Association between Life's Essential 8 scores with 5-year all-cause and cardiovascular mortality among postmenopausal females: based on a cohort study

Abstract Background Numerous studies have shown that postmenopausal women face a significantly increased risk of cardiovascular disease (CVD) and mortality. According to the Life’s Essential 8 (LE8) scoring system, recently proposed by the American Heart Association to assess cardiovascular health (CVH), higher CVH scores are associated with reduced risks of all-cause and cardiovascular mortality. However, it remains unclear whether achieving a higher LE8 score can improve outcomes in postmenopausal women. Purpose This study aims to explore the relationship between LE8 scores and all-cause and cardiovascular mortality in postmenopausal women. Methods This retrospective cohort study utilized data from the National Health and Nutrition Examination Survey (NHANES) collected between 2007 and 2016. Postmenopausal women were identified through reproductive health questionnaires. Based on LE8 scores (ranging from 0 to 100), participants were categorized into low (0–49), moderate (50–79), and high (80–100) CVH groups. Multivariable Cox proportional hazards models were constructed to examine the association between LE8 scores and mortality risk in postmenopausal women. Restricted cubic spline curves were used to assess nonlinear relationships, and Kaplan-Meier analysis was employed to evaluate future mortality risks across different LE8 score groups. Stratified analyses were also conducted based on age (≤60 vs. 60 years), hypertension, and atherosclerotic cardiovascular disease (ASCVD) to explore the association between LE8 scores and mortality risk in different subgroups. Results A total of 2,212 postmenopausal women were included in the study (low group: 384; moderate group: 1,526; high group: 302). Compared to the other groups, women with high LE8 scores were younger, had lower BMI, were more likely to be non-Hispanic white, had higher education levels, were less likely to smoke, and had fewer clinical comorbidities (P 0.001). After adjusting for covariates, the Cox proportional hazards model revealed that low LE8 scores were associated with increased risks of cardiovascular mortality Hazard Ratio (HR) = 13.39; 95% Confidence Interval (CI): 1.83–98.11 and all-cause mortality (HR = 9.01; 95% CI: 3.58–22.70). Restricted cubic spline curves indicated a linear trend between higher LE8 scores and reduced risks of all-cause and cardiovascular mortality (P 0.05). Kaplan-Meier analysis showed that both cardiovascular and all-cause mortality decreased with higher LE8 scores (P 0.05). Stratified analysis demonstrated that, compared to the high LE8 score group, low LE8 scores were significantly associated with increased mortality risk regardless of age or ASCVD status (P 0.05). Conclusions In the U.S. population, higher LE8 scores are associated with a gradual reduction in 5-year all-cause and cardiovascular mortality risks among postmenopausal women. Therefore, maintaining an ideal LE8 score may provide long-term benefits for postmenopausal women.Cox proportional hazards models Restricted cubic spline curves