Association between life’s crucial 9 and stroke: results from the NHANES 2005–2018

Life's Crucial 9 (LC9) is a composite cardiovascular health score comprising nine modifiable factors. This study examines the relationship between LC9 scores and stroke prevalence in US adults. This study conducted a cross-sectional analysis of National Health and Nutrition Examination Survey data from 2005 to 2018. To facilitate analysis, LC9 values were separated into four quartiles. The relationship between LC9 scores and the prevalence of stroke was evaluated using subgroup analysis, restricted cubic spline (RCS) modeling, and weighted multivariable logistic regression. Among 19 207 participants with an average LC9 score of 70.70 ± 0.22, the overall stroke prevalence was 2.87%. Each one-point increase in LC9 score was associated with a 4.7% reduction in stroke odds (95% CI 0.943-0.963; p < 0.001). Compared with the lowest LC9 quartile (Q1), individuals in the highest quartile (Q4) had a 72.6% lower stroke prevalence (95% CI 0.169-0.446; p < 0.001). Stratified analyses and interaction assessments indicated that the inverse association remained consistent across age, sex, BMI, diabetes, and hypertension categories, with no significant interactions observed. Furthermore, curve fitting analysis identified a linear correlation between LC9 scores and the risk of stroke. Our findings indicated that higher LC9 scores were associated with a reduced likelihood of stroke. Preserving a favorable LC9 score may serve as a potential strategy for stroke prevention. To substantiate these observations and establish clinically applicable LC9 thresholds, additional large-scale prospective studies with prolonged follow-up are needed.