Association of the “life’s crucial 9” cardiovascular health with all-cause and cardiovascular disease mortality: a national cohort study
Abstract Background In 2022, the American Heart Association launched an updated algorithm for quantifying cardiovascular health (CVH), termed Life’s Essential 8 (LE8). This new approach has been shown to be associated with various noncommunicable chronic diseases and mortality. However, LE8 did not...
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BMC
2025-04-01
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| Series: | Archives of Public Health |
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| Online Access: | https://doi.org/10.1186/s13690-025-01607-2 |
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| author | Dingyuan Tu Qiang Xu Jie Sun Ping Li Chaoqun Ma |
| author_facet | Dingyuan Tu Qiang Xu Jie Sun Ping Li Chaoqun Ma |
| author_sort | Dingyuan Tu |
| collection | DOAJ |
| description | Abstract Background In 2022, the American Heart Association launched an updated algorithm for quantifying cardiovascular health (CVH), termed Life’s Essential 8 (LE8). This new approach has been shown to be associated with various noncommunicable chronic diseases and mortality. However, LE8 did not take into consideration the importance of psychological health on CVH. Recently, a perspective article proposed Life’s Crucial 9 (LC9), which would add psychological health as another component to LE8, as a novel metric to assess CVH. This study aims to investigate the association of LC9 with all-cause and cardiovascular disease (CVD) mortality. Methods This study included 23,080 adults from National Health and Nutrition Examination Survey 2005–2018, and mortality was ascertained by linkage to National Death Index records through 31 December 2019. The LC9 scoring algorithm was categorized into low (0–49), moderate (50–79), and high (80–100) CVH. Weighted Cox proportional hazards regression models and restricted cubic spline analysis were applied to evaluate the association of LC9 with mortality. Results During a median follow-up of 7.8 years, a total of 2,388 overall deaths were identified, covering 613 CVD deaths. Compared with adults with a low CVH score, those with a high CVH score had 52% (hazard ratio, 0.48; 95% confidence interval, 0.38–0.60) and 64% (0.36; 0.23–0.56) reduced risk of all-cause and CVD mortality. Similarly, a moderate CVH score was associated with 33% (0.67; 0.58–0.78) and 49% (0.51; 0.40–0.64) reduced risk of all-cause and CVD mortality. The population-attributable fractions of high vs. moderate or low CVH score were 46.0% for all-cause mortality and 75.8% for CVD mortality. Elevated blood lipids, high body mass index, and poor sleep quality were the three major contributors to all-cause mortality, whereas nicotine exposure, unhealthy psychology, and elevated blood lipids were the three significant ones to CVD mortality. There were approximately negative linear dose-response relationships of total LC9 score with all-cause and CVD mortality. Conclusions Adhering to a high LC9 score is related to a reduced risk of all-cause and CVD mortality. This new CVH definition shows promise as a primordial preventive strategy to reduce mortality rates. |
| format | Article |
| id | doaj-art-0e7e5afc654b4261ac76a8ba4528acde |
| institution | OA Journals |
| issn | 2049-3258 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Archives of Public Health |
| spelling | doaj-art-0e7e5afc654b4261ac76a8ba4528acde2025-08-20T02:10:53ZengBMCArchives of Public Health2049-32582025-04-0183111910.1186/s13690-025-01607-2Association of the “life’s crucial 9” cardiovascular health with all-cause and cardiovascular disease mortality: a national cohort studyDingyuan Tu0Qiang Xu1Jie Sun2Ping Li3Chaoqun Ma4Cardiovascular Research Institute, Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), General Hospital of Northern Theater CommandDepartment of Cardiology, Navy 905 Hospital, Naval Medical UniversityHospital-Acquired Infection Control Department, Yantai Ludong HospitalDepartment of Cardiology, The 961st Hospital of the Joint Logistics Support Force of The Chinese People’s Liberation ArmyCardiovascular Research Institute, Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), General Hospital of Northern Theater CommandAbstract Background In 2022, the American Heart Association launched an updated algorithm for quantifying cardiovascular health (CVH), termed Life’s Essential 8 (LE8). This new approach has been shown to be associated with various noncommunicable chronic diseases and mortality. However, LE8 did not take into consideration the importance of psychological health on CVH. Recently, a perspective article proposed Life’s Crucial 9 (LC9), which would add psychological health as another component to LE8, as a novel metric to assess CVH. This study aims to investigate the association of LC9 with all-cause and cardiovascular disease (CVD) mortality. Methods This study included 23,080 adults from National Health and Nutrition Examination Survey 2005–2018, and mortality was ascertained by linkage to National Death Index records through 31 December 2019. The LC9 scoring algorithm was categorized into low (0–49), moderate (50–79), and high (80–100) CVH. Weighted Cox proportional hazards regression models and restricted cubic spline analysis were applied to evaluate the association of LC9 with mortality. Results During a median follow-up of 7.8 years, a total of 2,388 overall deaths were identified, covering 613 CVD deaths. Compared with adults with a low CVH score, those with a high CVH score had 52% (hazard ratio, 0.48; 95% confidence interval, 0.38–0.60) and 64% (0.36; 0.23–0.56) reduced risk of all-cause and CVD mortality. Similarly, a moderate CVH score was associated with 33% (0.67; 0.58–0.78) and 49% (0.51; 0.40–0.64) reduced risk of all-cause and CVD mortality. The population-attributable fractions of high vs. moderate or low CVH score were 46.0% for all-cause mortality and 75.8% for CVD mortality. Elevated blood lipids, high body mass index, and poor sleep quality were the three major contributors to all-cause mortality, whereas nicotine exposure, unhealthy psychology, and elevated blood lipids were the three significant ones to CVD mortality. There were approximately negative linear dose-response relationships of total LC9 score with all-cause and CVD mortality. Conclusions Adhering to a high LC9 score is related to a reduced risk of all-cause and CVD mortality. This new CVH definition shows promise as a primordial preventive strategy to reduce mortality rates.https://doi.org/10.1186/s13690-025-01607-2Cardiovascular healthLife’s crucial 9All-cause mortalityCardiovascular disease mortalityNational health and nutrition examination survey |
| spellingShingle | Dingyuan Tu Qiang Xu Jie Sun Ping Li Chaoqun Ma Association of the “life’s crucial 9” cardiovascular health with all-cause and cardiovascular disease mortality: a national cohort study Archives of Public Health Cardiovascular health Life’s crucial 9 All-cause mortality Cardiovascular disease mortality National health and nutrition examination survey |
| title | Association of the “life’s crucial 9” cardiovascular health with all-cause and cardiovascular disease mortality: a national cohort study |
| title_full | Association of the “life’s crucial 9” cardiovascular health with all-cause and cardiovascular disease mortality: a national cohort study |
| title_fullStr | Association of the “life’s crucial 9” cardiovascular health with all-cause and cardiovascular disease mortality: a national cohort study |
| title_full_unstemmed | Association of the “life’s crucial 9” cardiovascular health with all-cause and cardiovascular disease mortality: a national cohort study |
| title_short | Association of the “life’s crucial 9” cardiovascular health with all-cause and cardiovascular disease mortality: a national cohort study |
| title_sort | association of the life s crucial 9 cardiovascular health with all cause and cardiovascular disease mortality a national cohort study |
| topic | Cardiovascular health Life’s crucial 9 All-cause mortality Cardiovascular disease mortality National health and nutrition examination survey |
| url | https://doi.org/10.1186/s13690-025-01607-2 |
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