Behavioral and health-factor domains of Life's Essential 8 in advanced cardiovascular-kidney-metabolic syndrome among Korean adults: a nationally representative cross-sectional analysis.

INTRODUCTION

Life's Essential 8 (LE8) summarizes cardiovascular health through four behavioral and four health-factor metrics, whereas cardiovascular-kidney-metabolic (CKM) syndrome staging characterizes disease burden and severity. Whether the two LE8 domains associate differently with advanced CKM syndrome in an Asian population remains unclear.

METHODS

We analyzed 17,351 Korean adults aged 20-79 years from the Korea National Health and Nutrition Examination Survey (2019-2021 and 2024) using a Korean-adapted, American Heart Association-aligned CKM framework incorporating Korean adiposity thresholds, the Korean cardiovascular risk equation, and Korean-specific LE8 body mass index scoring. Advanced CKM (Stage ≥ 3) was the primary outcome. Survey-weighted logistic regression estimated adjusted odds ratios (aORs) per 10-point LE8 increment, with prespecified sequential CKM-spectrum restriction, four outcome definitions, and medication-stratified lipid analyses.

RESULTS

The weighted prevalence of advanced CKM was 4.13% (931 cases). Each 10-point higher LE8 score was associated with lower odds of advanced CKM (aOR 0.765, 95% confidence interval [CI] 0.716-0.818). Behavioral and health-factor subscores remained independently associated after mutual adjustment. Across sequential CKM-spectrum restrictions, the behavioral association remained stable (aORs 0.879-0.897), whereas the health-factor association attenuated to non-significance at the most restricted level (aOR 0.998). Participants in the lowest LE8 quintile had 3.32-fold higher odds than those in the highest quintile (95% CI 2.30-4.80).

DISCUSSION: Higher LE8-defined cardiovascular health was inversely associated with advanced CKM; behavioral-domain associations remained stable across CKM-spectrum restriction, whereas health-factor associations require cautious interpretation owing to stage-definition overlap and treatment-related score modification. The cross-sectional design precludes causal inference.