Association between the life's essential 8 health behaviors and prognosis in patients with advanced cardiovascular-kidney-metabolic syndrome

BACKGROUND: This study aimed to evaluate the association between the Life's Essential 8 (LE8) and mortality risk in patients with advanced cardiovascular-kidney-metabolic (CKM) syndrome, focusing on the prognostic impact of its health behavior and health factor components. METHOD: A total of 10,321 participants were included from the NHANES. Kaplan-Meier curve and Cox proportional-hazards models, and restricted cubic splines (RCS) were used to assess the associations of LE8, health behaviors, and health factors with mortality risk. RESULT: Among all participants, 2629 had advanced CKM syndrome. Over a median 78-month follow-up, 579 deaths occurred. Each 10-point increase in the LE8 score reduced advanced CKM syndrome risk by 15% (OR = 0.85), while low CVH increased risk by 105% (OR = 2.05). Advanced CKM syndrome was associated with higher mortality risks, while each 10-point increase in the LE8 score reduced mortality risk. However, no significant difference in mortality risk was observed between the moderate and high CVH groups. Notably, each 10-point increase in the health behavior score lowered all-cause (HR = 0.80), cardiovascular (HR = 0.83), and CKM-related mortality risk (HR = 0.82), while patients with moderate (HR = 2.08, 1.88, 1.94) and low CVH (HR = 3.25, 253, 2.89) faced higher mortality risks. In contrast, the health factor showed no significant association with mortality risk. CONCLUSION: The LE8, particularly its health behavior, is independently associated with mortality in advanced CKM syndrome. These findings suggest that LE8-based behavioral interventions could potentially reduce risk in advanced CKM syndrome patients.