Life's essential 8 and risk of all-cause mortality in individuals with cardiovascular diseases: A prospective community-based study

Abstract

Background: Although risk factors for mortality in individuals with cardiovascular diseases (CVD) have been reported, little is known regarding the association between the comprehensive cardiovascular health (CVH) index assessed by life's essential 8 (LE8) and the risk of mortality.

Hypothesis: The aim of this study was to evaluate the CVH assessed by LE8 and risk of mortality in individuals with CVD.

Methods: A total of 1391 participants with CVD diagnosed before 2014 from the Kailuan cohort were included in the analysis. The CVH score ranged from 0 to 100 was assessed using the LE8 metrics (diet quality, physical activity, sleep health, cigarette smoking, body mass index, lipids, blood glucose, and blood pressure). Cox regression model was used to estimate the association between the CVH score and risk of all-cause mortality.

Results: During a mean follow-up of 6.1 ± 1.5 years, 229 deaths occurred. The hazard ratio for all-cause mortality was 0.57 (95% confidence interval [CI]: 0.38, 0.84) in the highest quartiles compared with the lowest quartiles of CVH scores and 0.85 (95% CI: 0.75, 0.95) for each 10 points increment in CVH scores (p_trend = .009), after adjustment for age, sex, CVD duration, social-economic status, alcohol consumption, inflammation, medicine use, and kidney function. We did not observe significant interactions between the CVH scores and age, sex, and duration of CVD diagnosis (p_interaction > .05 for all).

Conclusions: The CVH assessed by the LE8 metrics was associated with a lower risk of all-cause mortality in individuals with CVD.

Keywords: all-cause mortality; cardiovascular disease; cardiovascular health; prevention.

Figure 1

Adjusted HRs and 95% confidence intervals for risk of all‐cause mortality across CVH score quartiles according to the types of cardiovascular disease. Model was adjusted for age, sex (men or women), family history of myocardial infarction and stroke (yes or no), waist circumference (quartiles), high sensitivity C‐reactive protein (≤3, >3 mg/L), estimated glomerular filtration rate (quartiles), alcohol consumption (never and past, current or missing), glucose‐lowering medications (yes or no), lipid‐lowing medications (yes or no), antihypertensive medications (yes or no), educational level (illiterate and primary, middle school, high school, and above), occupation (white collar, coal miner, or blue collar), monthly salary (≤1000, 1001–3000, >3000 RMB, or missing). CVH, cardiovascular health; DASH: dietary approaches to stop hypertension; HEI, healthy eating index; HR, hazard ratio.

Figure 2

Adjusted HRs and 95% confidence intervals for risk of all‐cause mortality across individual metrics of cardiovascular health score *The HR value was the highest tertiles of FBG compared with the lowest tertiles. Model was adjusted for age, sex (men or women), family history of myocardial infarction and stroke (yes or no), waist circumference (quartiles), high sensitivity C‐reactive protein (≤3, >3 mg/L), estimated glomerular filtration rate (quartiles), alcohol consumption (never and past, current or missing), glucose‐lowering medications (yes or no), lipid‐lowing medications (yes or no), antihypertensive medications (yes or no), educational level (illiterate and primary, middle school, high school, and above), occupation (white collar, coal miner, or blue collar), monthly salary (≤1000, 1001–3000, >3000 RMB, or missing). BMI, body mass index; BP: blood pressure; FBG, fasting blood glucose; HDL‐C, high‐density lipoprotein cholesterol; HR, hazards ratio; LE8, life's essential 8.