Cardiovascular health trajectories before age 50 and subsequent cardiovascular disease, mortality, and CVD-free survival: Implications for predictive, preventive, and personalized medicine in a Chinese community cohort
Author Identifier (ORCID)
Abstract
Objectives: To examine how distinct cardiovascular health (CVH) trajectories before age 50, estimated by Life’s Essential 8 (LE8), a composite measure comprising four behavioral and four biological components, relate to incident cardiovascular disease (CVD), all-cause mortality, and CVD-free survival in a Chinese population, from a predictive, preventive, and personalized medicine (PPPM) perspective. Methods: We included 39,305 CVD-free participants (77.3% men) from the Kailuan Cohort with at least three LE8 assessments before age 50. Group-based trajectory modelling over 6–12 years was used to identify LE8 patterns, with model selection based on the lowest Bayesian Information Criterion, average posterior probabilities > 0.70, and a minimum of 5% of the sample per trajectory. Multivariable Cox models estimated hazard ratios (HRs) for CVD and all-cause mortality, and restricted mean survival time (RMST) at age 45 was calculated to quantify CVD-free survival. Results: During a median follow-up of 6.05 years, 1,254 CVD events and 917 deaths occurred. Five trajectories were identified: Low-stable, Moderate-increasing, Moderate-decreasing, Moderate-stable, and High-stable. Compared with Moderate-stable, High-stable was associated with lower risks of CVD (HR 0.42, 95% CI 0.30–0.58, P < 0.001) and mortality (HR 0.67, 95% CI 0.50–0.90, P = 0.007). Using Moderate-decreasing as reference, Moderate-increasing showed a 24% lower CVD risk (HR 0.76, 95% CI 0.60–0.96, P = 0.028) despite initial lower scores. Both sex and age modified these associations (P for interaction < 0.001 and 0.003, respectively), with women and individuals maintaining high LE8 between ages 45 and 50 showing greater cardiovascular protection. RMST ranged from 18.06 years in Low-stable to 19.72 years in High-stable, a difference of 1.66 CVD-free years (95% CI 1.37–1.96, P < 0.001). Conclusions: CVH trajectories before age 50 predicted subsequent CVD risk and survival. Sustained or improving trajectories were associated with lower CVD risk and longer CVD-free survival. From a PPPM perspective, early identification and modification of adverse CVH trajectories may enable proactive intervention before irreversible vascular damage occurs.
Keywords
all-cause mortality, cardiovascular disease, cardiovascular health, Life's Essential 8 (LE8), predictive preventive personalized medicine (PPPM / 3PM), restricted mean survival time, risk stratification, targeted prevention, trajectory
Document Type
Journal Article
Date of Publication
1-1-2026
ISSN
18785077
Publication Title
EPMA Journal
Publisher
Springer
School
Nutrition and Health Innovation Research Institute / School of Medical and Health Sciences
Funding Information
This work was supported by the Yanzhao Gold Talent Project of Hebei Province (HJZD202506).
Copyright
subscription content
Content Type
Metadata only
Recommended Citation
Liu, P., Gui, M., Wang, J., Liu, D., Lu, Q., Chen, S., Wu, S., & Wang, Y. (2026). Cardiovascular health trajectories before age 50 and subsequent cardiovascular disease, mortality, and CVD-free survival: Implications for predictive, preventive, and personalized medicine in a Chinese community cohort. EPMA Journal. Advance online publication. https://doi.org/10.1007/s13167-026-00459-2