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. 2025 Jul 17:zwaf443.
doi: 10.1093/eurjpc/zwaf443. Online ahead of print.

Association between the Life's Essential 8 Health Behaviors and Prognosis in Patients with Advanced Cardiovascular-Kidney-Metabolic Syndrome

Siyuan Tan  1   2   3   4 , Jiabao Zhou  1   2   3   4 , Fanqi Li  1   2   3   4 , Gaoming Zeng  1   2   3   4 , Na Liu  1   2   3   4 , Tao Tu  1   2   3   4 , Hao Chen  5 , Qiuzhen Lin  1   2   3   4 , Qiming Liu  1   2   3   4
Affiliations

Association between the Life's Essential 8 Health Behaviors and Prognosis in Patients with Advanced Cardiovascular-Kidney-Metabolic Syndrome

Siyuan Tan et al. Eur J Prev Cardiol. .

Abstract

Background: This study aimed to evaluate the association between the Life's Essential 8 (LE8) and mortality risk in patients with advanced cardiovascular-kidney-metabolic (CKM) syndrome, focusing on the prognostic impact of its health behavior and health factor components.

Method: A total of 10,321 participants were included from the NHANES. Kaplan-Meier curve and Cox proportional-hazards models, and restricted cubic splines (RCS) were used to assess the associations of LE8, health behaviors, and health factors with mortality risk.

Result: Among all participants, 2629 had advanced CKM syndrome. Over a median 78-month follow-up, 579 deaths occurred. Each 10-point increase in the LE8 score reduced advanced CKM syndrome risk by 15% (OR = 0.85), while low CVH increased risk by 105% (OR = 2.05). Advanced CKM syndrome was associated with higher mortality risks, while each 10-point increase in the LE8 score reduced mortality risk. However, no significant difference in mortality risk was observed between the moderate and high CVH groups. Notably, each 10-point increase in the health behavior score lowered all-cause (HR = 0.80), cardiovascular (HR = 0.83), and CKM-related mortality risk (HR = 0.82), while patients with moderate (HR = 2.08, 1.88, 1.94) and low CVH (HR = 3.25, 253, 2.89) faced higher mortality risks. In contrast, the health factor showed no significant association with mortality risk.

Conclusion: The LE8, particularly its health behavior, is independently associated with mortality in advanced CKM syndrome. These findings suggest that LE8-based behavioral interventions could potentially reduce risk in advanced CKM syndrome patients.

Keywords: Cardiovascular-kidney-metabolic syndrome; Health behavior; Health factor; Life’s essential 8; Prognosis.

Plain language summary

This study focuses on better understanding and managing advanced cardiovascular-kidney-metabolic (CKM) syndrome. People with this condition face higher risks of death, but current methods to assess their risks are incomplete. For the first time, researchers used a comprehensive health score called Life’s Essential 8 (LE8) to evaluate patients with advanced CKM syndrome. LE8 combines eight factors: LE8 health behaviors (diet score, physical activity, nicotine exposure, and sleep health) and LE8 health factors (body mass index (BMI), blood lipids, blood glucose, and blood pressure). By studying 10,321 U.S. adults, the team found that people with lower LE8 scores had a much higher risk of dying from all-cause, CVD, and CKM-related complications. However, participants with moderate cardiovascular health (CVH) showed no significant difference in mortality risk compared with those with high CVH.A groundbreaking finding is the distinct role of the LE8 health behaviors in predicting mortality. Each 10-point increase in health behavior score reduced all-cause, cardiovascular, and CKM-related mortality risks, whereas LE8 health factors showed no significant association. This underscores that behavioral interventions may outweigh metabolic management in advanced stages of CKM syndrome.

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