Table 3.
Adjusted hazard ratios of Life’s Essential 8 cardiovascular health (CVH) score with risk of cardiovascular disease mortality, NHANES 2005–2018
| CVH components | CVH score, HR (95% CI) | P for trendc | PAF | |||
|---|---|---|---|---|---|---|
| 0–49 | 50–74 | 75–100 | ||||
| Score ≥ 75 vs. < 75 points | Score ≥ 85 vs. < 85 points | |||||
| Total | ||||||
| Cases/participants | 209/4810 | 250/11,257 | 39/3884 | |||
| Age-, sex-, and race/ethnicity-adjusted | 1.00 (reference) | 0.50 (0.37–0.66) | 0.24 (0.15–0.40) | < 0.001 | ||
| Fully adjusteda | 1.00 (reference) | 0.62 (0.46–0.83) | 0.36 (0.21–0.59) | < 0.001 | 42.9 | 70.6 |
| Diet | ||||||
| Cases/participants | 245/8761 | 132/5426 | 121/5764 | |||
| Age-, sex-, and race/ethnicity-adjusted | 1.00 (reference) | 0.77 (0.56–1.05) | 0.64 (0.46–0.89) | 0.007 | ||
| Fully adjustedb | 1.00 (reference) | 0.87 (0.63–1.22) | 0.87 (0.59–1.27) | 0.449 | 5.9 | 5.0 |
| Physical activity | ||||||
| Cases/participants | 359/11,133 | 22/1008 | 117/7810 | |||
| Age-, sex-, and race/ethnicity-adjusted | 1.00 (reference) | 1.05 (0.57–1.93) | 0.52 (0.39–0.70) | < 0.001 | ||
| Fully adjustedb | 1.00 (reference) | 1.40 (0.79–2.49) | 0.74 (0.53–1.03) | 0.103 | 17.8 | 15.2 |
| Nicotine exposure | ||||||
| Cases/participants | 155/5213 | 23/691 | 320/14,047 | |||
| Age-, sex-, and race/ethnicity-adjusted | 1.00 (reference) | 0.76 (0.38–1.53) | 0.57 (0.43–0.77) | < 0.001 | ||
| Fully adjustedb | 1.00 (reference) | 0.87 (0.42–1.79) | 0.78 (0.55–1.09) | 0.102 | 7.1 | 8.8 |
| Sleep health | ||||||
| Cases/participants | 111/3508 | 114/4420 | 273/12,023 | |||
| Age-, sex-, and race/ethnicity-adjusted | 1.00 (reference) | 0.80 (0.56–1.15) | 0.71 (0.52–0.98) | 0.047 | ||
| Fully adjustedb | 1.00 (reference) | 1.07 (0.74–1.54) | 0.98 (0.71–1.34) | 0.750 | 2.2 | 2.2 |
| Body mass index | ||||||
| Cases/participants | 231/8422 | 166/6681 | 101/4848 | |||
| Age-, sex-, and race/ethnicity-adjusted | 1.00 (reference) | 0.57 (0.42–0.76) | 0.56 (0.40–0.79) | < 0.001 | ||
| Fully adjustedb | 1.00 (reference) | 0.72 (0.53–0.99) | 0.75 (0.52–1.09) | 0.067 | 9.7 | 9.7 |
| Blood lipids (non-HDL cholesterol) | ||||||
| Cases/participants | 193/7557 | 85/4697 | 220/7697 | |||
| Age-, sex-, and race/ethnicity-adjusted | 1.00 (reference) | 0.90 (0.62–1.30) | 0.96 (0.72–1.28) | 0.836 | ||
| Fully adjustedb | 1.00 (reference) | 1.06 (0.73–1.54) | 0.92 (0.69–1.22) | 0.506 | 6.5 | 3.3 |
| Blood glucose | ||||||
| Cases/participants | 186/3660 | 178/7811 | 134/8480 | |||
| Age-, sex-, and race/ethnicity-adjusted | 1.00 (reference) | 0.52 (0.38–0.70) | 0.41 (0.29–0.57) | < 0.001 | ||
| Fully adjustedb | 1.00 (reference) | 0.68 (0.48–0.95) | 0.63 (0.44–0.89) | 0.031 | 10.3 | 10.2 |
| Blood pressure | ||||||
| Cases/participants | 235/5583 | 100/4051 | 163/10,317 | |||
| Age-, sex-, and race/ethnicity-adjusted | 1.00 (reference) | 0.80 (0.57–1.13) | 0.63 (0.46–0.87) | 0.006 | ||
| Fully adjustedb | 1.00 (reference) | 0.94 (0.67–1.32) | 0.74 (0.54–1.01) | 0.047 | 12.5 | 16.2 |
CVH cardiovascular health, CI confidence interval, HR hazard ratio, NA not available, PAF population-attributable fraction
aAdjusted for sex, age, race/ethnicity, education level, marital status, ratio of family income poverty, and history of heart disease and stroke
bAdjusted for sex, age, race/ethnicity, education level, marital status, ratio of family income poverty, history of heart disease and stroke, diet, nicotine exposure, physical activity, sleep health, body mass index, blood glucose, blood lipids, and blood pressure. When the association between each CVH metric and mortality was evaluated, this metric was excluded from the adjustment
cTests for linear trends across three categories of cardiovascular health metrics scores were performed by modeling the median value within each category as a continuous variable
dThe individual PAFs were not calculated since the individual cardiovascular health metrics with adjusted HRs were ≥ 1.0