Association of Life's Crucial 9 with all-cause and cardiovascular mortality among the individuals with chronic inflammatory airway diseases: A prospective cohort study.
Elevated Life's Crucial 9 scores are linked to a lower likelihood of all-cause and cardiovascular mortality in individuals suffering from chronic inflammatory airway diseases.
Key Findings
Results
Higher LC9 scores were associated with a 71% reduced risk of all-cause mortality among patients with chronic inflammatory airway diseases.
Hazard ratio = 0.29, 95% confidence interval: 0.18–0.49 for the highest versus lowest LC9 quartile
Adjusted for age, sex, ethnicity, education level, marital status, poverty-to-income ratio, and insurance status
LC9 scores were divided into 4 quartiles with the lowest quartile as the reference category
Analysis used Cox proportional hazards regression models
Results
Higher LC9 scores were associated with an 87% reduced risk of cardiovascular mortality among patients with chronic inflammatory airway diseases.
Hazard ratio = 0.13, 95% confidence interval: 0.05–0.35 for the highest versus lowest LC9 quartile
Adjusted for the same set of confounding factors including age, sex, ethnicity, education level, marital status, poverty-to-income ratio, and insurance status
The highest quartile of LC9 was compared against the lowest quartile as reference
Results
A nonlinear, positive association was found between LC9 scores and both all-cause and cardiovascular mortality rates in CIAD patients.
Restricted cubic spline analysis was used to estimate possible nonlinear associations
The association was described as 'nonlinear, positive' between LC9 scores and mortality rates
This nonlinear pattern applied to both all-cause and cardiovascular mortality outcomes
Methods
The study included 2403 patients with chronic inflammatory airway diseases drawn from a nationally representative survey.
Participants were from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2018
Total sample size was 2403 patients with CIAD
Study design was a prospective cohort study
Life's Crucial 9 (LC9) is a newly introduced measure of cardiovascular health by the American Heart Association
Background
Patients with chronic inflammatory airway diseases carry a higher burden of cardiovascular diseases, motivating investigation of cardiovascular health metrics in this population.
The elevated cardiovascular disease burden in CIAD patients was identified as the rationale for the study
LC9 was selected as the cardiovascular health metric because it is a newly introduced measure by the American Heart Association
The study objective was to explore the link between LC9 and risks of all-cause and cardiovascular mortality specifically among CIAD patients
What This Means
This research suggests that people with chronic inflammatory airway diseases (such as asthma or chronic obstructive pulmonary disease) who score higher on a cardiovascular health measure called 'Life's Crucial 9' (LC9) — developed by the American Heart Association — have substantially lower risks of dying from any cause or from cardiovascular disease. The study followed over 2,400 American adults with these airway conditions over more than a decade, finding that those in the top quarter of LC9 scores had a 71% lower risk of all-cause death and an 87% lower risk of cardiovascular death compared to those in the bottom quarter, after accounting for factors like age, sex, income, and education.
The relationship between LC9 scores and mortality was not simply linear — a more complex pattern emerged when researchers used a statistical technique called restricted cubic spline analysis, suggesting the benefits may vary across different levels of cardiovascular health. This is important because people with chronic airway diseases are already known to have a higher-than-average risk of cardiovascular problems, making cardiovascular health optimization particularly relevant for this group.
This research suggests that maintaining good cardiovascular health — as measured by the LC9 composite score — may be especially important for individuals living with chronic inflammatory airway conditions. The findings point to the potential value of monitoring and improving cardiovascular health factors in this population, though as an observational study, it cannot prove that improving LC9 scores directly causes lower mortality rates.
Wen Y, Li W, Bai J, Teng G, Ge Y, Fan Y, et al.. (2026). Association of Life's Crucial 9 with all-cause and cardiovascular mortality among the individuals with chronic inflammatory airway diseases: A prospective cohort study.. Medicine. https://doi.org/10.1097/MD.0000000000050633