Life’s Essential 8 and Mortality Risk in Cardiovascular Disease: Results From a Nationwide Population Survey

Abstract

Life’s Essential 8 (LE8), a comprehensive metric integrating behavioral and physiological cardiovascular health factors, may serve as a valuable stratification tool for identifying high-risk subgroups within patients already diagnosed with cardiovascular disease (CVD). In this study, we analyzed data from 3681 individuals with CVD from the US National Health and Nutrition Examination Survey (2007–2018) linked with mortality data. LE8 scores were calculated based on multidomain health indicators, and survival outcomes were assessed across score quartiles. We employed adjusted weighted Cox regression analyses, which accounted for the complex survey design by incorporating appropriate sample weights, strata, and primary sampling units through survey-weighted statistical methods. Higher LE8 scores were significantly associated with reduced all-cause mortality (adjusted HR per unit increase: 0.76 and 95% CI: 0.69–0.85), with a 60% reduction in mortality risk observed in the highest quartile compared with the lowest. These associations remained robust after adjustment for key sociodemographic covariates. Restricted cubic spline analysis confirmed a dose-response relationship between LE8 and mortality risk. Our findings underscore the value of composite health metrics such as LE8 in refining disease taxonomies, enhancing risk stratification, and potentially guiding personalized intervention strategies. This population-scale phenotypic analysis offers a clinical foundation for future AI-driven or multiomics investigations to unravel the mechanistic underpinnings and identify modifiable therapeutic targets among phenotypically diverse CVD populations.