Adherence to the American Heart Association’s Life’s Essential 8 Is Associated With Reduced Odds of Albuminuria Among American Indian Individuals in the Strong Heart Family Study

BACKGROUND: Kidney disease disproportionately affects American Indian (AI) individuals. Identifying potential areas for intervention is critical to optimize kidney health in this population. This study examined associations of achievement of the American Heart Association's Life's Essential 8 (LE8) with albuminuria (marker of kidney injury and cardiovascular disease) among AI individuals in the SHFS (Strong Heart Family Study). METHODS: The study included participants from the SHFS, a longitudinal study of cardiovascular disease among AI individuals from 12 tribes (analytic cohort: n=1642; age, 39±16 years; 62% women). Participants completed baseline (2001-2003) and follow-up (2007-2009) examinations. The primary exposure was a modified LE8 score, excluding sleep. The primary outcome was incident albuminuria (albumin-to-creatinine ratio ≥30 mg/g). Descriptive statistics and generalized estimating equations were used to examine associations of modified LE8 with incident albuminuria. RESULTS: In this young cohort of AI individuals, kidney disease risk factors were common. Based on modified LE8 scores, 26%, 65%, and 9% had low, moderate, or high cardiovascular health, respectively. Compared with participants with low cardiovascular health scores, participants with moderate and high cardiovascular health scores had decreased odds of incident albuminuria. Corresponding odds ratios were 0.58 (95% CI, 0.41-0.82) and 0.17 (95% CI, 0.05-0.57), for moderate and high LE8 scores, respectively. LE8 components for nicotine exposure, physical activity, blood glucose, and body mass index contribute to this association, with only blood glucose and body mass index remaining significant after adjustment. CONCLUSIONS: Preventive interventions that promote optimal health factors and behaviors, like LE8, may improve cardiovascular and kidney disease risk among AI individuals.