A recent study published in the American Journal of Preventive Cardiology has revealed a concerning reality: only 13.2% of French adults exhibit optimal cardiovascular health. Using the American Heart Association’s updated Life’s Essential 8 (LE8) scoring system, researchers conducted a large-scale, nationally representative study to assess the heart health of adults in France. The findings highlight not only the limited prevalence of optimal cardiovascular health (CVH) but also key determinants associated with better heart health outcomes.
Why Cardiovascular Health Still Matters
Despite major public health improvements like smoking bans and increased awareness, cardiovascular disease (CVD) remains one of the leading causes of death globally, responsible for one-third of all fatalities. Beyond mortality, CVD imposes a heavy financial burden on health systems—€282 billion in the European Union in 2021 alone, with only 3% of that directed toward primary prevention.
This study underscores the critical need for primordial prevention, which focuses on preventing the development of risk factors before they emerge, thereby reducing the long-term risk of CVD.
Life’s Essential 8: A New Tool to Measure Heart Health
To aid in cardiovascular monitoring, the American Heart Association developed the Life’s Essential 8 (LE8)—a score ranging from 0 to 100 that evaluates heart health across eight key metrics:
- Diet
- Physical activity
- Nicotine exposure
- Body Mass Index (BMI)
- Sleep health
- Blood glucose (glycemia)
- Blood pressure
- Blood lipids (cholesterol)
The LE8 builds upon earlier models by incorporating sleep as a core health metric, recognizing its significant role in overall well-being.
Study Methodology
Population Sample
The analysis was based on 191,335 French adults aged 18 to 69 (from a larger cohort that included participants up to age 75). This sample was representative of roughly 45 million French citizens in this age range. Data were collected between 2012 and 2019.
Data Collection
The study combined clinical measurements (e.g., blood glucose, pressure, and cholesterol), self-reported lifestyle habits (diet, sleep, activity, smoking), and demographic information (education, employment, location, mental health, alcohol use).
Each LE8 component was individually scored and then averaged. The final scores were categorized as:
- Poor (0–49)
- Moderate (50–79)
- High (80–100)
Medications for blood pressure or cholesterol reduced relevant scores by 20 points to account for treatment-related bias.
Key Findings
Average Scores and Distribution
Average LE8 score: 66.1
Women scored significantly higher than men (68.9 vs. 62.8)
Score categories:
- High: 12.4%
- Moderate: 78.2%
- Low: 9.4%
When using weighted population estimates, only 11.35% reached the high CVH category—slightly lower than the initial 13.2% due to potential selection effects.
Gender Disparities
Women were nearly three times more likely than men to achieve high LE8 scores. Men scored lower in most components, especially blood pressure and BMI.
Impact of Education
- Only 4.8% of people with less than a high school education had high CVH.
- This rose to 17.8% for those with two or more years of education beyond high school.
Urban vs. Rural
Contrary to typical assumptions, rural residents scored higher in cardiovascular health than urban residents, even after adjusting for other factors.
Top and Bottom Metrics
- Best-performing metric: Blood glycemia (average score of 95.5)
- Worst-performing metric: Diet (average score of 41.5)
The poor diet scores—especially low among men—highlight a major area for public health intervention.
Other Significant Determinants
High LE8 scores were more common among individuals who were:
- Female
- Younger
- Well-educated
- Living in rural areas
- Employed in higher-skilled jobs
- Not cohabiting
- Less depressed
- Consuming less alcohol
- Experiencing lower deprivation
Age Trends
LE8 scores showed a gradual decline from ages 18–55, then plateaued. This suggests that different life stages require different approaches to maintaining cardiovascular health.
European and U.S. Comparison
France lags slightly behind the U.S. in high CVH prevalence:
France: 13.2% (or 11.35% with weighting)
United States: 19.6%
However, French adults had better physical activity, BMI, and glucose levels than Americans, while scoring worse in blood pressure, cholesterol, and sleep.
Study Strengths and Limitations
Strengths
Large sample size with national representation
Detailed socioeconomic data
Use of both clinical and self-reported data
Limitations
Reliance on self-reported data for some metrics (e.g., sleep, HbA1c)
Cross-sectional design limits ability to assess changes over time
Incomplete dietary data—missing values for sodium and fiber
Public Health Implications
The study estimates that if all participants achieved high LE8 scores, 81% of CVD events could be prevented. This underscores the potential impact of investing in early prevention and population-wide interventions.
A Call for Action
Targeted strategies are needed for low-performing groups, especially men and individuals with low education or urban residency.
The researchers advocate for a shift from a care-centric model to one that emphasizes prevention, especially primordial prevention.
Attention to intersectional factors, such as mental health and minority status, is essential in tailoring effective interventions.
Conclusion
This groundbreaking nationwide analysis of heart health in France highlights a sobering fact: only about 1 in 8 French adults enjoy optimal cardiovascular health. The findings reveal deep disparities by gender, education, geography, and socioeconomic status. As France grapples with an aging population and rising chronic disease rates, primordial prevention and tailored health strategies must take center stage.
By understanding and addressing the factors associated with better LE8 scores, France—and other nations—can make meaningful progress in the fight against cardiovascular disease.
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