Associations of life's essential 8 and life's crucial 9 scores with all-cause and cardiovascular mortality: A population-based cohort study of postmenopausal women

Abstract

Objectives

This study examines the associations of scores on the Life's Essential 8 (LE8) and Life's Crucial 9 (LC9) scales with all-cause and cardiovascular mortality among postmenopausal women in the United States.

Methods

We analyzed data from 5499 postmenopausal women aged ≥20 years from the 2005–2014 National Health and Nutrition Examination Survey (NHANES), linked to mortality data through December 31, 2019. LE8 includes four behavioral and four clinical metrics; LC9 adds psychological well-being. Cox proportional hazards models were used to estimate hazard ratios (HRs) for all-cause mortality. Generalized additive models explored dose–response relationships. Kaplan–Meier curves and log-rank tests assessed survival differences across score tertiles.

Results

During a median follow-up of 64 months, 1154 deaths occurred (20.99 %), including 358 (31.0 %) from cardiovascular causes. Mean LC9 score was 63.7 (SD = 14.2). Each 1-SD increase in LE8 and LC9 scores was associated with a 27 % (HR = 0.73, 95 % CI: 0.68–0.78) and 30 % (HR = 0.70, 95 % CI: 0.66–0.76) lower risk of all-cause mortality, respectively. Compared with the lowest tertiles, the highest tertiles of LE8 and LC9 were associated with 50 % (HR = 0.50, 95 % CI: 0.43–0.59) and 51 % (HR = 0.49, 95 % CI: 0.41–0.57) lower risks. Dose–response curves showed inverse, approximately linear associations. Kaplan–Meier survival curves showed significantly higher survival probabilities among participants with higher LE8 and LC9 scores (log-rank P < 0.0001).

Conclusions

Higher LE8 and LC9 scores were associated with lower all-cause and cardiovascular mortality among postmenopausal women.