ESC Congress 2026 Abstract · Oct 26, 2026

Three distinct life’s essential 8 profiles and their links to cardiac disease and psychological vulnerability

By Hermans H, Van de Ven J, Kupper HM

Background: Life’s Essential 8 (LE8) provides a comprehensive framework for cardiovascular health, yet individuals may cluster into distinct lifestyle profiles that differ in psychological vulnerability and cardiac disease burden. Psychological factors such as depression, anxiety, and adverse childhood events are common among cardiac patients and may co-occur with poorer lifestyle patterns. Identifying lifestyle-based profiles may help clarify how combinations of LE8 behaviours relate to cardiac risk. Purpose: To identify latent classes based on dichotomized LE8 components and examine how demographic characteristics, presence of cardiac disease, and psychological factors differ across these classes. Methods: Latent class analysis was conducted in MPlus using dichotomized LE8 indicators in 2,768 participants (59.3% female; mean age = 66.0, SD = 10.3) from the Health and Retirement Study. Classes were characterized using age, sex, educational level, presence of cardiac disease (myocardial infarction, angina pectoris, heart failure, arrhythmia), depressive and anxiety symptoms, and adverse childhood events. Results: A three-class model offered the best fit. The healthy lifestyle class (32.2%) comprised individuals with predominantly favourable LE8 scores. The inactive but otherwise healthy class (12.6%) showed good overall LE8 scores but low physical activity levels. The unhealthy class (55.2%) was characterised by low activity levels and a higher probability of obesity and hypertension. Compared with the unhealthy class, the healthy lifestyle class had higher educational attainment (OR= 3.02, 95% CI= 2.01-4.52), were less likely to have a cardiac disease (OR= 0.54, 95% CI= 0.36-0.80), and reported fewer depressive (OR= 0.69, 95% CI= 0.57-0.83) and anxiety symptoms (OR= 0.92, 95% CI= 0.86-0.98). When compared with the inactive class, participants in the healthy lifestyle class were older (OR= 1.09, 95% CI= 1.04-1.13), more likely to be highly educated (OR= 2.94, 95% CI= 1.23-7.07), and reported fewer depressive symptoms (OR= 0.68, 95% CI= 0.54-0.86), but they had a higher likelihood of cardiac disease (OR= 3.99, 95% CI= 1.14-13.95). The inactive class was younger (OR= 0.92, 95% CI= 0.89-0.95) and were less likely to have a cardiac disease (OR= 0.13, 95% CI= 0.04-0.42) than the unhealthy class. Conclusions: Distinct lifestyle profiles based on LE8 domains are differentially associated with cardiac disease, demographic and psychological factors. Poorer LE8 profiles co-occurred with lower educational attainment and more depressive symptoms, supporting the notion that psychological vulnerability and socioeconomic disadvantage may contribute to unhealthy lifestyle patterns. These findings highlight the importance of integrating psychological assessment and support into lifestyle-based cardiovascular prevention strategies.Figure1_LE8_classes

doi.org/10.1093/eurheartj/ehag785.3560Open accessPopulations