During a median follow-up of 7.8 years, 2,388 overall deaths were identified among 23,080 adults.
A high cardiovascular health score () is associated with a 52% reduction in all-cause mortality risk and a 64% reduction in cardiovascular disease (CVD) mortality risk compared to a low score.
A moderate cardiovascular health score is linked to a 33% reduction in all-cause mortality and a 49% reduction in CVD mortality risk.
High cardiovascular health scores account for 46.0% of all-cause mortality and 75.8% of CVD mortality in the population studied.
Elevated blood lipids, high body mass index, and poor sleep quality are significant contributors to all-cause mortality.
Nicotine exposure, unhealthy psychological factors, and elevated blood lipids are major contributors to CVD mortality.
A negative linear dose-response relationship exists between total LC9 score and both all-cause and CVD mortality.
Simplified
BACKGROUND: In 2022, the American Heart Association launched an updated algorithm for quantifying cardiovascular health (CVH), termed Life's Essential 8 (LE8). This new approach has been shown to be associated with various noncommunicable chronic diseases and mortality. However, LE8 did not take into consideration the importance of psychological health on CVH. Recently, a perspective article proposed (LC9), which would add psychological health as another component to LE8, as a novel metric to assess CVH. This study aims to investigate the association of LC9 with all-cause and cardiovascular disease (CVD) mortality.
METHODS: This study included 23,080 adults from National Health and Nutrition Examination Survey 2005-2018, and mortality was ascertained by linkage to National Death Index records through 31 December 2019. The LC9 scoring algorithm was categorized into low (0-49), moderate (50-79), and high (80-100) CVH. Weighted Cox proportional hazards regression models and restricted cubic spline analysis were applied to evaluate the association of LC9 with mortality.
RESULTS: During a median follow-up of 7.8 years, a total of 2,388 overall deaths were identified, covering 613 CVD deaths. Compared with adults with a low CVH score, those with a high CVH score had 52% (hazard ratio, 0.48; 95% confidence interval, 0.38-0.60) and 64% (0.36; 0.23-0.56) reduced risk of all-cause and CVD mortality. Similarly, a moderate CVH score was associated with 33% (0.67; 0.58-0.78) and 49% (0.51; 0.40-0.64) reduced risk of all-cause and CVD mortality. The population-attributable fractions of high vs. moderate or low CVH score were 46.0% for all-cause mortality and 75.8% for CVD mortality. Elevated blood lipids, high body mass index, and poor sleep quality were the three major contributors to all-cause mortality, whereas nicotine exposure, unhealthy psychology, and elevated blood lipids were the three significant ones to CVD mortality. There were approximately negative linear dose-response relationships of total LC9 score with all-cause and CVD mortality.
CONCLUSIONS: Adhering to a high LC9 score is related to a reduced risk of all-cause and CVD mortality. This new CVH definition shows promise as a primordial preventive strategy to reduce mortality rates.
Key numbers
52%
Decrease in All-Cause Mortality Risk
Compared to adults with low scores.
46.0%
Population-Attributable Fraction for All-Cause Mortality
Reflects the proportion of all-cause mortality that could be averted.
64%
Decrease in Cardiovascular Disease Mortality Risk
Compared to adults with low scores.
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Declarations. Ethics approval and consent to participate: The NHANES was approved by the National Center for Health Statistics Research Ethics Review Board, and all participants provided written informed consent. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.
