Life's Essential 8 and Mortality in US Adults With Diabetes: Greater Risk Reduction Compared to Those Without Diabetes

IF 2.7 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Canadian Journal of Diabetes Pub Date : 2026-08-01 Epub Date: 2026-04-10 DOI:10.1016/j.jcjd.2026.04.004

Ying Li MSc, Yuting Chu MSc, Adilan Abudukeranmu MSc, Zhixin Pang MSc, Yaxu Zhuang MSc, Jingdan Chang MSc, Hanbing Fan MSc, Jinnan Li MSc, Pengcheng Li MSc, Hong Zhu PhD

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引用次数: 0

Abstract

Objectives

Diabetes prevalence is high and increases the risk of all-cause, cardiovascular disease (CVD), and cancer-related deaths. In this study we investigated the association between Life's Essential 8 (LE8) and these mortality risks, and the potential modifying effect of diabetes.

Methods

We analyzed 20,231 US adults (3,497 with diabetes and 16,724 without diabetes) from the National Health and Nutrition Examination Survey 2005–2018. LE8 scores (0 to 100) were categorized by weighted tertiles. Cox proportional hazards regression models were used to assess associations with prospectively tracked mortality (through 2019).

Results

Over a median 7.2 years, 1,920 all-cause, 472 CVD, and 484 cancer-related deaths occurred. Mortality rates were higher in people with diabetes. Among people without diabetes, a 10-point increment in the LE8 score was linked to a significant 23% decreased risk of all-cause mortality (hazard ratio [HR] 0.77, 95% confidence interval [CI] 0.67 to 0.90) and a 21% decreased risk of CVD mortality (HR 0.79, 95% CI 0.64-0.98). However, no significant association was detected between LE8 score and cancer mortality in people with diabetes (HR 0.89, 95% CI 0.70 to 1.13). In the nondiabetes population, the HRs for LE8 score and all-cause, CVD, and cancer mortality were 0.58 (95% CI 0.44 to 0.75), 0.63 (95% CI 0.40-0.98), and 0.64 (95% CI 0.42 to 0.97), respectively. There was a synergistic additive interaction between diabetes and LE8 score for CVD death (relative excess risk due to interaction: 0.56, 95% CI 0.04 to 1.09; attributable proportion of interaction: 0.30, 95% CI 0.04 to 0.57; synergy index: 2.91, 95% CI 0.54 to 15.69).

Conclusions

Higher LE8 score conferred greater mortality risk reduction in people with diabetes vs those without diabetes. Diabetes and suboptimal LE8 scores may synergistically accelerate CVD death, underscoring the necessity for dual interventions addressing both glycemic management and cardiovascular health optimization in this population.

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美国成人糖尿病患者的生命要素和死亡率：与非糖尿病患者相比，风险降低更大。

目的：糖尿病患病率高，增加全因、心血管疾病（cvd）和癌症死亡风险。本研究调查了生命必需8 （LE8）与这些死亡风险之间的关系，以及糖尿病的潜在调节作用。方法：我们分析了2005-2018年国家健康与营养检查调查（NHANES）的20,231名美国成年人（3,497名糖尿病患者；16,724名非糖尿病患者）。LE8得分（0-100）按加权分位数进行分类。Cox比例风险回归模型评估了与前瞻性追踪死亡率（至2019年）的关联。结果：在平均7.2年的时间里，发生了1920例全因死亡、472例心血管疾病死亡和484例癌症死亡。糖尿病患者的死亡率更高。在无糖尿病人群中，LE8评分每增加10分，全因死亡率风险显著降低23% (HR=0.77, 95% CI: 0.67-0.90)，心血管疾病死亡率风险显著降低21% （HR=0.79, 95% CI: 0.64-0.98）。然而，LE8评分与糖尿病患者癌症死亡率之间未发现显著关联（HR=0.89, 95% CI: 0.70-1.13）。在非糖尿病人群中，LE8和全因心血管疾病、癌症死亡率的hr分别为0.58（95% CI: 0.44-0.75）、0.63（95% CI: 0.40-0.98）和0.64（95% CI: 0.42-0.97）。糖尿病和LE8评分在心血管疾病死亡方面存在增效加性相互作用（相对危险度：0.56,95% CI: 0.04-1.09；相对危险度：0.30,95% CI: 0.04-0.57；相对危险度：2.91,95% CI: 0.54-15.69）。结论：与非糖尿病患者相比，较高的LE8评分使糖尿病患者的死亡风险降低得更大。糖尿病和次优LE8评分可能协同加速CVD死亡，强调在这一人群中进行血糖控制和心血管健康优化的双重干预的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Canadian Journal of Diabetes ENDOCRINOLOGY & METABOLISM-

CiteScore

4.80

自引率

4.00%

发文量

130

审稿时长

54 days

期刊介绍： The Canadian Journal of Diabetes is Canada''s only diabetes-oriented, peer-reviewed, interdisciplinary journal for diabetes health-care professionals. Published bimonthly, the Canadian Journal of Diabetes contains original articles; reviews; case reports; shorter articles such as Perspectives in Practice, Practical Diabetes and Innovations in Diabetes Care; Diabetes Dilemmas and Letters to the Editor.