Huether Katherine M, Pinheiro Laura C, Judd Suzanne E, Long D Leann, Safford Monika M, Lloyd-Jones Donald M, Plante Timothy B
Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA.
Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, USA.
JACC Adv. 2025 Jun;4(6 Pt 2):101731. doi: 10.1016/j.jacadv.2025.101731. Epub 2025 May 8.
Cardiovascular disease (CVD) and cancer are leading causes of death in adults. Life's Essential 8 (LE8) estimates cardiovascular health (CVH) and includes body mass index, blood pressure, blood sugar, cholesterol, diet, physical activity, sleep, and smoking. CVD, cancer, and other mortality are competing risks.
The purpose of this study was to determine the risk of CVD mortality, cancer mortality, and other mortality by LE8-quantified CVH in a competing risk framework.
REGARDS (REasons for Geographic and Racial Differences in Stroke) study recruited 30,239 Black and White adults from the 48 contiguous U.S. states from 2003 to 2007. We excluded prevalent CVD or cancer, missing LE8, or no follow-up. LE8 scores were categorized as low (<50), moderate (50-79), or high CVH (≥80). Adjusted cause-specific hazard models estimated relative hazard of CVD mortality, cancer mortality, and non-CVD, noncancer mortality as competing risks.
Among 11,385 included participants (mean age 65 ± 9 years, 52% female, 44% Black adults), 24%, 66%, and 10% had low, moderate, and high CVH, respectively. Over a median (IQR) follow-up of 14 (IQR: 8-17) years, 8% died from CVD, 7% from cancer, and 17% from other causes. Higher CVH was associated with significantly lower HRs for CVD (0.37; 95% CI: 0.28-0.49), cancer (0.48; 95% CI: 0.36-0.66), and non-CVD, noncancer (0.39; 95% CI: 0.32-0.48) mortality compared to low CVH levels.
Better LE8-quantified CVH was associated with lower CVD and cancer mortality in a competing risk framework. These findings underscore the significance of lifestyle modifications in mortality risk reduction, advocating for their incorporation into clinical guidelines and preventive counseling.
心血管疾病（CVD）和癌症是成年人的主要死因。生命基本要素8项指标（LE8）用于评估心血管健康（CVH），包括体重指数、血压、血糖、胆固醇、饮食、身体活动、睡眠和吸烟情况。心血管疾病、癌症和其他死因存在竞争风险。
本研究旨在确定在竞争风险框架下，通过LE8量化的心血管健康水平与心血管疾病死亡率、癌症死亡率及其他死亡率之间的风险关系。
REGARDS（卒中地理和种族差异原因）研究于2003年至2007年从美国48个相邻州招募了30239名黑人和白人成年人。我们排除了患有心血管疾病或癌症、缺少LE8指标数据或无随访信息的参与者。LE8得分被分为低（<50）、中（50 - 79）或高心血管健康水平（≥80）。调整后的特定病因风险模型估计了心血管疾病死亡率、癌症死亡率以及非心血管疾病、非癌症死亡率作为竞争风险的相对风险。
在纳入研究的11385名参与者中（平均年龄65±9岁，52%为女性，44%为黑人成年人），分别有24%、66%和10%的人具有低、中、高心血管健康水平。在中位（四分位间距）随访14年（四分位间距：8 - 17年）期间，8%的人死于心血管疾病，7%死于癌症，17%死于其他原因。与低心血管健康水平相比，较高水平心血管健康与心血管疾病（风险比[HR]为0.37；95%置信区间[CI]：0.28 - 0.49）、癌症（HR为0.48；95%CI：0.36 - 0.66）以及非心血管疾病、非癌症（HR为0.39；95%CI：0.32 - 0.48）死亡率显著降低相关。
在竞争风险框架下，更好的LE8量化心血管健康水平与较低的心血管疾病和癌症死亡率相关。这些发现强调了生活方式改变在降低死亡风险中的重要性，提倡将其纳入临床指南和预防性咨询中。
