In a cross-sectional analysis of 44,982 adults (with a 1,426-person matched MRI subsample), each standard-deviation increase in Life's Essential 8 (LE8) cardiovascular health score corresponded to lower white matter hyperintensity volume (−0.13 SD) and lower combined small-vessel disease burden (OR 0.89 per SD), with no detected difference by ethnoracial group. Black participants had the least favorable LE8 scores and higher WMH volume than White participants (0.209 SD). However, cognitive differences between groups did not track MRI burden, and the pooled WMH–cognition association was null.
The consistency of the LE8 signal across groups is the most useful takeaway: the eight modifiable components (diet, activity, nicotine exposure, sleep, BMI, lipids, glucose, blood pressure) appear to matter for brain vasculature regardless of background, reinforcing prevention as a shared target. Still, cross-sectional data cannot show that improving LE8 reduces lesions; reverse causation and residual confounding, including socioeconomic factors, remain open. The null WMH–cognition link is surprising given prior literature and may reflect limited cognitive testing or modest effect sizes, so it should be read cautiously. Focal-lesion comparisons (lacunes, microbleeds) used a small subsample and were inconclusive. This is a preprint that has not been peer reviewed, so findings may change. Overall the work is confirmatory rather than paradigm-shifting, adding population-scale support for LE8 as a brain-health framework and underscoring the need for prospective studies.