Cardiovascular

Behavioral and health-factor domains of Life's Essential 8 in advanced cardiovascular-kidney-metabolic syndrome among Korean adults: a nationally representative cross-sectional analysis.

TL;DR

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.

Key Findings

Each 10-point higher overall LE8 score was associated with significantly lower odds of advanced CKM syndrome (Stage ≥ 3).

  • Adjusted odds ratio (aOR) was 0.765 per 10-point LE8 increment (95% CI 0.716–0.818)
  • Analysis was conducted on 17,351 Korean adults aged 20–79 years from the Korea National Health and Nutrition Examination Survey (2019–2021 and 2024)
  • Survey-weighted logistic regression was used to estimate aORs
  • The weighted prevalence of advanced CKM (Stage ≥ 3) was 4.13% (931 cases)

Both behavioral and health-factor LE8 subscores were independently associated with lower odds of advanced CKM syndrome after mutual adjustment.

  • Behavioral and health-factor subscores 'remained independently associated after mutual adjustment'
  • The behavioral domain includes metrics such as diet, physical activity, nicotine exposure, and sleep
  • The health-factor domain includes metrics such as BMI, blood lipids, blood glucose, and blood pressure
  • Independent associations persisted even when both domains were included simultaneously in the model

The behavioral LE8 subscore association with advanced CKM remained stable across sequential CKM-spectrum restrictions, whereas the health-factor subscore association attenuated to non-significance at the most restricted level.

  • Behavioral domain aORs ranged from 0.879 to 0.897 across sequential CKM-spectrum restrictions
  • The health-factor association attenuated to non-significance at the most restricted level (aOR 0.998)
  • Prespecified sequential CKM-spectrum restriction was used as a sensitivity analysis approach
  • Authors attributed health-factor attenuation to 'stage-definition overlap and treatment-related score modification'

Participants in the lowest LE8 quintile had more than three times higher odds of advanced CKM syndrome compared to those in the highest quintile.

  • Lowest LE8 quintile had 3.32-fold higher odds than the highest quintile (95% CI 2.30–4.80)
  • Quintile-based analysis provided a dose-response perspective on the LE8–CKM relationship
  • Four outcome definitions were examined as prespecified sensitivity analyses

The study applied a Korean-adapted CKM framework that incorporated population-specific thresholds and risk equations.

  • The framework incorporated Korean adiposity thresholds, the Korean cardiovascular risk equation, and Korean-specific LE8 body mass index scoring
  • The CKM staging framework was aligned with the American Heart Association's CKM framework but adapted for Korean adults
  • Medication-stratified lipid analyses were prespecified to address treatment-related score modification in the health-factor domain
  • The sample was drawn from a nationally representative survey, enabling survey-weighted analyses

The cross-sectional study design precludes causal inference between LE8 scores and advanced CKM syndrome.

  • Authors explicitly stated 'The cross-sectional design precludes causal inference'
  • The study used data from two survey cycles: 2019–2021 and 2024
  • Health-factor domain associations require 'cautious interpretation owing to stage-definition overlap and treatment-related score modification'
  • Medication use can alter LE8 health-factor scores independently of underlying cardiovascular health status

What This Means

This research suggests that having better cardiovascular health, as measured by a scoring system called Life's Essential 8 (LE8), is associated with lower odds of having advanced cardiovascular-kidney-metabolic (CKM) syndrome among Korean adults. CKM syndrome is a framework that links heart disease risk with kidney disease and metabolic conditions like diabetes and obesity. Using data from over 17,000 Korean adults in a nationally representative survey, the researchers found that for every 10-point improvement in the LE8 score, a person's odds of having advanced CKM syndrome (Stage 3 or higher) dropped by roughly 24%. People with the lowest cardiovascular health scores had more than three times the odds of advanced CKM compared to those with the highest scores. The LE8 score is made up of two groups of measures: 'behavioral' factors (diet, physical activity, smoking, and sleep) and 'health-factor' measures (body weight, blood lipids, blood sugar, and blood pressure). This study found that both groups were independently linked to lower odds of advanced CKM. However, when the researchers applied progressively stricter definitions of CKM to test how robust these associations were, the behavioral domain's association remained consistent, while the health-factor domain's association weakened and eventually became statistically non-significant. The authors suggest this may be because some health-factor measures (like cholesterol levels) overlap with how CKM stages are defined, and because medications that treat conditions like high cholesterol can artificially alter a person's LE8 health-factor score. This research is notable because it adapted the LE8 framework and CKM staging to fit Korean-specific standards for body weight and cardiovascular risk, rather than applying Western thresholds directly to an Asian population. The findings suggest that promoting healthy behaviors—such as regular physical activity, better diet, not smoking, and adequate sleep—may have a particularly robust relationship with avoiding advanced CKM syndrome, independent of measured health factors. However, because the study design is cross-sectional (a snapshot in time), it cannot prove that poor cardiovascular health causes CKM syndrome, only that the two are statistically associated.

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Citation

Lim J, Han K, Yu S, Park J, Moon S, Lee C, et al.. (2026). Behavioral and health-factor domains of Life's Essential 8 in advanced cardiovascular-kidney-metabolic syndrome among Korean adults: a nationally representative cross-sectional analysis.. Frontiers in endocrinology. https://doi.org/10.3389/fendo.2026.1905093