Life's Essential 8 and Risk of All-Cause and Cardiovascular Mortality in US Adults With Arthritis: A Retrospective Cohort Study Utilizing NHANES Database

IF 2 4区医学 Q2 RHEUMATOLOGY International Journal of Rheumatic Diseases Pub Date : 2025-02-10 DOI:10.1111/1756-185X.70105

Feiyu Yao, Jiafeng Zhang, Xianhua Li, Meng Sun, Po-Cheng Shih, Tuo Li

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Abstract

Background

Life's Essential 8 (LE8) is a recently updated algorithm for evaluating cardiovascular health (CVH). This study investigates the association between LE8 and mortality risk among individuals with arthritis in the United States.

Methods

We conducted a retrospective cohort study using data from the US National Health and Nutritional Examination Survey (NHANES) 2005–2018. Participants with arthritis were included. Mortality data, including underlying causes of death, were obtained through linkage to national death records up to December 31, 2019. LE8 components (diet, physical activity, nicotine exposure, sleep, body mass index, blood lipids, glucose, and pressure) were measured and scored from 0 to 100. The total LE8 score, calculated as the unweighted average of all components, was categorized into low (0–49), moderate (50–79), and high (80–100) CVH. We employed Kaplan–Meier curves to estimate survival probabilities and weighted Cox proportional hazards regression models to evaluate hazard ratios (HRs) with 95% confidence intervals (CIs) for all-cause and cardiovascular disease (CVD) mortality. Stratified analyses and interaction tests were performed to explore potential effect modifications.

Results

Among 4519 participants with arthritis (median follow-up: 7.67 years), we observed 793 all-cause deaths, including 213 CVD deaths. Every 10-point increase in the LE8 score was associated with a 17% lower risk of all-cause mortality (HR: 0.83, 95% CI: 0.77–0.89) and a 25% lower risk of CVD mortality (HR: 0.75, 95% CI: 0.66–0.85). Compared to the lowest CVH tertile, individuals in the highest tertile demonstrated a 38% lower risk of all-cause mortality (HR: 0.62, 95% CI: 0.41–0.92) and a 62% lower risk of CVD mortality (HR: 0.38, 95% CI: 0.18–0.80). Kaplan–Meier survival curves revealed significantly higher survival probability for patients with high CVH compared to those with lower CVH (log-rank p < 0.05). Stratified analyses confirmed consistent associations across various subgroups. Similar findings were observed in sensitivity analyses focusing on osteoarthritis and other arthritis subtypes.

Conclusion

Higher adherence to LE8 recommendations is associated with reduced risks of all-cause and cardiovascular mortality among US adults with arthritis.

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美国成年关节炎患者的生命要素8和全因及心血管死亡风险：一项利用NHANES数据库的回顾性队列研究

Life's Essential 8 （LE8）是最近更新的评估心血管健康（CVH）的算法。本研究调查了美国关节炎患者体内LE8与死亡风险之间的关系。方法：我们使用2005-2018年美国国家健康与营养检查调查（NHANES）的数据进行了回顾性队列研究。患有关节炎的参与者也包括在内。通过与截至2019年12月31日的国家死亡记录联系，获得了包括潜在死亡原因在内的死亡率数据。LE8成分（饮食、体力活动、尼古丁暴露、睡眠、体重指数、血脂、血糖和血压）被测量并打分从0到100。总LE8得分以所有成分的未加权平均值计算，分为低（0-49），中（50-79）和高（80-100）CVH。我们采用Kaplan-Meier曲线估计生存率，加权Cox比例风险回归模型评估全因和心血管疾病（CVD）死亡率的95%置信区间的风险比（hr）。进行分层分析和相互作用试验以探索潜在的效应改变。结果在4519例关节炎患者中（中位随访时间：7.67年），我们观察到793例全因死亡，包括213例心血管疾病死亡。LE8评分每增加10分，全因死亡风险降低17% (HR: 0.83, 95% CI: 0.77-0.89)，心血管疾病死亡风险降低25% （HR: 0.75, 95% CI: 0.66-0.85）。与最低CVH分位数的个体相比，最高分位数的个体全因死亡风险降低38% (HR: 0.62, 95% CI: 0.41-0.92)， CVD死亡风险降低62% （HR: 0.38, 95% CI: 0.18-0.80）。Kaplan-Meier生存曲线显示CVH高患者的生存率显著高于CVH低患者（log-rank p < 0.05）。分层分析证实了不同亚组之间的一致关联。在骨关节炎和其他关节炎亚型的敏感性分析中也观察到类似的结果。结论：在美国成年关节炎患者中，较高的LE8推荐依从性与全因死亡率和心血管死亡率降低相关。

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来源期刊

International Journal of Rheumatic Diseases RHEUMATOLOGY-

CiteScore

3.70

自引率

4.00%

发文量

362

审稿时长

1 months

期刊介绍： The International Journal of Rheumatic Diseases (formerly APLAR Journal of Rheumatology) is the official journal of the Asia Pacific League of Associations for Rheumatology. The Journal accepts original articles on clinical or experimental research pertinent to the rheumatic diseases, work on connective tissue diseases and other immune and allergic disorders. The acceptance criteria for all papers are the quality and originality of the research and its significance to our readership. Except where otherwise stated, manuscripts are peer reviewed by two anonymous reviewers and the Editor.