Association of life's essential 8 with pulmonary function impairment: a cross-sectional analysis of the Kailuan study

Pulmonary function impairment not only reflects underlying respiratory disease but also serves as an independent predictor of systemic morbidity, particularly cardiovascular disease. Life's Essential 8 (LE8), a composite cardiovascular health (CVH) metric endorsed by the American Heart Association, encompasses four health behaviors and four health factors. Despite its comprehensive nature, direct evidence on the relationship between LE8 and pulmonary function impairment remains scarce.

Between 2015 and 2023, a total of 17,191 adults (with 97.8% men and 2.2% women) in the Kailuan study underwent pulmonary function testing, pulmonary function impairment was defined as percent-predicted FEV₁ < 80% or percent-predicted FVC < 80%. LE8 scores were calculated using American Heart Association algorithms and categorized as low (0-49), moderate (50-79), or high (80-100). Logistic regression were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for impairment across LE8 categories and per 10-point increment. Dose-response associations were examined with restricted cubic splines, population attributable risk percent (PAR%) was estimated, component importance was evaluated using weighted quantile sum (WQS) regression, and robustness was assessed through subgroup and sensitivity analyses.

Mean age was 43.6 years and pulmonary function impairment prevalence was 33.4%. The mean LE8 score was 60.2 (low n = 3,395; moderate n = 13,069; high n = 727). Impairment prevalence was 38.6, 32.3, and 28.2% across low, moderate, and high groups (p for trend <0.001). In adjusted logistic regression models, ORs (vs. low) were 0.80 (95% CI, 0.74-0.87) for moderate and 0.73 (95% CI, 0.61-0.87) for high (both p < 0.001); each 10-point higher LE8 was associated with OR 0.91 (95% CI, 0.89-0.94). WQS regression identified smoking, BMI, sleep health, and blood pressure as the major contributors, whereas blood glucose, diet quality, blood lipids, and physical activity contributed only modestly. Results were consistent across subgroup and sensitivity analyses.

In this cross-sectional analysis, higher Life's Essential 8 scores were associated with lower odds of impaired pulmonary function. However, women comprised only 385 (2.2%) of the sample; thus, the findings primarily reflect a male cohort and may not be generalizable to women.