Association of Life’s Crucial 9 with the risk of all-cause and cardiovascular mortality among US patients with stroke

Previous studies have demonstrated an association between the Life's Crucial 9 (LC9)-based cardiovascular health score and all-cause and cardiovascular mortality in individuals without cardiovascular disease. Higher scores have been associated with reduced all-cause and cardiovascular mortality. However, no study has explored the association between the LC9 and the survival outcomes in stroke patients. This study aimed to analyze the association between the LC9 and all-cause and cardiovascular mortality in the American stroke population. Based on the National Health and Nutrition Examination Survey database from 2007 to 2018, a total of 949 eligible patients were enrolled in our cohort study. The relationship between LC9 and mortality was analyzed using univariate weighted Cox proportional regression analysis models and Kaplan-Meier curves. A subgroup analysis was conducted to ascertain whether there was an interaction between age, sex, education, hypertension, and diabetes. The restricted cubic spline curve was employed to examine the association of LC9 with risk of death. The study cohort comprised 949 patients who had experienced a stroke, of with 313 died from all causes and 89 died from cardiovascular causes. In the Cox regression model, after adjusting for confounding factors, a significant inverse association was observed between the highest third of the patients' LC9 and all-cause mortality (95% confidence interval 0.35-0.78, P = .001) and cardiovascular mortality (95% confidence interval 0.12-0.56, P < .001). Furthermore, a negative association was identified between the LC9 and patient mortality rate, indicating that the higher the LC9 score, the lower the mortality rate. The Kaplan-Meier curve showed that the higher LC9 score, the better prognosis for the patient and a reduced mortality rate. No interaction was identified in the subgroup analysis. Dose-response analysis also showed that LC9 was linearly and negatively associated with all-cause mortality and cardiovascular mortality in patients.