ESC Congress 2026 Abstract · Oct 26, 2026
Adverse cardiac remodelling links life's essential 8 to heart failure risk
By Shyam-Sundar V, Hoang MT, Yang T et al.
Background: Life’s Essential 8 (LE8), comprising health behaviours and health factors is an initiative to improve and maintain individual and population cardiovascular health. Higher LE8 scores are associated with lower cardiovascular disease risk but it is unclear how LE8 and cardiovascular magnetic resonance (CMR) phenotypes affect heart failure risk. Purpose: To evaluate the longitudinal association between LE8 and incident heart failure, and quantify the extent to which this relationship is mediated by CMR phenotypes in the UK Biobank (UKBB). Methods: Baseline LE8 score for UKBB participants in the imaging substudy was calculated and categorised as low, moderate or high. CMR phenotypes encompassing left atrial (LA) and left ventricular (LV) measures of systolic function, volumes and mass were assessed at both initial and follow-up imaging visits. Linear mixed-effects models, adjusted for age, sex, ethnicity, Townsend index, and waist-to-hip ratio, were used to evaluate the association between high versus low LE8 and CMR phenotypes over time. Causal mediation analysis was employed to investigate the extent to which there was an association between LE8 and incident heart failure mediated by CMR phenotypes. Results: The mean LE8 score (n=81243) was 70±11, corresponding to moderate cardiovascular health and the mean age was 55±8 years. 52% of the imaging cohort studied were female. Median time to the follow-up imaging visit (n= 5004) was 15 years (14 to 16 years). In adjusted linear mixed-effects models, a higher LE8 score was significantly associated with a lower LV mass-to-volume ratio (LVMVR) (Figure 1). Across the imaging visits, higher LE8 scores were also associated with a higher LA ejection fraction (Figure 2). In causal mediation analysis, a higher LE8 score was associated with a significantly lower risk of incident heart failure (HR = 0.65, 95% confidence interval, 0.60–0.71). LV mass (LVM) was the most significant mediator accounting for 31.1% of the total effect of LE8 on the risk of heart failure. LVEDV and LAEF were also significant mediators but explained a much smaller proportion of the risk reduction (5.5% and 3.5% respectively) for heart failure. Other LV functional parameters such as ejection fraction and global longitudinal strain showed inconsistent mediation effects. Conclusions: Higher Life’s Essential 8 scores were associated with cardiac structural changes affecting the left atrium and left ventricle. Higher LE8 was significantly associated with a reduced risk of heart failure, a relationship partially mediated by favourable cardiac phenotypic changes including a lower LV mass, and a higher LA ejection fraction. The preservation of lower LV mass and LA function suggest pathways through which better cardiovascular health exerts its protective influence. These findings support cardiac remodelling as a measurable biomarker linking behavioural and cardiometabolic health to incident heart failure.