AHA Life’s Simple 7 Metric May Predict Chronic Kidney Disease Risk

The Life’s Simple 7 metric developed by the American Heart Association (AHA) for the promotion of cardiovascular health can also predict lower risk of chronic kidney disease (CKD), according to an analysis published in the Journal of the American Heart Association.

Researchers analyzed data from the ARIC (Atherosclerosis Risk in Communities) study to determine the association between Life’s Simple 7 and incident CKD.

The Life’s Simple 7 health factors consist of: non-smoking status or having quit more than 1 year ago, body mass index (BMI) <25 kg/m², ≥150 minutes per week of physical activity, health dietary pattern (high in fruits and vegetables, fish, and fiber-rich whole grains; low in sodium and sugar-sweetened beverages), total cholesterol <200 mg/dL, blood pressure <120/80 mm/Hg, and fasting blood glucose <100 mg/dL.

Of the 14 832 patients, 2743 CKD cases developed during a median of 22 follow-up years. Risk factors included smoking, BMI, physical activity, blood pressure, and blood glucose. As the authors expected, the CKD risk was “inversely related to the number of ideal health factors.”

Interestingly, a model that used the Life’s Simply 7 health factors was more predictive of CKD risk than a base model that used only age, sex, race, and estimated glomerular filtration rate (eGFR).

A patient’s fasting blood glucose level had the strongest association with CKD (hazard ratio [HR] for ideal: 0.37; 95% confidence interval [CI]: 0.33-0.41; HR for intermediate: 0.40; 95% CI: 0.36-0.45). Blood pressure was the next strongest association (HR for ideal: 0.50; 95% CI: 0.44-0.56; HR for intermediate: 0.73; 95% CI: 0.67-0.81).

Healthy diet and total cholesterol levels were not associated with incident CKD (P value for trend=.55 and .62, respectively).

In terms of number of ideal health factors and CKD risk, about one-third of patients who had 0 ideal health factors at baseline developed CKD vs 6.5% of patients who had 6 or 7 ideal health factors. After adjustment for age, sex, race, and eGFR, there was a graded relationship between the number of ideal health factors and risk (P value for trend <.001). Having 6 or 7 ideal health factors compared to 0 was associated with an 81% reduced risk of CKD (HR: 0.19; 95% CI: 0.12-0.29).

While their study posed some limitations—eg, the observed lack of association between dietary factors and CKD and the Life’s Simple 7 health factors being assessed only at a single time point which indicates this strategy would most likely be implanted during a clinical encounter.

Nonetheless, the study had several major strengths as well. “The ARIC study population is large and diverse; thus the results are broadly generalizable to adults in the US,” researchers wrote. “Given the extended follow-up period, we were able to enumerate several thousand incident chronic kidney disease events in individuals free of kidney disease at baseline, whereas previous studies were limited to chronic kidney disease cohorts with fewer kidney disease events.”

Attaining these ideal health factors, the researchers concluded, may be an effective strategy for CKD prevention.

Reference

Rebholz C, Anderson C, Grams M, et al. Relationship of the AHA impact goals (Life’s Simply 7) with risk of chronic kidney disease: results from the ARIC cohort study. J Am Heart Assoc. 2016. doi: 10.1161/JAHA.116.003192.