{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T05:43:50Z","timestamp":1785908630642,"version":"3.56.0"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Life\u2019s Essential 8 (LE8) summarizes cardiovascular health through four behavioral and four health-factor metrics, whereas cardiovascular-kidney-metabolic (CKM) syndrome staging characterizes disease burden and severity. Whether the two LE8 domains associate differently with advanced CKM syndrome in an Asian population remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed 17,351 Korean adults aged 20\u201379 years from the Korea National Health and Nutrition Examination Survey (2019\u20132021 and 2024) using a Korean-adapted, American Heart Association-aligned CKM framework incorporating Korean adiposity thresholds, the Korean cardiovascular risk equation, and Korean-specific LE8 body mass index scoring. Advanced CKM (Stage \u2265 3) was the primary outcome. Survey-weighted logistic regression estimated adjusted odds ratios (aORs) per 10-point LE8 increment, with prespecified sequential CKM-spectrum restriction, four outcome definitions, and medication-stratified lipid analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The weighted prevalence of advanced CKM was 4.13% (931 cases). Each 10-point higher LE8 score was associated with lower odds of advanced CKM (aOR 0.765, 95% confidence interval [CI] 0.716\u20130.818). Behavioral and health-factor subscores remained independently associated after mutual adjustment. Across sequential CKM-spectrum restrictions, the behavioral association remained stable (aORs 0.879\u20130.897), whereas the health-factor association attenuated to non-significance at the most restricted level (aOR 0.998). Participants in the lowest LE8 quintile had 3.32-fold higher odds than those in the highest quintile (95% CI 2.30\u20134.80).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>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. The cross-sectional design precludes causal inference.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1905093","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T04:45:24Z","timestamp":1785905124000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Behavioral and health-factor domains of Life\u2019s Essential 8 in advanced cardiovascular-kidney-metabolic syndrome among Korean adults: a nationally representative cross-sectional analysis"],"prefix":"10.3389","volume":"17","author":[{"given":"Jung Ah","family":"Lim","sequence":"first","affiliation":[{"name":"Department of Endocrinology and Metabolism, Hanyang University Guri Hospital, Hanyang University College of Medicine","place":["Guri, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyungdo","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Statistics and Actuarial Science, Soongsil University","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung Hoon","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Hanyang University Guri Hospital, Hanyang University College of Medicine","place":["Guri, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jung Hwan","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Hanyang University Seoul Hospital, Hanyang University College of Medicine","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinje","family":"Moon","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Hanyang University Seoul Hospital, Hanyang University College of Medicine","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang Beom","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Hanyang University Guri Hospital, Hanyang University College of Medicine","place":["Guri, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sangmo","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Hanyang University Guri Hospital, Hanyang University College of Medicine","place":["Guri, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001184","article-title":"Cardiovascular-kidney-metabolic health: a presidential advisory from the American Heart 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