Abstract 4141843: Cardiovascular Disease and Cancer Mortality by Cardiovascular Health: Life's Essential 8 in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Introduction: Cardiovascular disease (CVD) and cancer are the top 2 causes of death among US adults. Life’s Essential 8 (LE8) is an updated cardiovascular health (CVH) metric that includes many factors known to reduce cancer risk. It is unclear how LE8-quantified CVH relates to CVD and cancer mortality in a competing risk framework. Methods: REGARDS recruited 30,239 Black and White adults from the 48 contiguous US states in 2003-07. We excluded individuals with prevalent CVD or cancer, missing LE8, or no follow-up. Baseline total LE8 scores were categorized as low (<50), moderate (50-79), or high CVH (≥80). Cause-specific hazard models estimated relative hazard of CVD and cancer mortality as competing risks, adjusting for age, sex, race, level of education, and region. Results: Among 11,385 REGARDS participants who were free of CVD and cancer (mean [SD] age 65 [9] years, 52% women, 44% Black adults), 24%, 66%, and 10% had low, moderate, and high CVH, respectively. Over a median (IQR) follow-up of 14 (8-18) years, 8% died from CVD, 7% from cancer, and 17% from other causes. Moderate and high CVH were significantly associated with graded lower risk of CVD and cancer mortality after adjusting for potential confounders ( Table ). CVD mortality was lower across better physical activity, blood pressure, diet, sleep, smoking, and glucose CVH groupings. Cancer mortality was lower across better diet and smoking groupings. Conclusion: LE8-quantified CVH was independently associated with lower CVD and cancer mortality in a competing risk framework and in graded fashion. These findings underscore the significance of lifestyle modifications in mortality risk reduction for the top 2 causes of death in the US, advocating for their incorporation into clinical guidelines and preventive counseling.