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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Association of quantified cardiovascular health status with all-cause mortality risk in prediabetic patients
Ao-Miao Chen, Qiu-Yu He, Yi-Chuan Wu, Jia-Qi Chen, Xiao-Qin Ma, Ling-Yuan Hu, Ge-Ning-Yue Wang, Zhuo-Tong Wang, Zhi-Yong Wu, Zong-Ji Zheng, Yi-Jie Jia
Ao-Miao Chen, Qiu-Yu He, Yi-Chuan Wu, Jia-Qi Chen, Xiao-Qin Ma, Ling-Yuan Hu, Ge-Ning-Yue Wang, Zhuo-Tong Wang, Zhi-Yong Wu, Zong-Ji Zheng, Yi-Jie Jia, Southern Medical University, Guangzhou 510515, Guangdong Province, China
Ao-Miao Chen, Qiu-Yu He, Yi-Chuan Wu, Jia-Qi Chen, Xiao-Qin Ma, Ling-Yuan Hu, Ge-Ning-Yue Wang, Zhuo-Tong Wang, Zhi-Yong Wu, Zong-Ji Zheng, Yi-Jie Jia, Department of Endocrinology & Metabolism, Southern Medical University, Guangzhou 510515, Guangdong Province, China
Ao-Miao Chen, Qiu-Yu He, Yi-Chuan Wu, Jia-Qi Chen, Xiao-Qin Ma, Ling-Yuan Hu, Ge-Ning-Yue Wang, Zhuo-Tong Wang, Zong-Ji Zheng, Yi-Jie Jia, De Feng Academy, Southern Medical University, Guangzhou 510515, Guangdong Province, China
Ao-Miao Chen, Qiu-Yu He, Ling-Yuan Hu, Zhuo-Tong Wang, The First School of Clinical Medicine, Southern Medical University, Guangzhou 510515, Guangdong Province, China
Yi-Chuan Wu, Ge-Ning-Yue Wang, School of Stomatology, Southern Medical University, Guangzhou 510515, Guangdong Province, China
Zhi-Yong Wu, College of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, Guangdong Province, China
Co-first authors: Ao-Miao Chen and Qiu-Yu He.
Co-corresponding authors: Zong-Ji Zheng and Yi-Jie Jia.
Author contributions: Chen AM, Chen JQ, Zheng ZJ, and Jia YJ designed this study. Chen AM extracted the data and performed statistical analysis; He QY, Wu YC, Chen JQ, Ma XQ, Hu LY, Wang GNY, Wu ZY and Wang ZT validated the statistical analysis; Chen AM and He QY wrote the original manuscript draft, which was revised by Wu YC, Chen JC, Wu ZY, Zheng ZJ, and Jia YJ. All authors made significant contributions to the manuscript and approved it for submission. Chen AM and He QY contributed equally to this work as co-first authors. Zheng ZJ and Jia YJ are the guarantors of this work and, as much, had full access to all the data in the study and take responsibility for the integrity of the data and accuracy of the data analysis. First, this decision reflects the significant contributions made by the two authors throughout the research process, demonstrating their equal role in the conceptualization, methodology, and implementation of the study. Second, each author brings unique expertise that is critical to the success of our research. In addition, this practice facilitates communication with potential collaborators within our hospital, providing multiple points of contact for consultation. We believe this approach recognizes the efforts and contributions of all parties involved and encourages future research collaborations.
Supported by National Natural Science Foundation of China, No. 82370818 and No. 82270862; the Natural Science Foundation of Guangdong Province, No. 2024A1515012744; the Guangzhou Science and Technology Project, No. 2025A04J3541; and the National Undergraduate Training Program for Innovation and Entrepreneurship, Southern Medical University, No. 202312121031 and No. S202312121167.
Institutional review board statement: This is a retrospective analysis using NHANES data and does not involve clinical trials. The data used in this study were obtained from the publicly available National Health and Nutrition Examination Survey (NHANES) database. In accordance with NHANES policies, all participants provided informed consent prior to the commencement of the study, and the research received ethical approval from the National Center for Health Statistics (NCHS) Institutional Review Board. Consequently, secondary analyses using the NHANES database are considered exempt from additional ethical review. All data were anonymized to protect the privacy of participants.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There is no conflict of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Yi-Jie Jia, PhD, Department of Endocrinology & Metabolism, Southern Medical University, No. 1023 South Shatai Road, Baiyun District, Guangzhou 510515, Guang
dong Province, China.
yijie0207@126.com
Received: October 8, 2024
Revised: December 4, 2024
Accepted: March 21, 2025
Published online: May 15, 2025
Processing time: 199 Days and 22.9 Hours
BACKGROUND
Patients with prediabetes are at increased risk of developing cardiovascular disease. The Life's Essential 8 (LE8) score, updated by the American Heart Association in 2022, is a tool used to quantify cardiovascular health (CVH). Quantifying healthy living status on the basis of the uniform standard LE8 will be useful for confirming whether health interventions can reduce the risk of death in prediabetic patients.
AIM
To investigate the associations between all-cause mortality risk and CVH status (as quantified by the LE8 score) in prediabetic patients.
METHODS
This study included 5344 participants with prediabetes (age: 52.9 ± 15.8 years; 51.6% men). The LE8 score includes four health indicators and four health behaviors. Cox proportional hazard ratios were calculated for all-cause mortality in the high CVH (LE8 ≥ 80), low CVH (LE8 ≤ 50), and moderate CVH (LE8 50-79) subgroups, and restricted cubic spline analyses were performed. Separate analyses of the associations of all-cause mortality risk with each LE8 component and CVH health behaviors and indicators were also performed.
RESULTS
In the median follow-up period of 8.33 years, 658 deaths occurred. Compared with those among participants with high CVH, the covariate-adjusted HRs (95% confidence intervals) for mortality among participants with moderate and low CVH were 2.55 (1.23-5.31) and 3.92 (1.70-9.02), respectively. There was a linear relationship between an improvement in CVH status and a reduction in all-cause mortality risk (P-overall < 0.0001, P-nonlinear = 0.7989). Improved CVH health behaviors had a more significant protective effect on patients with prediabetes than did the improvement in CVH health indicators.
CONCLUSION
High CVH status (as quantified by the LE8 score) is significantly associated with reduced mortality risk in prediabetic adults in the United States.
Core Tip: This study addresses an important and timely topic by exploring the relationship between quantified cardiovascular health, as defined by Life’s Essential 8, and all-cause mortality risk in prediabetic patients. The research is relevant and supported by comprehensive data analysis.
