Association between the life's essential 8 health behaviors and prognosis in patients with advanced cardiovascular-kidney-metabolic syndrome

Abstract Aims This study aimed to evaluate the association between the Life’s Essential 8 (LE8) and mortality risk in patients with advanced cardiovascular–kidney–metabolic (CKM) syndrome, focusing on the prognostic impact of its health behaviour and health factor components. Methods and results A total of 10 321 participants were included from the National Health and Nutrition Examination Survey (NHANES). Kaplan–Meier curve and Cox proportional-hazards models, and restricted cubic splines (RCS) were used to assess the associations of LE8, health behaviours, and health factors with mortality risk. Result Among all participants, 2629 had advanced CKM syndrome. Over a median 78-month follow-up, 579 deaths occurred. Each 10-point increase in the LE8 score reduced advanced CKM syndrome risk by 15% (OR = 0.85), while low cardiovascular health (CVH) increased risk by 105% (OR = 2.05). Advanced CKM syndrome was associated with higher mortality risks, while each 10-point increase in the LE8 score reduced mortality risk. However, no significant difference in mortality risk was observed between the moderate and high CVH groups. Notably, each 10-point increase in the health behaviour score lowered all-cause (HR = 0.80), cardiovascular (HR = 0.83), and CKM-related mortality risk (HR = 0.82), while patients with moderate (HR = 2.08, 1.88, 1.94) and low CVH (HR = 3.25, 2.53, 2.89) faced higher mortality risks. In contrast, the health factor showed no significant association with mortality risk. Conclusion The LE8, particularly its health behaviour, is independently associated with mortality in advanced CKM syndrome. These findings suggest that LE8-based behavioural interventions could potentially reduce risk in advanced CKM syndrome patients.