Clinical and experimental nephrology · 2026
Associations between cardiovascular health metrics and mortality among adults with chronic kidney disease.
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Zhang Bin, Hong Dongxi, Sun Jiaping, Guan Guifen, Xiao Junnan, Zhang Yingyong
Аннотация
BACKGROUND: This study aimed to evaluate the associations between cardiovascular health (CVH) scores, measured by Life's Simple 7 (LS7), Life's Essential 8 (LE8), and Life's Crucial 9 (LC9), and the risks of all-cause and cardio-cerebrovascular disease (CCD) mortality among individuals with chronic kidney disease (CKD).
METHODS: Data from 4,989 adults with CKD in the National Health and Nutrition Examination Survey (NHANES) 2005-2018 were analyzed. Cox proportional hazards regression models assessed associations between CVH metrics and mortality risks. Predictive performance was evaluated using receiver operating characteristic (ROC) curves and area under the curve (AUC) values at 3-, 5-, and 10 year follow-ups.
RESULTS: During a median follow-up of 6.2 years, higher CVH scores across all metrics were associated with significantly lower risks of all-cause and CCD mortality. Higher CVH scores were significantly associated with lower risks of all-cause and CCD mortality. For all-cause mortality, participants with the highest LS7 scores (≥ 11) had a 71% lower risk (HR = 0.29, 95% CI: 0.18-0.46) compared to those with the lowest scores (≤ 4). Similarly, participants with the highest LE8 (> 79.9) and LC9 (> 79.9) scores had a 69% and 73% lower risk of all-cause mortality, respectively.
CONCLUSIONS: LS7, LE8, and LC9 showed similar discrimination for all-cause and CCD mortality. Adding sleep and psychological health components did not meaningfully improve risk discrimination beyond LS7 in adults with CKD, supporting LS7 as a practical tool for mortality risk stratification.
METHODS: Data from 4,989 adults with CKD in the National Health and Nutrition Examination Survey (NHANES) 2005-2018 were analyzed. Cox proportional hazards regression models assessed associations between CVH metrics and mortality risks. Predictive performance was evaluated using receiver operating characteristic (ROC) curves and area under the curve (AUC) values at 3-, 5-, and 10 year follow-ups.
RESULTS: During a median follow-up of 6.2 years, higher CVH scores across all metrics were associated with significantly lower risks of all-cause and CCD mortality. Higher CVH scores were significantly associated with lower risks of all-cause and CCD mortality. For all-cause mortality, participants with the highest LS7 scores (≥ 11) had a 71% lower risk (HR = 0.29, 95% CI: 0.18-0.46) compared to those with the lowest scores (≤ 4). Similarly, participants with the highest LE8 (> 79.9) and LC9 (> 79.9) scores had a 69% and 73% lower risk of all-cause mortality, respectively.
CONCLUSIONS: LS7, LE8, and LC9 showed similar discrimination for all-cause and CCD mortality. Adding sleep and psychological health components did not meaningfully improve risk discrimination beyond LS7 in adults with CKD, supporting LS7 as a practical tool for mortality risk stratification.