Achievement of the American Heart Association Life's Essential 8 Goals With Death Among American Indian People: The Strong Heart Family Study

BACKGROUND: The American Heart Association's Life's Essential 8 is a metric used to assess cardiovascular health (CVH) that includes 4 health behaviors and 4 health factors. We examined the association of achievement of Life's Essential 8 with death among American Indian people who participated in the SHFS (Strong Heart Family Study), a study of cardiovascular disease risk factors in 12 rural American Indian communities in the United States. METHODS: A total of 2230 SHFS participants were included. A composite CVH score (0-100) was created on the basis of the achievement of Life's Essential 8 goals except sleep and categorized into low (0-49), moderate (50-69), and high (70-100) CVH. Cox proportional hazards models were used to examine the association of CVH with mortality risk (all-cause and cardiovascular disease death). RESULTS: There were 555 deaths over a median 19.3-year follow-up. The risk of death from any cause was lower among participants who achieved high CVH (hazard ratio [HR], 0.52 [95% CI, 0.38-0.70]) or moderate CVH (HR, 0.67 [95% CI, 0.56-0.78]) compared with those with low CVH. Similarly, the risk of death from cardiovascular disease was lower among participants with high CVH (HR, 0.30 [95% CI, 0.14-0.67]) or moderate CVH (HR, 0.56 [95% CI, 0.39-0.79]) compared with participants with low CVH. CONCLUSIONS: Higher achievement of Life's Essential 8 was associated with lower risk of all-cause and cardiovascular disease death. This work highlights the importance of promoting optimal CVH to minimize risk of death in American Indian communities.