In a groundbreaking retrospective cohort study published in BMC Cancer, researchers have unveiled compelling evidence on the pivotal role played by the American Heart Association’s updated cardiovascular health metric, known as the Life’s Essential 8 (LE8), in predicting not only cardiovascular mortality but also all-cause mortality among adults with and without cancer. This study leverages extensive data from the National Health and Nutrition Examination Survey (NHANES) collected between 2005 and 2018, uniquely linked to mortality outcomes up to 2019 via the National Death Index. The findings represent a significant leap forward in cardiovascular and oncological prognostication.
The new LE8 score, introduced by the American Heart Association, refines previous cardiovascular health assessment algorithms by encompassing eight critical health behaviors and factors. This study set out to quantify the association between cardiovascular health levels as measured by the LE8 score and mortality risks, providing a nuanced understanding of survival outcomes in both cancer-affected populations and those cancer-free. Researchers meticulously applied Cox proportional hazards regression models and utilized restricted cubic spline analyses to dissect these relationships with statistical precision.
Among the 29,352 adults studied, only a minority—14.8%—achieved a high LE8 cardiovascular health score, whereas 20.3% registered low scores indicative of suboptimal cardiovascular wellness. This distribution highlights a widespread public health challenge and underscores the importance of cardiovascular health maintenance. The stratification of LE8 scores into low, moderate, and high categories enabled a clear demonstration of how cardiovascular health correlates with mortality risk gradients.
For adults without cancer, the calculated hazard ratios (HRs) delineated a protective effect associated with improved LE8 scores. Specifically, individuals with moderate LE8 scores exhibited a 29% reduction in all-cause mortality risk compared to those with low scores, while those with high scores experienced an astounding 54% reduction. These findings underscore the LE8 score’s robustness as a prognostic tool and its potential utility in primary prevention strategies targeting cardiovascular events and overall survival enhancement.
When focusing on cardiovascular disease (CVD) mortality, the protective association strengthened further. Moderate LE8 scores correlated with a 42% risk reduction, and high scores nearly tripled the survival advantage with a 70% reduction in CVD mortality. This emphasizes the comprehensive cardiovascular protective effect embedded within the composite LE8 metric and validates its construction encompassing multiple modifiable health-related behaviors and biological parameters.
Intriguingly, when the population was stratified to reflect adults with cancer diagnosis histories, the LE8 score continued to demonstrate a protective trend against all-cause mortality, albeit with slightly attenuated effect sizes. Here, moderate cardiovascular health scores were associated with a 27% reduced risk of death, a significant finding affirming that optimal cardiovascular health remains critically relevant even among individuals grappling with oncologic disease. However, high LE8 scores in cancer patients did not exhibit statistically significant mortality risk reductions as clearly, indicating complex interplay between cancer pathology and cardiovascular health factors.
A noteworthy aspect of this study was the consistent protective effects observed across all eight components of the LE8 score in relation to cardiovascular mortality. This finding confirms the integrated nature of cardiovascular health determinants and advocates for multipronged interventions rather than singular focus on isolated risk factors. Each LE8 element—from diet and physical activity to blood pressure, cholesterol, glucose levels, body mass index, smoking status, and sleep health—played a vital role in enhancing cardiovascular prognosis.
The methodological approach using Cox regression modeling allowed adjustment for critical confounders, strengthening the causal inferences drawn from the associations observed. The use of restricted cubic splines further permitted the exploration of potential nonlinear relationships between LE8 score levels and mortality risks, enhancing understanding beyond binary risk categorizations and revealing dose-response dynamics.
Crucially, this study bridges a knowledge gap concerning the interplay between cardiovascular health and cancer survivorship, an increasingly pertinent arena given the rising numbers of aging cancer survivors prone to cardiovascular complications. The data advocate for integrating cardiovascular health optimization as an essential aspect of comprehensive cancer care and survivorship programs to improve longevity outcomes.
Moreover, the public health implications are profound. Given the prevalence of suboptimal cardiovascular health in the general population and the mounting burden of cancer diagnoses, strategies to improve LE8 scores at the population level could translate into reduced overall mortality and better quality of life. Health policy initiatives could prioritize cardiovascular health screening using the LE8 algorithm, lifestyle modification programs, and targeted therapeutics integration across diverse clinical settings.
This pioneering research dovetails with ongoing efforts to enhance predictive algorithms incorporating lifestyle, biological, and clinical factors to generate personalized mortality risk profiles. It reinforces the importance of holistic health metrics that capture multiple dimensions of well-being beyond traditional singular biomarker assessments, advancing precision medicine paradigms.
In conclusion, the 2025 study led by Peng et al. provides robust epidemiological evidence that the Life’s Essential 8 cardiovascular health score is a powerful tool for predicting both cardiovascular and all-cause mortality risks in adults, regardless of cancer status. These findings serve as a clarion call for clinicians, researchers, and public health authorities to embrace the LE8 paradigm to foster healthier populations and mitigate deaths linked to cardiovascular disease and potentially cancer-associated mortality.
Continued longitudinal research and intervention trials are warranted to explore causality more definitively and assess how modifications in LE8 components may translate into mortality improvements over time, particularly in vulnerable groups such as cancer survivors. As the medical community progresses toward integrated chronic disease prevention and management, the Life’s Essential 8 stands out as a beacon guiding evidence-based cardiovascular health promotion.
Subject of Research:
Cardiovascular health assessment using the American Heart Association’s Life’s Essential 8 (LE8) and its association with all-cause and cardiovascular mortality in adults with and without cancer.
Article Title:
Association of the American Heart Association’s new “Life’s Essential 8″ cardiovascular health with all-cause and cardiovascular mortality in adults with and without cancer: a retrospective cohort study.
Article References:
Peng, S., Chen, Q., Liu, Q., et al. Association of the American Heart Association’s new “Life’s Essential 8” cardiovascular health with all-cause and cardiovascular mortality in adults with and without cancer: a retrospective cohort study. BMC Cancer 25, 1706 (2025). https://doi.org/10.1186/s12885-025-14464-7
Image Credits:
Scienmag.com
DOI:
10.1186/s12885-025-14464-7 (Published 04 November 2025)
Keywords:
Cardiovascular health, Life’s Essential 8, all-cause mortality, cardiovascular mortality, cancer survivorship, NHANES, retrospective cohort study, AHA health metrics
