Jung Ah Lim, Kyungdo Han, Sung Hoon Yu, Jung Hwan Park, Shinje Moon, Chang Beom Lee, Sangmo Hong
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).
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.