Associations of Life’s Essential 10 with Mortality and Healthspan Free of Cardiovascular Disease and Cancer: Findings in Two Nationwide Cohorts

Aims To evaluate associations of cardiovascular health (CVH) based on Life’s Essential 10 (LE10) with all-cause mortality, cardiovascular disease (CVD) and cancer mortality and incidence, and life expectancy free of CVD and cancer. Methods and results This prospective study included 110,806 UK Biobank participants (aged 37–73) and 20,031 National Health and Nutrition Examination Survey (NHANES) participants (aged ≥20). LE10 (0–100), which integrates alcohol consumption and mental health with Life’s Essential 8, categorised CVH as low (<60), moderate (60–79), and high (≥80). Cox regression and competing risk models were applied to estimate adjusted hazard ratios (aHRs). Life expectancy was calculated using multi-state and flexible parametric survival models. Over a median follow-up of 13.8 years, 6137 deaths, 13,968 CVD events, and 18,077 cancer cases were documented in UK Biobank. In UK Biobank, high CVH was associated with lower risks of all-cause mortality (men: aHR 0.43, 95% CI 0.39–0.48; women: aHR 0.34, 95% CI 0.29–0.39), alongside CVD and cancer mortality and incidence, compared to low CVH. At age 50, high CVH conferred greater projected overall (men +5.47 years, women +5.85) and disease-free life expectancy (men +4.02 years, women +4.40). Having more low-risk CVH metrics was associated with up to 9.73 years of projected gains in life expectancy. Associations were replicated and consistent in 7.2-year NHANES follow-up. Conclusion Higher LE10-based CVH levels were associated with lower all-cause mortality, reduced CVD and cancer mortality and incidence, and longer life expectancy free of CVD and cancer. LE10 may provide additional targets for CVH management.