Association between Life's Essential 8 and all-cause or cardiovascular-specific mortality in patients with rheumatoid arthritis

Apr 12, 2024Clinical and experimental rheumatology

Links between Life’s Essential 8 health measures and overall or heart-related death risk in rheumatoid arthritis patients

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Abstract

A total of 1424 rheumatoid arthritis patients were analyzed over a median follow-up of 82 months, during which 270 all-cause deaths occurred.

Participants with moderate cardiovascular health had an 85.8% increased risk of all-cause mortality compared to those with high cardiovascular health.
Those in the low cardiovascular health group faced a 129.5% increased risk of all-cause mortality compared to the high group.
Each 1 point decrease in the Life's Essential 8 score was associated with a 2.6% increased risk of cardiovascular disease mortality.
Significant interactions were observed between Life's Essential 8 score and the non-Hispanic white population regarding all-cause mortality risk.
The association between Life's Essential 8 score and all-cause mortality was found to be robust, while the association with cardiovascular disease mortality was less consistent.

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OBJECTIVES: Patients with rheumatoid arthritis (RA) have been found to have a higher cardiovascular disease (CVD) burden. We aimed to examine the associations between Life's Essential 8 (LE8), a metric of cardiovascular health (CVH) recently proposed by the American Heart Association, and all-cause and CVD mortality in RA patients.

METHODS: This prospective cohort study analysed RA patients from the National Health and Nutrition Examination Survey 2005-2018 with linked mortality data through December 31, 2019. Total LE8 scores were calculated and divided into the high- (LE8 80-100), moderate- (LE8 50-79), and low-CVH (LE8 0-49) groups. Weighted multivariable Cox regression, logistic regression and restricted cubic spline models were applied to explore the association between LE8 and outcomes.

RESULTS: A total of 1424 RA patients were enrolled with a weighted mean age of 57.87 years and female proportion of 58.94%. During a median follow-up of 82 months, 270 all-cause (85 CVD) deaths were recorded. Compared with the high-CVH group, participants in the moderate- and low-CVH groups had an 85.8% and 129.5% increased risk of all-cause mortality, respectively. After adjustment for potential confounders, each 1 point decrease in LE8 score was associated with a 2.6% increased risk of CVD mortality. Subgroup analyses showed significant interactions between LE8 score and non-Hispanic white population with risk of all-cause mortality. The results were robust for all-cause mortality, but not for CVD mortality in the sensitivity analysis.

CONCLUSIONS: CVH measured by the LE8 score is a robust and independent predictor of all-cause mortality among U.S. RA patients.

Association between Life's Essential 8 and all-cause or cardiovascular-specific mortality in patients with rheumatoid arthritis

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