Life's Essential 8 and Mortality in US Adults With Diabetes: Greater Risk Reduction Compared to Those Without...

Diabetes prevalence is high and increases the risk of all-cause, cardiovascular disease (CVD), and cancer-related deaths. In this study we investigated the association between Life's Essential 8 (LE8) and these mortality risks, and the potential modifying effect of diabetes.

We analyzed 20,231 US adults (3,497 with diabetes and 16,724 without diabetes) from the National Health and Nutrition Examination Survey 2005-2018. LE8 scores (0 to 100) were categorized by weighted tertiles. Cox proportional hazards regression models were used to assess associations with prospectively tracked mortality (through 2019).

Over a median 7.2 years, 1,920 all-cause, 472 CVD, and 484 cancer-related deaths occurred. Mortality rates were higher in people with diabetes. Among people without diabetes, a 10-point increment in the LE8 score was linked to a significant 23% decreased risk of all-cause mortality (hazard ratio [HR] 0.77, 95% confidence interval [CI] 0.67 to 0.90) and a 21% decreased risk of CVD mortality (HR 0.79, 95% CI 0.64-0.98). However, no significant association was detected between LE8 score and cancer mortality in people with diabetes (HR 0.89, 95% CI 0.70 to 1.13). In the nondiabetes population, the HRs for LE8 score and all-cause, CVD, and cancer mortality were 0.58 (95% CI 0.44 to 0.75), 0.63 (95% CI 0.40-0.98), and 0.64 (95% CI 0.42 to 0.97), respectively. There was a synergistic additive interaction between diabetes and LE8 score for CVD death (relative excess risk due to interaction: 0.56, 95% CI 0.04 to 1.09; attributable proportion of interaction: 0.30, 95% CI 0.04 to 0.57; synergy index: 2.91, 95% CI 0.54 to 15.69).

Higher LE8 score conferred greater mortality risk reduction in people with diabetes vs those without diabetes. Diabetes and suboptimal LE8 scores may synergistically accelerate CVD death, underscoring the necessity for dual interventions addressing both glycemic control and cardiovascular health optimization in this population.