Abstract Body (Do not enter title and authors here): Introduction: Cardiovascular disease (CVD) and cancer are the top 2 causes of death among US adults. Life’s Essential 8 (LE8) is an updated cardiovascular health (CVH) metric that includes many factors known to reduce cancer risk. It is unclear how LE8-quantified CVH relates to CVD and cancer mortality in a competing risk framework.

Methods: REGARDS recruited 30,239 Black and White adults from the 48 contiguous US states in 2003-07. We excluded individuals with prevalent CVD or cancer, missing LE8, or no follow-up. Baseline total LE8 scores were categorized as low (<50), moderate (50-79), or high CVH (≥80). Cause-specific hazard models estimated relative hazard of CVD and cancer mortality as competing risks, adjusting for age, sex, race, level of education, and region.

Results: Among 11,385 REGARDS participants who were free of CVD and cancer (mean [SD] age 65 [9] years, 52% women, 44% Black adults), 24%, 66%, and 10% had low, moderate, and high CVH, respectively. Over a median (IQR) follow-up of 14 (8-18) years, 8% died from CVD, 7% from cancer, and 17% from other causes. Moderate and high CVH were significantly associated with graded lower risk of CVD and cancer mortality after adjusting for potential confounders (Table). CVD mortality was lower across better physical activity, blood pressure, diet, sleep, smoking, and glucose CVH groupings. Cancer mortality was lower across better diet and smoking groupings.

Conclusion: LE8-quantified CVH was independently associated with lower CVD and cancer mortality in a competing risk framework and in graded fashion. These findings underscore the significance of lifestyle modifications in mortality risk reduction for the top 2 causes of death in the US, advocating for their incorporation into clinical guidelines and preventive counseling.