Association of Life’s Essential 8 Score with All-Cause and Cardiovascular Mortality in Patients with Diabetic Nephropathy: A NHANES-Based Cohort Study

This study aimed to assess the relationship between the "Life's Essential 8" (LE8) score and all-cause and cardiovascular mortality in patients with diabetic nephropathy (DN). This observational cohort study utilized data from the National Health and Nutrition Examination Survey (NHANES, 2005-2018). A total of 1,745 patients with DN were included. The LE8 score encompassed health behaviors (diet, physical activity, nicotine control, sleep) and physiological indices (body mass index, non-high-density lipoprotein cholesterol, blood glucose, blood pressure). A multivariate Cox proportional risk model was employed to assess the effect of the LE8 score on the risk of death, and the dose-response relationship was analyzed by a restricted cubic spline (RCS) model. Subgroup analyses and multiple imputations were performed to verify the robustness of the findings. After adjusting for confounders, a 10-point increase in the LE8 score was associated with a 12% reduction in the risk of all-cause mortality [hazard ratio (HR) = 0.88, P < 0.001] and a 16% reduction in the risk of cardiovascular death (HR = 0.84, P = 0.007). The risk of all-cause mortality was 33% lower in the highest tertile group compared with the lowest group (HR = 0.67, P < 0.001), and the risk of cardiovascular mortality was 36% lower (HR = 0.64, P = 0.014). RCS analysis showed that LE8 scores were linearly negatively correlated with mortality (nonlinear P > 0.05). Subgroup analyses further confirmed the consistency of this association across various characteristic subgroups. LE8 score has been identified as an independent protective factor for the risk of death in patients with DN, exhibiting a linear dose-response relationship consistent across sociodemographic subgroups. This finding underscores the importance of incorporating LE8 into a comprehensive assessment system for DN patients, providing a foundation for precision intervention.