Only 13% of French adults have optimal heart health - here's what's driving the gap

Only 13% of French adults have optimal heart health - here's what's driving the gap

Despite universal access to healthcare, most French adults have suboptimal heart health - but new research shows that even modest improvements in lifestyle could dramatically limit cardiovascular risk.

Despite significant advances in medicine, cardiovascular disease remains a major cause of mortality worldwide. A recently published study in theAmerican Journal of Prudemitive Cardiologyfound that only 13% of French adults aged 18 to 69 years in metropolitan areas have optimal cardiovascular health. In this research, cardiovascular health was assessed using the American Heart Association's updated Life's Essential 8 (LE8) (replacing the previous LS7), which shows that a significant majority of the French population does not achieve ideal cardiovascular well-being.

Assessment of cardiovascular health

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Cardiovascular diseases (CVDs) remain a major global health problem despite advances in prevention and public health initiatives such as smoking bans. In 2019, CVDs accounted for a third of all deaths worldwide and continue to be a leading cause of disability. In the European Union, the economic burden of managing cardiovascular diseases (CVDs) reached €282 billion in 2021, with only a small portion of this spending allocated to primary prevention.

This situation highlights the urgent need for more effective prevention strategies. The American Heart Association developed the LE8 score, a tool for assessing and monitoring cardiovascular health in populations. Higher LE8 levels are associated with reduced incidence of cardiovascular disease (CVD), lower mortality rates, and improved overall health. However, ideal outcomes remain uncommon, and there is limited data on the factors that determine LE8 outcomes, particularly outside the United States.

The current study

In the present study, a team of scientists in France analyzed data from the Constances Cohort, a large-scale French study that recruited participants aged 18 to 69 years from different regions in metropolitan France between 2012 and 2019. Participants were randomly selected from the French national social security database.

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The researchers used design weights to ensure that the sample accurately represented the French population in terms of age, gender, socioeconomic status and geographical distribution. They then examined participants' cardiovascular health using the LE8 score, which includes eight components: diet, body mass index (BMI), physical activity levels, nicotine exposure, sleep health (a new addition to the AHA metrics), blood lipids, blood sugar levels, and blood pressure.

Diet was assessed using a food frequency questionnaire, while physical activity and sleep duration were self-reported by participants. Nicotine exposure was determined from self-reported smoking status, and BMI was calculated from measurements at health assessment centers. Additionally, blood pressure, lipid levels, and blood glucose were measured by standardized tests (with the exception of HbA1c, which was self-reported by 99% of participants and measured in only 1%). The LE8 score for each of the eight components ranged from 0 to 100, with the total LE8 score being the average of these components.

The study also considered various covariates, including gender, age, rural or urban residence, socio-professional status, education level, cohabitation status (partner/no partner), alcohol consumption, depressive symptoms, socioeconomic deprivation, and family history of CVD.

Results

The study found that the average LE8 score for French adults was 66.11, with women scoring higher than men (68.92 versus 62.79). Only 13.21% of participants achieved a high LE8 score (equal to or more than 80 points). The majority (76.81%) had moderate scores (50–79 points) and 9.43% had low scores (below 50 points).

Among the individual components of the LE8 score, diet had the lowest average score (41.50) and blood sugar had the highest (95.50). These scores demonstrated significant variation in achieving optimal cardiovascular health, with dietary habits being a particularly critical area for improvement.

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Several factors have been identified as predictors of higher LE8 scores, including younger age, female gender, higher education, self-employment, fewer depressive symptoms, no partner, lower alcohol consumption, living in rural areas, lower socioeconomic deprivation, and no family history of cardiovascular disease (CVD). These results suggest that both individual behaviors and socioeconomic diseases play a critical role in cardiovascular health.

Notably, women were almost three times as likely as men to achieve a high LE8 score (18.3% versus 7.2%). The study also discussed how biological, psychosocial and health access factors – such as education, depression and alcohol consumption – may contribute to this inequality.

The researchers also found that LE8 levels tended to decrease with age, particularly from young adulthood to midlife, after which they plateaued, highlighting the need for lifelong, age-adjusted prevention strategies.

The study also estimated that a significant proportion of cardiovascular events could be prevented by improving LE8 levels in the population. If all participants achieved a high LE8 score, 81% of CVD events could potentially be avoided, assuming comparable CVD incidence rates across populations. Even a modest improvement in LE8 values ​​could prevent 68% of events. In addition, the researchers estimated that increasing the percentage of the population with high LE8 levels from 13% to 20% could avert approximately 14% of cardiovascular events.

The researchers acknowledged several limitations, including the incompleteness of the dietary metrics due to missing data on fiber and sodium levels, self-reported Hba1c data, and the potential for bias in self-reported data. They also noted that the study excluded individuals from French foreign territories, limiting generalizability. Despite these limitations, the study provided valuable insights into the cardiovascular health status of French adults.

Conclusions

In conclusion, the study showed that despite universal access to healthcare in metropolitan France, only a small proportion of the adult population in the country has optimal cardiovascular health. Only 13% of the adult population had optimal LE8 levels, and the majority had suboptimal levels of cardiovascular health.

However, the results suggest that even modest lifestyle and dietary changes could lead to significant improvements. The results highlighted the need not only for personalized and context-specific prevention strategies, but also for the implementation of root cause prevention approaches aimed at preventing the development of risk factors in the first place. These findings support the development of integrated, multidisciplinary public health policies tailored to population subgroups and life stages.

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