Life's Essential 8 Health Behaviors and All-Cause Mortality Across CKM Stages: Accounting for Construct Overlap in NHANES 2005–2014
Year: 2026
Type: preprint
Abstract: Cardiovascular-kidney-metabolic (CKM) syndrome staging and Life's Essential 8 (LE8) share several metabolic and cardiovascular constructs. We evaluated stage-specific associations of the LE8 health behavior score with all-cause mortality and compared their magnitude with associations for total LE8. Using NHANES 2005–2014 linked to the 2019 public-use mortality files, we included 5,949 participants aged 30–79 years (893 deaths) and applied complex survey-weighted Cox models, global Wald and stage-interaction tests, restricted cubic splines, and marginal standardization. Per 10-point higher behavior score, adjusted hazard ratios were 0.807 (95% CI, 0.724–0.900), 0.952 (0.835–1.086), and 0.831 (0.787–0.877) for CKM stages 0–2, 3, and 4, respectively. The global Wald, stage-interaction, and nonlinearity P values were 9.36×10⁻¹⁰, 0.0484, and 1.18×10⁻⁷. Corresponding standardized 5-year mortality risk differences were − 0.300, − 0.589, and − 1.885 percentage points; the stage 3 interval was wide. The global comparison of stage-specific slopes between the behavior and total LE8 scores yielded P = 0.094 (Holm-adjusted P = 0.120 for stage 3). Higher behavior scores were associated with lower mortality in stages 0–2 and 4. These observational findings support joint interpretation of relative and absolute risks and require validation in independent cohorts.
Source: Research Square
Authors: Yang Zhang, Yanyuan Wu, Hongxi Zhang, Xiaochen Liu
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7213888128