Prognostic Value of Life’s Essential 8 for Multiple Disease Mortality in a Southwestern Chinese Cohort: A Novel Application of AFT and PAF Models

Background: To investigate Life’s Essential 8(LE8) , a measure of cardiovascular health (CVH),and itsassociation with all-cause and disease-specific mortality. Methods: CVH and LE8 were categorized into 0-49 (low), 50-74 (moderate), and 75-100 (high) groups. Theoutcomes included all-cause, cardiovascular or cerebrovascular diseases(CVD), endocrine system diseases, malignant tumors, respiratory disease and digestive diseases mortality. The hazard ratios for the associations of total CVH and each element of LE8 with the risk of outcomes were calculated by cox proportional hazards models or competing risk analysis models. Population attributable fractions of each element of LE8 were calculated by graphPAF package with Direct method. Results: Atotal of 8290 participants aged 18 years above from Guizhou Population Health Cohort Study were enrolled in this study. During a median follow-up of 11.69 years, 507 death cases were identified.Having moderateor high CVH score could reduce the risk of death by at least 40% for all-cause mortality,49% for CVD mortality and 86% for endocrine system diseases mortality, and also could prolong survival time for death fromabove-mentioned diseases.Blood pressure and diet were the primary contributors of the population-attributable risks for all-cause and CVD mortality,while for malignancy mortality, nicotine exposure and blood glucose level accounted for the largest proportion.Physical activity exerted the broadest impact. Sleep quality was the independent contributor to all-cause mortality. Conclusion: Among southwestern Chinese adults, higher CVH is independently linked to lower all-cause, CVD and endocrine system diseases mortality risks,and is associated with extended survival time.Earlyintervention for blood pressure,blood glucose,diet,physical activity and sleep are necessary.