Objective: Although the "Life's Essential 8" (LE8) proposed by the American Heart Association is a useful tool for assessing individuals' lifestyles and cardiovascular health, its relationship with suicidal behavior remains poorly understood. This study analyzed the relationship between LE8 levels and suicide mortality. Methods: This cohort study included 54,382 adults in South Korea who were matched to the National Death Registry between 2007 and 2022. The LE8 score, which ranges from 0 to 100, was calculated using 4 health behaviors and 4 biometric health factors. LE8 levels were classified into poor (0-49), intermediate (50-79), and ideal (80-100). Suicide mortality was defined as death due to intentional self-harm (ICD codes: X60-X84). Cox regressions were employed to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results: Among participants, 19.7% (n=10,703), 68.7% (n=37,346), and 11.6% (n=6,333) had ideal, intermediate, and poor LE8 scores, respectively. The median follow-up was 9.67 years, and the suicide mortality rate was 0.28 per 1,000 person-years. Compared with participants with an ideal LE8 score, those with a poor LE8 score had a higher risk of suicide mortality (HR: 2.49, 95% CI: 1.06-5.82), while the association for the intermediate LE8 score was not clear (HR: 1.83, 95% CI: 0.91-3.72). Additionally, among the subdimensions of the LE8 construct, the score for health behaviors had a stronger association with suicide mortality than did the score for biometric health factors. Conclusion: This cohort study found that poor LE8 scores were associated with a higher suicide risk among Korean adults.
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