# Beyond Life's Essential 8: optimizing cardiovascular health metrics to predict mortality

## TL;DR

This study shows that adjusting how cardiovascular health metrics are scored can better predict mortality risks, suggesting improved ways to assess and manage heart health.

## Contribution

The paper introduces rescored and weighted models of the Life's Essential 8 metrics to enhance mortality prediction accuracy.

## Key findings

- Higher cardiovascular health is associated with significantly lower all-cause and CVD mortality risks.
- Rescoring and weighting models improve mortality prediction compared to the original Life's Essential 8 model.
- Individual CVH metrics contribute unequally to mortality prediction when weighted.

## Abstract

Cardiovascular health (CVH), as assessed by the American Heart Association's Life's Essential 8 (LE8), is strongly associated with mortality risk. However, whether rescoring or weighting individual CVH components improves mortality prediction remains unclear.

Using data from the 2005–2018 National Health and Nutrition Examination Survey, we examined the associations between CVH categories and risks of all-cause and cardiovascular disease (CVD) mortality. We compared three CVH scoring approaches: the original LE8 model, a rescored model with recalibrated eight metrics, and a weighted model assigning relative importance to each metric. Cox proportional hazards models adjusted for confounders estimated hazard ratios. Model performance was evaluated by C-statistic and net reclassification improvement.

Among 32,076 US adults followed for a median of 7.5 years, higher CVH was consistently associated with lower all-cause and CVD mortality risks across all models. Compared to individuals with low CVH, individuals with high CVH had 58 %–78 % lower all-cause mortality risk and 64 %–87 % lower CVD mortality. For CVD mortality, the rescored model improved risk reclassification, while the weighted model improved discrimination. Compared to the original model, both rescored and weighted models are with modest improvements in all-cause mortality prediction. Weighting revealed substantial variation in the contribution of individual CVH components to mortality risk.

Higher CVH is strongly protective against mortality. Refining LE8 scoring through rescoring and weighting can enhance mortality risk discrimination and reclassification, supporting improved CVH assessment for targeted prevention.

•Higher CVH is linked to lower all-cause and CVD mortality risk.•Rescoring and weighting CVH improves all-cause mortality prediction.•Weighting CVH could improve discrimination of CVD mortality prediction.•Rescoring CVH could improve reclassification of CVD mortality prediction.•Individual CVH metrics contribute unequally to mortality prediction.

Higher CVH is linked to lower all-cause and CVD mortality risk.

Rescoring and weighting CVH improves all-cause mortality prediction.

Weighting CVH could improve discrimination of CVD mortality prediction.

Rescoring CVH could improve reclassification of CVD mortality prediction.

Individual CVH metrics contribute unequally to mortality prediction.