Life’s Essential 8 cardiovascular health, cardiovascular-kidney-metabolic syndrome stages, and incident cardiovascular events: a nationwide 10-year prospective cohort study in China
Abstract Background Definition and staging rationale of cardiovascular-kidney-metabolic syndrome were developed. The utility of cardiovascular-kidney-metabolic construct in risk stratification and target strategies of health and behavior modifications needs to be addressed. The study aims to investi...
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2025-05-01
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| Series: | Cardiovascular Diabetology |
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| Online Access: | https://doi.org/10.1186/s12933-025-02735-3 |
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| author | Mian Li Min Xu Yi Ding Hong Lin Guijun Qin Tiange Wang Yu Xu Yuhong Chen Shuangyuan Wang Zhiyun Zhao Jie Zheng Li Yan Lixin Shi Zhengnan Gao Lulu Chen Tianshu Zeng Ruying Hu Zhen Ye Xuefeng Yu Gang Chen Qing Su Yiming Mu Xulei Tang Qin Wan Guixia Wang Feixia Shen Xuejiang Gu Zuojie Luo Yingfen Qin Li Chen Xinguo Hou Yanan Huo Qiang Li Hong Qiao Yinfei Zhang Chao Liu Youmin Wang Shengli Wu Tao Yang Huacong Deng Jiajun Zhao Guang Ning Jieli Lu Weiqing Wang Yufang Bi |
| author_facet | Mian Li Min Xu Yi Ding Hong Lin Guijun Qin Tiange Wang Yu Xu Yuhong Chen Shuangyuan Wang Zhiyun Zhao Jie Zheng Li Yan Lixin Shi Zhengnan Gao Lulu Chen Tianshu Zeng Ruying Hu Zhen Ye Xuefeng Yu Gang Chen Qing Su Yiming Mu Xulei Tang Qin Wan Guixia Wang Feixia Shen Xuejiang Gu Zuojie Luo Yingfen Qin Li Chen Xinguo Hou Yanan Huo Qiang Li Hong Qiao Yinfei Zhang Chao Liu Youmin Wang Shengli Wu Tao Yang Huacong Deng Jiajun Zhao Guang Ning Jieli Lu Weiqing Wang Yufang Bi |
| author_sort | Mian Li |
| collection | DOAJ |
| description | Abstract Background Definition and staging rationale of cardiovascular-kidney-metabolic syndrome were developed. The utility of cardiovascular-kidney-metabolic construct in risk stratification and target strategies of health and behavior modifications needs to be addressed. The study aims to investigate the individual and combined associations of cardiovascular-kidney-metabolic stage and cardiovascular health (CVH) by Life’s Essential 8 (LE 8) with incident cardiovascular events (CVD), and determine the distribution and contribution of domain-specific CVH across cardiovascular-kidney-metabolic stages. Methods The study included 100,727 individuals in the China Cardiovascular Disease and Cancer Cohort with complete data on cardiovascular-kidney-metabolic factors and LE 8 metrics, with a median follow-up of 10.1 years. Cardiovascular-kidney-metabolic stages and CVH metrics (nicotine exposure, diet, physical activity, sleep, body mass index, blood lipids, blood pressure, blood glucose) were defined according to Presidential Advisory from the American Heart Association. Incident CVD events including cardiovascular death, myocardial infarction, and stroke were validated. The Fine-Gray hazard model was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of CKM stages or CVH status associated with CVD. Results Compared with cardiovascular-kidney-metabolic stage 0, the adjusted competing HRs and 95% CIs of CVD events were 1.20 (0.95–1.51), 2.45 (1.97–3.04), 4.43 (3.53–5.58), and 5.95 (4.75–7.45) from stage 1 to stage 4, respectively. Optimal CVH status and each optimal CVH metric presented a significantly decreased risk of CVD events. Variation was observed in the association between cardiovascular-kidney-metabolic stage and CVD events with different CVH status or numbers of optimal CVH metrics. Compared with those in stage 0, Participants in stage 1 or 2 with optimal CVH no longer had elevated risks for incident CVD events. Suboptimal health factor contributed larger population attributable fractions to CVD events in cardiovascular-kidney-metabolic stage 0–2 (51.2%) than in stage 3–4 (25.2%), whereas suboptimal health behavior exhibited larger contribution in advanced stages (13.1% in stage 0–2 and 18.2% in stage 3–4). Conclusions The study indicated that cardiovascular-kidney-metabolic stage was associated with cardiovascular events, and optimal cardiovascular health could attenuate this risk. Health factor contributed predominantly at the early-stage, whereas health behavior exhibited consistent and slightly increased contribution along the spectrum. These findings support the utility of cardiovascular-kidney-metabolic construct and highlight the importance of target health improvement based on LE 8 framework. Graphic abstract |
