Impact of the American Heart Association’s Life’s Essential 8 goals on incident cardiovascular diseases (CVD) in the Strong Heart Family Study

Cardiovascular diseases (CVD) are a leading cause of morbidity and mortality among American Indians. In 2022, the American Heart Association (AHA) developed the Life’s Essential 8 goals to promote optimal cardiovascular health (CVH) for Americans. The goals comprise 4 health behaviors (i.e., diet, physical activity, nicotine exposure, and sleep) and 4 health factors (i.e., body mass index, blood lipids, blood pressure, and blood glucose). We examined whether achievement of the AHA’s Life’s Essential 8 goals was associated with incidence of CVD in American Indians who participated in the Strong Heart Family Study (SHFS), a longitudinal study of risk factors for CVD in 12 American Indian communities. Methods: A total of 2,139 SHFS participants without CVD at baseline were included in analyses. We created a composite CVH score based on achievement of the AHA Life’s Essential 8 goals. The composite score used data on diet quality, physical activity, nicotine exposure, body mass index, blood lipids, blood pressure and blood glucose; sleep data were not collected in the SHFS, and sleep was not included in the composite score. Scores of 0-49 represented low CVH, 50-69 moderate CVH, and 70-100 high CVH. Incident CVD was defined as new onset myocardial infarction, coronary heart disease, congestive heart failure, or stroke. Cox proportional hazard models were used to examine the relationship of CVH and incident CVD. Results: The incidence rate of CVD at the 20-year follow-up (through 2021) was 7.43 per 1000 person-years. Compared to participants with low CVH, participants who had moderate and high CVH had a lower risk of incident CVD; the hazard ratios and 95% confidence intervals (CI) for incident CVD for moderate and high CVH were 0.52 (95% CI: 0.40-0.68) and 0.25 (95% CI: 0.14-0.44), respectively, after adjustment for age, sex, education, and study site. Conclusion: Better CVH was associated with lower risks of CVD in American Indians. Our findings support the need for comprehensive public health interventions targeting CVH promotion to reduce the risk of CVD among American Indians.