Association of Life's Crucial 9 score with mortality among adults with arthritis: A prospective cohort analysis
Xiao-Mei Huang1, Yao-Wei Zou2, Jie Lu1
1Department of Rheumatology and Immunology, Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, Zhanjiang, 524000, China.
Insights
Life's Crucial 9 (LC9) effectively predicts mortality in arthritis patients, showing a significant inverse association with both all-cause and cardiovascular disease (CVD) death. This new metric surpasses Life's Simple 7 (LS7) and Life's Essential 8 (LE8) in prognostic value.
Area of Science:
- Cardiovascular health and epidemiology
- Arthritis research
- Public health and mortality studies
Background:
- Cardiovascular diseases (CVD) are the leading cause of death among individuals with arthritis.
- The prognostic value of the new cardiovascular health metric, Life's Crucial 9 (LC9), compared to Life's Simple 7 (LS7) and Life's Essential 8 (LE8) in this population is not well-established.
Purpose of the Study:
- To investigate the association between Life's Crucial 9 (LC9) and all-cause and CVD mortality in patients with arthritis.
- To compare the predictive performance of LC9 against Life's Simple 7 (LS7) and Life's Essential 8 (LE8) for mortality risk in arthritis patients.
Main Methods:
- Prospective cohort study utilizing data from seven cycles of the National Health and Nutrition Examination Survey (NHANES) (2005-2018).
- Weighted Cox regression analysis was employed to assess the association between LC9 and mortality outcomes.
- C-statistics and net reclassification improvement (NRI) were used to compare the predictive accuracy of LC9, LS7, and LE8.
Main Results:
- The study included 7247 arthritis patients, with 1293 deaths recorded during follow-up.
- Each one-unit increase in LC9 was significantly associated with a 1.9% decrease in all-cause mortality and a 2.4% decrease in CVD mortality.
- LC9 demonstrated superior predictive performance over LS7 and LE8 for both all-cause and CVD mortality, indicated by higher C-statistics and NRI values.
Conclusions:
- Life's Crucial 9 (LC9) is inversely correlated with mortality in arthritis patients.
- LC9 exhibits enhanced prognostic capability for predicting all-cause and CVD mortality compared to LS7 and LE8.
- LC9 serves as a valuable tool for comprehensive mortality risk assessment in individuals with arthritis.
Objectives:
Cardiovascular diseases (CVD) are the predominant cause of death in arthritis patients. For Life's Crucial 9 (LC9), a newly proposed cardiovascular health metric, its association with mortality in the arthritis population and its prognostic value compared to the conventional Life's Simple 7 (LS7) and Life's Essential 8 (LE8) remain unclear.
Study Design:
This is a prospective cohort study, data from seven cycles of the NHANES survey (2005-2018) were analyzed.
Methods:
In this prospective cohort study, participants with self-reported arthritis from the NHANES were followed-up until December 2019. Weighted Cox regression was used to analyze the association between LC9 and mortality, while predictive performance of each metric was compared using C-statistics and net reclassification improvement (NRI).
Results:
Among 7247 arthritis patients (weighted mean age 59.49 years, 59.86% female), 1293 deaths were recorded during a median follow-up of 6.58 years (32.17% were CVD-related). In fully adjusted models, each 1-unit increase in LC9 was linearly associated with a 1.9% decrease in all-cause mortality (hazard ratios [HR] = 0.981, 95% confidence intervals [CI]: 0.974-0.988) and 2.4% decrease in CVD mortality (HR = 0.976, 95% CI: 0.965-0.987). Weighted Quartile Sum identified physical activity (29.1%) and sleep health (32.2%) as the primary contributors to all-cause and cardiovascular mortality, respectively. Notably, LC9 consistently outperformed LS7 and LE8: for all-cause mortality, ΔC-statistic = +0.008 vs. LS7 and +0.002 vs. LE8, NRI was 6.6% and 2.1%, while for CVD mortality, ΔC-statistic = +0.013 vs. LS7 and +0.002 vs. LE8, NRI was 12.3% and 4.8%, respectively.
Conclusions:
LC9 exhibits a linear inverse correlation with mortality in arthritis patients and demonstrates superior predictive performance compared to LS7 and LE8. This metric is useful for comprehensively evaluating mortality risk in arthritis patients.
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