Chinese Study: 8 Healthy Habits Cut Death Risk in CKM Syndrome

A Study from China Reveals How 8 Healthy Habits Can Save Lives for Americans with CKM Syndrome

A study from China, conducted by researchers at Sichuan Provincial People's Hospital and the University of Electronic Science and Technology of China in Chengdu, offers important new insights into how everyday lifestyle habits affect survival odds for people living with cardiovascular-kidney-metabolic (CKM) syndrome — a condition that affects millions of Americans managing diabetes, kidney disease, and heart risk simultaneously.

What Is CKM Syndrome?

CKM syndrome is a framework introduced by the American Heart Association (AHA) that recognizes how metabolic disorders like obesity and diabetes, chronic kidney disease (CKD), and cardiovascular disease are deeply interconnected. It is staged from 0 (no risk factors) to 4 (established heart disease). Most Americans with type 2 diabetes fall into stages 1 through 3.

What the Researchers Studied

Using data from the nationally representative National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018, the Chinese research team analyzed 9,152 American adults (average age 45 years) to see whether the AHA's Life's Essential 8 (LE8) score predicted who lived longer. The majority of participants — 60% — were already at CKM Stage 2, meaning they had measurable metabolic or kidney risk factors.

The LE8 framework scores eight health behaviors and metrics on a scale of 0–100:

• Diet quality
• Physical activity
• Nicotine/tobacco exposure
• Sleep health
• Body mass index (BMI)
• Blood lipid profiles (cholesterol)
• Glycemic (blood sugar) status — including fasting glucose and HbA1c
• Blood pressure

Key Findings

After tracking participants through December 2019 (a median follow-up of nearly 8 years), the results were striking:

• Every 10-point increase in the LE8 health behaviors score was linked to a 22% reduction in all-cause mortality for those at CKM stages 0–1.
• For those at the more advanced CKM stages 2–3, every 10-point improvement still delivered a meaningful 13% reduction in death risk.
• The relationship was linear — meaning every incremental improvement in lifestyle habits mattered, with no ceiling effect.

Importantly, when researchers separated the LE8 into health behaviors (diet, activity, sleep, smoking) and health factors (BMI, blood sugar, cholesterol, blood pressure), the behaviors component drove the most significant results across all disease stages.

US Measurement Context

The glycemic component of LE8 evaluates fasting blood glucose and HbA1c. In US-standard units, optimal fasting glucose is below 100 mg/dL (versus the SI unit of 5.6 mmol/L used in international research). Current ADA guidelines target an HbA1c of below 7% for most adults with diabetes — consistent with what the LE8 framework rewards with higher scores.

Why This Matters for US Patients

This research is particularly valuable because it was conducted using American patient data (NHANES), yet analyzed through the fresh lens of Chinese medical researchers who specialize in health management systems. Their independent analysis confirms what US guidelines recommend — but adds a critical nuance: lifestyle habits matter even when your disease is already progressing. You don't have to be perfectly healthy to benefit. Even patients at CKM Stage 2 or 3 — who already have diabetes complications or early kidney disease — can meaningfully reduce their risk of dying by improving daily habits. This validates the AHA's push to screen and score all patients using the LE8 framework, and supports integrating this tool into routine diabetes care visits across the US.

Bottom line: Whether you're newly diagnosed or managing complex diabetes-related conditions, improving even a few of Life's Essential 8 behaviors could add years to your life.

Source: Zhang, Yin, Liu. "Association between the Life's Essential 8 Health Behaviors Score and Mortality Risk in US Adults with Cardiovascular-Kidney-Metabolic Syndrome Stage 0–3." Diabetes & Metabolism Journal, 2025. PMID: 41423828. DOI: 10.4093/dmj.2025.0366