Tu Dingyuan, Zuo Xiaoli, Li Ping, Wang Jianming
Department of Congenital Heart Disease, General Hospital of Northern Theater Command, Shenyang, Liaoning, China.
Department of Cardiology, The 961st Hospital of the Joint Logistics Support Force of The Chinese People's Liberation Army, Qiqihar, Heilongjiang, China.
Front Nutr. 2025 Jun 27;12:1612693. doi: 10.3389/fnut.2025.1612693. eCollection 2025.
Cardiovascular-kidney-metabolic (CKM) syndrome, a novel and multistage disorder recently proposed by the American Heart Association (AHA), highlights the intricate connection between cardiovascular, renal, and metabolic illnesses. Poor CKM health is highly prevalent in the U.S. We aimed to examine the association of Life's Essential 8 (LE8), the AHA's key measures for improving and maintaining cardiovascular health (CVH), with all-cause mortality among U.S. CKM syndrome patients.
This population-based prospective cohort study analyzed data of adults in the National Health and Nutrition Examination Survey from 2011 to 2018, with linked mortality information until 2019. LE8 score, which included four health behaviors and four health factors, was categorized into low (0-49), moderate (50-79), and high (80-100) CVH. Five CKM syndrome stages (stages 0-4) were defined according to the 2023 AHA guidelines, with advanced (stages 3 or 4) and non-advanced (stages 1 or 2) disease. Multivariable Cox regression and restricted cubic spline models were used to assess the associations.
Among 11,638 CKM syndrome patients (2,060 advanced stages), 831 deaths occurred over a median follow-up of 5.0 years. Interestingly, the relationship between total LE8 score and all-cause mortality was only significant in advanced CKM syndrome patients, while not significant in non-advanced CKM syndrome patients. Further analyses of LE8 subscales revealed that advanced CKM syndrome patients with moderate and high LE8 health behaviors score exhibited a reduced risk of all-cause mortality (moderate: hazard ratio, 0.52; 95% confidence interval, 0.39-0.70; high: 0.35; 0.24-0.49), as well as non-advanced CKM syndrome patients (moderate: 0.75; 0.55-0.98; high: 0.38; 0.24-0.59). Population attributable fraction suggested that 22.5 and 23.9% of all-cause mortality attributed to poor or moderate LE8 health behaviors score could be avoided if high score was achieved in advanced and non-advanced CKM syndrome patients.
Our study revealed a significant association between the LE8 health behaviors score and all-cause mortality in both advanced and non-advanced CKM syndrome patients, underscoring the value of this score in enhancing risk management approaches for CKM syndrome patients in future research and clinical practice.
心血管-肾脏-代谢（CKM）综合征是美国心脏协会（AHA）最近提出的一种新型多阶段疾病，它突出了心血管、肾脏和代谢疾病之间的复杂联系。CKM健康状况不佳在美国非常普遍。我们旨在研究美国CKM综合征患者中，AHA改善和维持心血管健康（CVH）的关键指标“生命八大要素”（LE8）与全因死亡率之间的关联。
这项基于人群的前瞻性队列研究分析了2011年至2018年美国国家健康与营养检查调查中的成年人数据，并关联了截至2019年的死亡率信息。LE8评分包括四种健康行为和四种健康因素，被分为低（0-49）、中（50-79）和高（80-100）CVH类别。根据2023年AHA指南定义了五个CKM综合征阶段（0-4期），分为晚期（3或4期）和非晚期（1或2期）疾病。使用多变量Cox回归和受限立方样条模型来评估关联。
在11638例CKM综合征患者（2060例晚期）中，中位随访5.0年期间发生了831例死亡。有趣的是，总LE8评分与全因死亡率之间的关系仅在晚期CKM综合征患者中显著，而在非晚期CKM综合征患者中不显著。对LE8子量表的进一步分析显示，LE8健康行为评分为中等和高的晚期CKM综合征患者全因死亡风险降低（中等：风险比，0.52；95%置信区间，0.39-0.70；高：0.35；0.24-0.49），非晚期CKM综合征患者也是如此（中等：0.75；0.55-0.98；高：0.38；0.24-0.59）。人群归因分数表明，如果晚期和非晚期CKM综合征患者都能达到高分，那么分别有22.5%和23.9%归因于LE8健康行为评分低或中等的全因死亡率可以避免。
我们的研究揭示了LE8健康行为评分与晚期和非晚期CKM综合征患者全因死亡率之间存在显著关联，强调了该评分在未来研究和临床实践中加强CKM综合征患者风险管理方法方面的价值。
