Association Between Life's Essential 8 and Cardiovascular, Cancer, and Other Cause Mortality: The REGARDS Study
Katherine M Huether1, Laura C Pinheiro2, Suzanne E Judd3
1Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA.
Insights
Improving cardiovascular health (CVH) through Life's Essential 8 (LE8) metrics is linked to reduced mortality from cardiovascular disease (CVD), cancer, and other causes. Lifestyle modifications are key for lowering overall mortality risk.
Area of Science:
- Public Health
- Epidemiology
- Cardiovascular Medicine
Background:
- Cardiovascular disease (CVD) and cancer are leading causes of adult mortality.
- Life's Essential 8 (LE8) is a metric for assessing cardiovascular health (CVH), encompassing lifestyle factors.
- CVD, cancer, and other causes of death represent competing risks.
Purpose of the Study:
- To evaluate the association between LE8-quantified CVH and the risks of CVD mortality, cancer mortality, and other mortality.
- To analyze these risks within a competing risk framework.
Main Methods:
- The Reasons for Geographic and Racial Differences in Stroke (REGARDS) study included 30,239 adults.
- LE8 scores were categorized into low, moderate, and high CVH.
- Adjusted cause-specific hazard models were used to estimate mortality risks.
Main Results:
- Among 11,385 participants, 24% had low, 66% moderate, and 10% high CVH.
- Higher CVH was significantly associated with reduced hazard ratios for CVD, cancer, and non-CVD, noncancer mortality.
- Specifically, higher CVH showed HRs of 0.37 for CVD, 0.48 for cancer, and 0.39 for other mortality compared to low CVH.
Conclusions:
- Enhanced cardiovascular health, as measured by LE8, is associated with decreased mortality from CVD and cancer.
- These findings highlight the importance of lifestyle modifications for reducing overall mortality.
- The study advocates for integrating CVH assessment and improvement into clinical practice and preventive strategies.
Background:
Cardiovascular disease (CVD) and cancer are leading causes of death in adults. Life's Essential 8 (LE8) estimates cardiovascular health (CVH) and includes body mass index, blood pressure, blood sugar, cholesterol, diet, physical activity, sleep, and smoking. CVD, cancer, and other mortality are competing risks.
Objectives:
The purpose of this study was to determine the risk of CVD mortality, cancer mortality, and other mortality by LE8-quantified CVH in a competing risk framework.
Methods:
REGARDS (REasons for Geographic and Racial Differences in Stroke) study recruited 30,239 Black and White adults from the 48 contiguous U.S. states from 2003 to 2007. We excluded prevalent CVD or cancer, missing LE8, or no follow-up. LE8 scores were categorized as low (<50), moderate (50-79), or high CVH (≥80). Adjusted cause-specific hazard models estimated relative hazard of CVD mortality, cancer mortality, and non-CVD, noncancer mortality as competing risks.
Results:
Among 11,385 included participants (mean age 65 ± 9 years, 52% female, 44% Black adults), 24%, 66%, and 10% had low, moderate, and high CVH, respectively. Over a median (IQR) follow-up of 14 (IQR: 8-17) years, 8% died from CVD, 7% from cancer, and 17% from other causes. Higher CVH was associated with significantly lower HRs for CVD (0.37; 95% CI: 0.28-0.49), cancer (0.48; 95% CI: 0.36-0.66), and non-CVD, noncancer (0.39; 95% CI: 0.32-0.48) mortality compared to low CVH levels.
Conclusions:
Better LE8-quantified CVH was associated with lower CVD and cancer mortality in a competing risk framework. These findings underscore the significance of lifestyle modifications in mortality risk reduction, advocating for their incorporation into clinical guidelines and preventive counseling.
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