Life’s Essential 8 and healthy longevity among people with and without cardiometabolic multimorbidity: A prospective study of UK Biobank

Aims: To investigate the impact of Life's Essential 8 (LE8) on mortality risk and life expectancy in patients with and without cardiometabolic multimorbidity (CMM). Methods: 264,675 participants from UK Biobank were categorized into low, moderate, and high cardiovascular health (CVH) levels based on LE8 score. Baseline disease status was categorized as no cardiometabolic diseases (CMD), single cardiometabolic disease (SCMD), or CMM. The Cox proportional hazards model was used to assess the risk of all-cause mortality, and the flexible parametric survival model was employed to estimate life expectancy. Results: During a median follow-up of 14.27 years, 20,335 all-cause deaths occurred. For each 10-point increase in LE8 score, the risk of all-cause mortality declined by approximately 20 % whether in groups of CMD-free, SCMD, or CMM. Compared to the CMD-free with high CVH group, the adjusted hazard ratio (HR) of all-cause mortality was 2.86 (95 % CI: 1.79-4.55) for CMM patients with high CVH, and 6.49 (95 % CI: 5.56-7.58) for CMM patients with low CVH. High CVH levels reduced CMM-related mortality risk by 66.12 %. Compared to those with low CVH, residual life expectancy at age 45 of participants with high CVH extended by 11.05 years (95 % CI: 10.97-11.14) in CMD-free group, 8.73 years (95 % CI: 8.56-8.92) in SCMD group, and 8.12 years (95 % CI: 7.59-8.64) in CMM group. Among CVH components, the tobacco/nicotine score had the greatest impact on mortality risk and life expectancy. Conclusions: Regardless of CMM statuses, higher LE8 scores were consistently associated with lower mortality risk and longer residual life expectancy.