Clinical Summary
Clinical Summary: Life’s Essential 8 Cardiovascular Health and Suicide Mortality: Findings From a Nationally Representative Cohort in South Korea
Suicide risk is usually approached through psychiatric symptoms and social stressors, but overall cardiovascular health may also identify patients with elevated vulnerability. In this national cohort from South Korea, worse Life’s Essential 8 cardiovascular health scores tracked with higher suicide mortality, with the strongest signal coming from modifiable health behaviors.
Design
cohort study
N
Among the study participants (n=54,382)
Population
adults aged ≥19 years and without missing values
Duration
The median follow-up was 9.67 years
Key Findings
- The mortality rate per 1,000 person-years was 0.28 among overall participants, and 0.13, 0.30, and 0.47 for the ideal, intermediate, and poor LE8 groups, respectively.
- Compared with those with an ideal LE8 score, those with poor LE8 score exhibited a 2.49 times higher risk (95% CI: 1.06–5.82) of suicide mortality during follow-up.
- Compared to those with an ideal health behavior score (≥80), those with poor health behavior score (<50) exhibited a 2.59 times higher risk (95% CI: 1.23–5.44) of suicide mortality, while no clear association emerged between biometric health factor scores and suicide risk.
- In the fully adjusted model, the score for nicotine exposure exhibited a negative association with suicide mortality (HR: 0.91, 95% CI: 0.86–0.96), whereas the score for BMI exhibited a positive association with suicide mortality (HR: 1.10, 95% CI: 1.02–1.18).
- The association was stronger in younger adults: in the stratified analysis by median age (<50 vs ≥50 years), the HRs (95% CI) for the association between LE8 score (10-point increment) and suicidal mortality were 0.70 (0.57–0.86) for those aged <50 years and 1.08 (0.87–1.34) for those aged ≥50 years; the P value for the interaction between age and LE8 score was .014.
Clinical Bottom Line
Poor Life’s Essential 8 cardiovascular health marked higher suicide mortality in Korean adults, and the clinically relevant signal came more from health behaviors than from biometric risk factors. Cardiovascular health behaviors belong in a broader suicide risk formulation, especially in younger adults.
Practice Implications
- When assessing suicide risk, consider overall lifestyle pattern alongside psychiatric and social risk factors; patients with poor LE8 scores had a 2.49 times higher risk (95% CI: 1.06–5.82) of suicide mortality than those with ideal scores.
- Pay particular attention to modifiable behaviors rather than relying only on biometric markers, because poor health behavior scores were associated with a 2.59 times higher risk (95% CI: 1.23–5.44) while biometric health factor scores showed no clear association.
- Smoking-related assessment appears especially informative: nicotine exposure score was inversely associated with suicide mortality (HR: 0.91, 95% CI: 0.86–0.96), supporting routine attention to cigarette smoking, electronic cigarette use, and secondhand smoke exposure.
- The association was stronger among younger adults, so low LE8 scores may warrant heightened attention in patients aged <50 years, among whom each 10-point increment in LE8 score was associated with an HR of 0.70 (0.57–0.86) for suicidal mortality.