| format | Article |
| id | doaj-art-bf58c7c46e9449d68653aa246dcc60da |
| institution | OA Journals |
| issn | 1475-2840 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Cardiovascular Diabetology |
| spelling | doaj-art-bf58c7c46e9449d68653aa246dcc60da2025-08-20T02:15:01ZengBMCCardiovascular Diabetology1475-28402025-05-0124111210.1186/s12933-025-02735-3Life’s Essential 8 cardiovascular health, cardiovascular-kidney-metabolic syndrome stages, and incident cardiovascular events: a nationwide 10-year prospective cohort study in ChinaMian Li0Min Xu1Yi Ding2Hong Lin3Guijun Qin4Tiange Wang5Yu Xu6Yuhong Chen7Shuangyuan Wang8Zhiyun Zhao9Jie Zheng10Li Yan11Lixin Shi12Zhengnan Gao13Lulu Chen14Tianshu Zeng15Ruying Hu16Zhen Ye17Xuefeng Yu18Gang Chen19Qing Su20Yiming Mu21Xulei Tang22Qin Wan23Guixia Wang24Feixia Shen25Xuejiang Gu26Zuojie Luo27Yingfen Qin28Li Chen29Xinguo Hou30Yanan Huo31Qiang Li32Hong Qiao33Yinfei Zhang34Chao Liu35Youmin Wang36Shengli Wu37Tao Yang38Huacong Deng39Jiajun Zhao40Guang Ning41Jieli Lu42Weiqing Wang43Yufang Bi44Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineDepartment of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineDepartment of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineDepartment of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineThe First Affiliated Hospital of Zhengzhou UniversityDepartment of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineDepartment of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineDepartment of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineDepartment of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineDepartment of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineDepartment of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineSun Yat-sen Memorial Hospital, Sun Yat-sen UniversityAffiliated Hospital of Guiyang Medical CollegeDalian Municipal Central HospitalUnion Hospital, Tongji Medical College, Huazhong University of Science and TechnologyUnion Hospital, Tongji Medical College, Huazhong University of Science and TechnologyZhejiang Provincial Center for Disease Control and PreventionZhejiang Provincial Center for Disease Control and PreventionTongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyFujian Provincial Hospital, Fujian Medical UniversityXinhua Hospital, Shanghai Jiao Tong University School of MedicineChinese people’s Liberation Army General HospitalThe First Hospital of Lanzhou UniversityThe Affiliated Hospital of Southwest Medical UniversityThe First Hospital of Jilin UniversityThe First Affiliated Hospital of Wenzhou Medical UniversityThe First Affiliated Hospital of Wenzhou Medical UniversityThe First Affiliated Hospital of Guangxi Medical UniversityThe First Affiliated Hospital of Guangxi Medical UniversityQilu Hospital of Shandong UniversityQilu Hospital of Shandong UniversityJiangxi Provincial People’s Hospital Affiliated to Nanchang UniversityThe Second Affiliated Hospital of Harbin Medical UniversityThe Second Affiliated Hospital of Harbin Medical UniversityCentral Hospital of Shanghai Jiading DistrictJiangsu Province Hospital on Integration of Chinese and Western MedicineThe First Affiliated Hospital of Anhui Medical UniversityKaramay Municipal People’s HospitalThe First Affiliated Hospital of Nanjing Medical UniversityThe First Affiliated Hospital of Chongqing Medical UniversityShandong Provincial Hospital Affiliated to Shandong UniversityDepartment of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineDepartment of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineDepartment of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineDepartment of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineAbstract Background Definition and staging rationale of cardiovascular-kidney-metabolic syndrome were developed. The utility of cardiovascular-kidney-metabolic construct in risk stratification and target strategies of health and behavior modifications needs to be addressed. The study aims to investigate the individual and combined associations of cardiovascular-kidney-metabolic stage and cardiovascular health (CVH) by Life’s Essential 8 (LE 8) with incident cardiovascular events (CVD), and determine the distribution and contribution of domain-specific CVH across cardiovascular-kidney-metabolic stages. Methods The study included 100,727 individuals in the China