Association of Life's Essential 8 Score With Incident Pancreatic Cancer: A Prospective Cohort Study in Shanghai, China

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ABSTRACT Life's Essential 8 (LE8) is a comprehensive metric of cardiovascular health (CVH). Higher LE8 scores have been associated with lower risks of chronic diseases, but evidence regarding pancreatic cancer (PC) in Chinese populations is scarce. We analyzed data from 60,556 cancer‐free adults in the Shanghai Suburban Adult Cohort and Biobank. LE8 includes four health behaviors (diet, physical activity, nicotine exposure, sleep) and four health factors (BMI, blood lipids, blood glucose, blood pressure), measured by questionnaires, physical examinations, and biochemical tests. Total scores (0–100) were categorized as low (< 50), moderate (50–79), and high (≥ 80) CVH. Incident PC was identified through cancer registries, hospital systems, and death records. Associations were assessed using multivariable Cox models. Over a median 7.4‐year follow‐up, 200 participants (0.3%) developed PC. Compared with participants with low CVH, those with moderate CVH (hazard ratio [HR] = 0.65, 95% confidence interval [CI] = 0.46–0.92) and high CVH (HR = 0.39, 95% CI = 0.19–0.82) had lower risks of PC. Each one standard deviation increase in LE8 score was associated with an 18% lower risk of PC (HR = 0.82, 95% CI = 0.70–0.96), with a linear inverse relationship. The association was attenuated after excluding the nicotine exposure component. The estimated population attributable fraction for suboptimal CVH was 40.5%. Stronger associations appeared in men and participants aged ≥ 60; a significant interaction with sex was observed. Overall, better LE8‐defined CVH was associated with reduced PC risk, and smoking‐related exposure may have contributed importantly to the observed association.