Comparing the predictive accuracy of life’s essential 8 and life’s crucial 9 scores for all-cause mortality in COPD patients among US adults: a prospective cohort study

Life’s Essential 8 (LE8) represents an established score for quantifying cardiovascular health (CVH). Life’s Crucial 9 (LC9) is a newly proposed metric that integrates psychological health with LE8. The prognostic significance of these scores concerning all-cause mortality risk in COPD patients remains unclear. We analyzed data from NHANES 2005–2018 to examine the relationship between CVH (quantified by LC9 and LE8 scores) and all-cause mortality among adults with COPD. Cox proportional hazards regression was applied, and additional analyses were conducted to assess robustness. Among 1,757 participants (380 deaths, 21.63%) over a 72-month median follow-up, the highest LC9 score quartile was associated with a significantly lower mortality risk when compared to the lowest quartile (HR = 0.36, 95% CI: 0.22–0.59). A similar inverse association was observed for the LE8 score. LC9 consistently demonstrated marginally higher predictive accuracy than LE8 across analyses. Higher CVH levels defined by either LC9 or LE8 were strongly associated with reduced all-cause mortality in COPD patients. The slightly superior performance of LC9 highlights the added value of psychological health inclusion into cardiovascular health assessment to enhance mortality risk stratification and guide comprehensive COPD management.