Cardiovascular Disease and Cancer Cohort with complete data on cardiovascular-kidney-metabolic factors and LE 8 metrics, with a median follow-up of 10.1 years. Cardiovascular-kidney-metabolic stages and CVH metrics (nicotine exposure, diet, physical activity, sleep, body mass index, blood lipids, blood pressure, blood glucose) were defined according to Presidential Advisory from the American Heart Association. Incident CVD events including cardiovascular death, myocardial infarction, and stroke were validated. The Fine-Gray hazard model was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of CKM stages or CVH status associated with CVD. Results Compared with cardiovascular-kidney-metabolic stage 0, the adjusted competing HRs and 95% CIs of CVD events were 1.20 (0.95–1.51), 2.45 (1.97–3.04), 4.43 (3.53–5.58), and 5.95 (4.75–7.45) from stage 1 to stage 4, respectively. Optimal CVH status and each optimal CVH metric presented a significantly decreased risk of CVD events. Variation was observed in the association between cardiovascular-kidney-metabolic stage and CVD events with different CVH status or numbers of optimal CVH metrics. Compared with those in stage 0, Participants in stage 1 or 2 with optimal CVH no longer had elevated risks for incident CVD events. Suboptimal health factor contributed larger population attributable fractions to CVD events in cardiovascular-kidney-metabolic stage 0–2 (51.2%) than in stage 3–4 (25.2%), whereas suboptimal health behavior exhibited larger contribution in advanced stages (13.1% in stage 0–2 and 18.2% in stage 3–4). Conclusions The study indicated that cardiovascular-kidney-metabolic stage was associated with cardiovascular events, and optimal cardiovascular health could attenuate this risk. Health factor contributed predominantly at the early-stage, whereas health behavior exhibited consistent and slightly increased contribution along the spectrum. These findings support the utility of cardiovascular-kidney-metabolic construct and highlight the importance of target health improvement based on LE 8 framework. Graphic abstracthttps://doi.org/10.1186/s12933-025-02735-3Cardiovascular healthHealth behaviorHealth factorCardiovascular-kidney-metabolic syndromeCardiovascular events |
| spellingShingle | Mian Li Min Xu Yi Ding Hong Lin Guijun Qin Tiange Wang Yu Xu Yuhong Chen Shuangyuan Wang Zhiyun Zhao Jie Zheng Li Yan Lixin Shi Zhengnan Gao Lulu Chen Tianshu Zeng Ruying Hu Zhen Ye Xuefeng Yu Gang Chen Qing Su Yiming Mu Xulei Tang Qin Wan Guixia Wang Feixia Shen Xuejiang Gu Zuojie Luo Yingfen Qin Li Chen Xinguo Hou Yanan Huo Qiang Li Hong Qiao Yinfei Zhang Chao Liu Youmin Wang Shengli Wu Tao Yang Huacong Deng Jiajun Zhao Guang Ning Jieli Lu Weiqing Wang Yufang Bi Life’s Essential 8 cardiovascular health, cardiovascular-kidney-metabolic syndrome stages, and incident cardiovascular events: a nationwide 10-year prospective cohort study in China Cardiovascular Diabetology Cardiovascular health Health behavior Health factor Cardiovascular-kidney-metabolic syndrome Cardiovascular events |
| title | Life’s Essential 8 cardiovascular health, cardiovascular-kidney-metabolic syndrome stages, and incident cardiovascular events: a nationwide 10-year prospective cohort study in China |
| title_full | Life’s Essential 8 cardiovascular health, cardiovascular-kidney-metabolic syndrome stages, and incident cardiovascular events: a nationwide 10-year prospective cohort study in China |
| title_fullStr | Life’s Essential 8 cardiovascular health, cardiovascular-kidney-metabolic syndrome stages, and incident cardiovascular events: a nationwide 10-year prospective cohort study in China |
| title_full_unstemmed | Life’s Essential 8 cardiovascular health, cardiovascular-kidney-metabolic syndrome stages, and incident cardiovascular events: a nationwide 10-year prospective cohort study in China |
| title_short | Life’s Essential 8 cardiovascular health, cardiovascular-kidney-metabolic syndrome stages, and incident cardiovascular events: a nationwide 10-year prospective cohort study in China |
| title_sort | life s essential 8 cardiovascular health cardiovascular kidney metabolic syndrome stages and incident cardiovascular events a nationwide 10 year prospective cohort study in china |
| topic | Cardiovascular health Health behavior Health factor Cardiovascular-kidney-metabolic syndrome Cardiovascular events |
| url | https://doi.org/10.1186/s12933-025-02735-3 |
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