lowest quartile, the highest CVH quartile had 39% lower risk of all-cause mortality (HR: 0.61, 95% CI: 0.56–0.67) and 38% lower risk of MACE (HR: 0.62, 95% CI: 0.58–0.67; both p<0.001). Associations were modified by age and multimorbidity. Simulated improvements in CVH could reduce all-cause mortality by 10% and MACE by 7%, with diet, smoking, blood pressure, and BMI contributing most.

Conclusion
Higher LE8 scores were independently associated with lower all-cause mortality and MACE risk in people with AF, supporting the role of lifestyle-based secondary prevention in AF care.

Item Type:	Article
Uncontrolled Keywords:	32 Biomedical and Clinical Sciences; 3201 Cardiovascular Medicine and Haematology; Prevention; Physical Activity; Cardiovascular; Heart Disease; Cardiovascular; 3201 Cardiovascular medicine and haematology
Subjects:	Q Science > QP Physiology R Medicine > RC Internal medicine > RC1200 Sports Medicine
Divisions:	Sport and Exercise Sciences
Publisher:	Elsevier BV
Date of acceptance:	27 December 2025
Date of first compliant Open Access:	13 January 2026
Date Deposited:	13 Jan 2026 12:56
Last Modified:	13 Jan 2026 12:56
DOI or ID number:	10.1016/j.ajpc.2025.101399
URI:	https://researchonline.ljmu.ac.uk/id/eprint/27897

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