Association Between Life's Essential 8 and Cardiovascular, Cancer, and Other Cause Mortality

BACKGROUND: 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. OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.