Life’s essential 8 and longevity: the sustained impact of cardiovascular health on mortality from middle age to centenarians

While Life’s Essential 8 (LE8) provides a comprehensive measure of cardiovascular health (CVH), its association with mortality among the oldest-old, including centenarians, remains unclear. This study evaluated the relationship between LE8-defined CVH and all-cause mortality across adulthood using data from the China Kadoorie Biobank (Hainan cohort) and the China Hainan Centenarian Cohort Study, including 31,473 individuals aged 30–116. Participants were categorized by life stage and CVH score (low, moderate, high). Higher CVH scores were associated with significantly reduced mortality risk at all life stages, including among centenarians, who experienced a 54.8% lower risk with high CVH. A near-linear dose–response relationship was observed. Population-attributable fractions for mortality reached 36.8% in centenarians. Physical activity and body mass were particularly important in reducing mortality among centenarians. These findings challenge therapeutic nihilism in the oldest-old while underscoring the need for age-specific strategies tailored to distinct physiological profiles is crucial for extending healthy lifespan across the adult life course.