Behavioral and health-factor domains of Life’s Essential 8 in advanced cardiovascular-kidney-metabolic syndrome among Korean adults: a nationally representative cross-sectional analysis

Figure 1. Participant flow diagram for the present analysis (Korean adults, KNHANES 2019–2024). Cohort assembly from pooled KNHANES respondents to the primary analytic cohort (n = 17,351). Reasons for exclusion at each step are shown in shaded boxes (right). The full-cohort sensitivity (n = 26,308) corresponds to the complete-case cohort across all six KNHANES cycles (2019–2024); the primary analytic cohort restricts to the four cycles (2019, 2020, 2021, 2024) with complete CKM Stage 4 ascertainment. CKM, cardiovascular-kidney-metabolic; DI3–DI6, KNHANES interview items for self-reported physician-diagnosed stroke, myocardial infarction, and angina; KNHANES, Korea National Health and Nutrition Examination Survey; LE8, Life’s Essential 8.

Figure 2. Adjusted odds ratios for advanced CKM per 10-point LE8 behavioral and health-factor subscore increment across sequentially restricted cohorts (L1, L2, and L3). Each marker shows the adjusted odds ratio (aOR) per 10-point increment in the corresponding Life’s Essential 8 (LE8) score from the primary multivariable model, estimated within three sequentially restricted cohorts: L1, full primary analytic cohort (n = 17,351; 931 cases); L2, CKM Stage 1 or higher (CKM Stage 0 excluded; n = 14,272; 931 cases); L3, CKM Stage 2 or higher (CKM Stages 0 and 1 excluded; n = 11,121; 931 cases). Horizontal bars indicate 95% confidence intervals; the dashed vertical line indicates the null reference value of 1.00. Behavioral and health-factor subscores were modeled separately in single-subscore Model 2 specifications.

Figure 3. Forest plots of adjusted odds ratios (aOR) for advanced cardiovascular-kidney-metabolic (CKM) syndrome (CKM Stage 3 or 4) per 10-point increment in (A) the eight individual Life’s Essential 8 (LE8) components in a single mutually-adjusted Model 2 regression, and (B) the LE8 total score, lipid component, and health-factor subscore, stratified by current use of lipid-lowering medication, in the primary analytic cohort of 17,351 Korean adults from the Korea National Health and Nutrition Examination Survey 2019, 2020, 2021, and 2024. Survey-weighted Model 2 estimates (per 10-point LE8 increment) in the primary analytic cohort (n = 17,351; 931 advanced CKM cases). Panel A: eight LE8 components in a single mutually-adjusted regression; the lipid component is identified separately. (B) lipid-medication-stratified estimates (user n = 3,450, non-user n = 13,901) for LE8 total, lipid component, and health-factor subscore. Horizontal bars indicate 95% confidence intervals; the dashed vertical line indicates the null reference value of 1.00; numerical aOR (95% CI) values are shown to the right of each row. aOR, adjusted odds ratio; CI, confidence interval; CKM,…

Figure 4. Forest plot of adjusted odds ratios (aOR) for advanced cardiovascular-kidney-metabolic (CKM) syndrome (CKM Stage 3 or 4) per 10-point increment in Life’s Essential 8 (LE8) total score, in the overall primary analytic cohort and in pre-specified subgroups defined by sex, age category, and diabetes status. Survey-weighted Model 2 estimates for LE8 total (per 10-point increment) in the primary analytic cohort (n = 17,351; 931 advanced CKM cases). Age (continuous) omitted from age-stratified models; sex from sex-stratified models. Horizontal bars: 95% CI; dashed line: null reference (aOR = 1.000); numerical aOR (95% CI) values are shown to the right of each row. P for interaction (LE8 × moderator) is shown adjacent to each stratifier subheading. aOR, adjusted odds ratio; CI, confidence interval; CKM, cardiovascular-kidney-metabolic; KNHANES, Korea National Health and Nutrition Examination Survey; LE8, Life’s Essential 8.