The study drew on the Seniors-ENRICA-2 cohort, a community-based sample of 3,273 adults aged 65 and older living in the metropolitan area of Madrid, enrolled between 2015 and 2017. After exclusions, the analytic sample comprised 2,487 participants who were examined at baseline and at two follow-up waves, the most recent a mean of 5.2 years later. Data collection was unusually thorough for this kind of research. Participants completed structured telephone interviews, and nurses made in-home visits to collect blood samples, perform physical examinations and assess diet using a validated diet history adapted from the European Prospective Investigation into Cancer and Nutrition. Blood lipids, fasting glucose and glycated hemoglobin were measured centrally at the La Paz University Hospital laboratory, and blood pressure was recorded with validated automatic devices under standardized procedures.

Cardiovascular health was quantified with Life’s Essential 8, the framework the American Heart Association introduced in 2022. It scores four behaviors—diet, physical activity, nicotine exposure and sleep health—and four biological factors—body mass index, blood lipids, blood glucose and blood pressure—each on a scale from 0 to 100, with the overall score calculated as their average. The researchers then confronted this score with two complementary measures of unhealthy aging. The first was a 52-item Deficit Accumulation Index, built on the frailty model developed by Kenneth Rockwood, which tallies functional impairments, self-reported health, mental health problems, morbidities and health service use. The second was an Intrinsic Capacity Impairment Score derived from the World Health Organization’s framework, capturing impairment across six domains: cognition, psychological well-being, vitality, hearing, vision and locomotion. Both indices were rescaled to 0 to 100, with higher values indicating worse health.

The statistical machinery behind the study was a class of mixed-effects linear regression models with random intercepts and slopes, which allow each individual to have their own starting point and rate of change while estimating population-level effects. The key analytical move was to include interaction terms between the LE8 score and time, so that the models could distinguish between two separable questions: whether better cardiovascular health was linked to a lower burden of deficits at baseline, and whether it was linked to a slower rate of deterioration afterward. To reduce measurement error, the team used cumulative averages of the time-varying LE8 components across follow-up waves, a technique that dampens the statistical attenuation produced by day-to-day and month-to-month variation in individual measurements.

The results were striking. At baseline, participants had a mean LE8 score of 62.8, and those with better scores carried markedly less deficit burden. Each 10-point increase in the LE8 score was associated with a 2.93-point lower Deficit Accumulation Index in women and 2.05 points lower in men, and a 3.44-point lower Intrinsic Capacity Impairment Score in women and 2.12 points lower in men. These baseline associations were consistently stronger in women, a pattern the authors attribute partly to the greater burden of disability and functional limitation that women carry into old age despite their longer life expectancy, and partly to sex-specific patterns of cardiovascular aging, including more pronounced age-related left ventricular remodeling and faster progression of arterial stiffness in women from the sixth decade onward.

The longitudinal findings were arguably more consequential. Higher LE8 scores predicted a slower annual increase in the Deficit Accumulation Index—0.10 fewer points per year for each 10-point advantage. That figure sounds small, but against a mean annual increase of 0.49 points per year in the overall cohort, it represents roughly a 20 percent reduction in the pace of deficit accumulation. Domain-level analyses sharpened the picture: the protective association was strongest for functional impairment and self-rated health, where the corresponding reductions in the rate of deterioration were approximately 35 and 57 percent, respectively. Better cardiovascular health was also linked to slower deterioration in locomotion, one of the six domains of intrinsic capacity. Interestingly, no significant association emerged between cardiovascular health and the overall rate of change in the Intrinsic Capacity Impairment Score, a result the researchers interpret through the lens of domain heterogeneity: sensory function and cognition may change too slowly, or be too loosely coupled to cardiovascular risk factors, for an effect to register when domains are pooled.

Dissecting the eight components of the LE8 score revealed which levers mattered most. Higher physical activity, better sleep health, an adequate body mass index and optimal blood glucose emerged as the strongest contributors to slower health decline, both cross-sectionally and over time. For example, each 10-point advantage in the sleep component was associated with an annual deficit accumulation that was 0.04 points slower, and adequate blood glucose with a rate 0.05 points slower. Physical activity and glycemic control were specifically linked to slower declines in intrinsic capacity, at 0.07 and 0.09 points per year, respectively. Not every component behaved as expected: lipid and blood pressure metrics, which in older adults may largely reflect treatment intensity rather than cumulative cardiometabolic risk, showed weaker longitudinal associations. One unexpected signal—slightly faster cognitive decline among those with better cardiovascular health—was small, biologically implausible and vanished in sensitivity analyses restricted to participants with complete follow-up, suggesting it reflected selective attrition rather than a real effect.

The authors are careful about the study’s limits. Participants lost to follow-up were older, less educated, more sedentary and sicker at baseline, a pattern that could bias estimates in either direction, although sensitivity analyses restricted to complete cases were reassuringly consistent. Both the exposure and the outcomes relied partly on self-reported measures, and the cohort, drawn from a largely homogeneous Mediterranean population, may not generalize to other sociocultural contexts. When the analysis treated cardiovascular health as fixed at baseline, the associations with rates of change attenuated, which the researchers read as evidence that changes in cardiovascular health over time, not just initial status, shape aging trajectories.

The public health implications reach well beyond cardiology clinics. Health economists have repeatedly shown that it is not chronological age but the number of years lived with chronic disease and disability that drives healthcare demand and cost. People who reach old age with fewer deficits tend to accumulate fewer deficits thereafter, while those starting from a heavier burden deteriorate faster, so intervening early—even into the sixties and beyond—could compress the period of disability at the end of life. The Spanish findings suggest that the Life’s Essential 8 score, a cheap and accessible composite of behaviors and clinical measurements, may serve as both a warning light and a roadmap: identifying older adults at risk of accelerated decline, and pointing to the specific modifiable factors—movement, sleep, weight, blood sugar control—that could slow it. The authors stop short of claiming cardiovascular health modulates biological aging itself, but the biological logic is coherent: physical activity supports mobility and cardiometabolic regulation, sleep underpins neuroendocrine and metabolic stability, and healthy diet and weight patterns temper the chronic inflammation, endothelial dysfunction and multimorbidity that feed deficit accumulation. In an era when the global population over 60 is projected to nearly double to 2.1 billion by 2050, the message is unambiguous: protecting the heart may be one of the most practical strategies available for protecting everything else that aging puts at risk.

Subject of Research: The association between cardiovascular health and longitudinal trajectories of unhealthy aging in older adults

Article Title: Cardiovascular health, as per life’s essential 8, and unhealthy aging trajectories

Article References: Cardiovascular health, as per life’s essential 8, and unhealthy aging trajectories. (n.d.). https://doi.org/10.1007/s11357-026-02553-9

Image Credits: AI Generated

DOI: 10.1007/s11357-026-02553-9

Keywords: cardiovascular health, Life's Essential 8, healthy aging, frailty, deficit accumulation index, intrinsic capacity, geroscience, physical activity, sleep health, blood glucose, older adults, Seniors-ENRICA-2