Associations of Life's Essential 10 with Mortality and Healthspan Free of Cardiovascular Disease and Cancer: Findings in Two Nationwide Cohorts.

AIMS: To evaluate associations of cardiovascular health (CVH) based on Life's Essential 10 (LE10) with all-cause mortality, cardiovascular disease (CVD) and cancer mortality and incidence, and life expectancy free of CVD and cancer.
METHODS AND RESULTS: This prospective study included 110,806 UK Biobank participants (aged 37-73) and 20,031 National Health and Nutrition Examination Survey (NHANES) participants (aged ≥20). LE10 (0-100), which integrates alcohol consumption and mental health with Life's Essential 8, categorised CVH as low (<60), moderate (60-79), and high (≥80). Cox regression and competing risk models were applied to estimate adjusted hazard ratios (aHRs). Life expectancy was calculated using multi-state and flexible parametric survival models. Over a median follow-up of 13.8 years, 6137 deaths, 13,968 CVD events, and 18,077 cancer cases were documented in UK Biobank. In UK Biobank, high CVH was associated with lower risks of all-cause mortality (men: aHR 0.43, 95% CI 0.39-0.48; women: aHR 0.34, 95% CI 0.29-0.39), alongside CVD and cancer mortality and incidence, compared to low CVH. At age 50, high CVH conferred greater projected overall (men +5.47 years, women +5.85) and disease-free life expectancy (men +4.02 years, women +4.40). Having more low-risk CVH metrics was associated with up to 9.73 years of projected gains in life expectancy. Associations were replicated and consistent in 7.2-year NHANES follow-up.
CONCLUSION: Higher LE10-based CVH levels were associated with lower all-cause mortality, reduced CVD and cancer mortality and incidence, and longer life expectancy free of CVD and cancer. LE10 may provide additional targets for CVH management.