S1 File -

Aims

To evaluate the association between ideal cardiovascular health metrics (ICVHM) and incident low estimated glomerular filtration rate (eGFR) among the Iranian population.

Methods

The study population included 6927 Iranian adults aged 20–65 years (2942 male) without prevalent low eGFR [i.e., eGFR < 60 ml/min/1.73 m²] and free of cardiovascular disease. The ICVHM was defined according to the 2010 American Heart Association. The multivariable Cox proportional hazards regression analysis was used to calculate the hazard ratios (HRs) of ICVHM both as continuous and categorical variables.

Results

Over the median of 12.1 years of follow-up, we found 1259 incident cases of low eGFR among the study population. In this population, ideal and intermediate categories of body mass index (BMI) and blood pressure (BP) and only the ideal category of fasting plasma glucose (FPG) significantly decreased the risk of developing low eGFR; the corresponding HRs and (95% confidence intervals) were (0.87, 0.77–0.99), (0.84, 0.76–0.99), (0.79, 0.68–0.93), (0.70, 0.60–0.83) and (0.76, 0.64–0.91). Also, one additional ICVHM was associated with a reduced risk of low eGFR for the global (0.92, 0.88–0.97) and biological cardiovascular health (0.88, 0.82–0.93) in these participants. A sensitivity analysis using the interval-censoring approach demonstrated that our method is robust, and results remained essentially unchanged. In a subgroup population with dietary data (n = 2285), we did not find the beneficial impact of having intermediate/ideal categories of nutrition status compared to its poor one on incident low eGFR.

Conclusion

We found a strong inverse association between having higher global ICVHM with incident low eGFR among the non-elderly Iranian population; the issue is mainly attributable to normal BP, BMI, and FPG levels.