AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Composite Social Risk and Life’s Essential 8 in Cardiovascular-Kidney-Metabolic Health Among US Adults
By Chen Y, Koirala B, Dennison Himmelfarb CR
Background: Both individual social determinants of health and cardiovascular health defined by Life’s Essential 8 (LE8) are found to be associated with the Cardiovascular-Kidney-Metabolic (CKM) health and cardiovascular disease (CVD) mortality. Yet, understanding of the extent to which composite social risk and LE8 scores relate with CKM stages remains limited. Objective: To examine the association between the number of composite social risk factors, LE8 scores, and CKM stages. Methods: We conducted a cross-sectional analysis of the 2005-2023 National Health and Nutrition Examination Survey (NHANES). Participants who were younger than 20 years and pregnant during the data collection were excluded. CKM stages were defined according to American Heart Association (AHA), ranging from 0 (no CVD risk factors), stage 1 (excess or dysfunctional adiposity), stage 2 (metabolic risk factors or kidney disease), stage 3 (subclinical CVD), and stage 4 (clinical CVD). We combined CKM stages 3-4 as they are both considered as the advanced CKM stages. Social risk factors included low family income, low education level, minority race/ethnic group (non-white status/white status), single-living status, uninsured, and unemployed. Composite social risk (Table 1) was categorized from 0 (no social risk factor) to 4 (4 and more social risk factors). LE8 (Table 1) was defined according to AHA and categorized from Quartile 1 to Quartile 4; with higher quartile indicating better cardiovascular health. Survey-weighted ordinal logistic regression models were used to examine the association of composite social risk and LE8 with CKM stages, adjusting for demographic variables (age and gender). Results: Among 9825 individuals (population size: 7,458,950), the mean age was 51.5 (SD:17.1), and 51.4% were males; 40.2% were non-Hispanic White, 25.4% were non-Hispanic Black, 21.4% were Hispanic individuals. In the unadjusted model, both social risk and LE8 quartiles were significantly associated with the CKM stages. In an adjusted analysis, social risk remained significantly associated with CKM stages. Compared with no social risk, having 1, 2, 3, and 4 or more social risk was associated with 2.40 (95% CI: 1.37-4.22), 2.69 (95% CI: 1.63-4.47), 2.31 (95% CI: 1.19-4.47), and 5.40 (95% CI: 2.57-11.33) times higher odds of more advanced CKM stage, respectively. Compared to individuals with highest LE8 (Quartile 4), those in Quartiles 1 and 2 had 2.22 (95% CI: 1.28-3.87) and 1.60 (95% CI: 1.00-2.55) times the odds of a higher CKM stage, respectively. Conclusions: Increased composite social risk and lower cardiovascular health were independently associated with more advanced CKM stages after adjustment for age and gender. Further research is needed to determine whether addressing social needs and improving cardiovascular health can enhance CKM health.