AHA/ASA Advisory Outlines Seven Steps to Brain Health

September 13, 2017

Seven steps already recommended to improve cardiovascular heath are now also the focus of a new "presidential advisory" from the American Heart Association (AHA)/American Stroke Association (ASA) to promote brain health.

The seven steps, called "Life's Simple 7," may also prevent dementia caused by strokes, vascular dementia, and Alzheimer's disease and have been chosen as metrics to define optimal brain health, the advisory states.

"Research convincingly demonstrates that the same risk factors that cause atherosclerosis are also major contributors to late-life cognitive impairment and Alzheimer's disease," commented Philip Gorelick, MD, Mercy Health Hauenstein Neurosciences in Grand Rapids, Michigan, chair of the advisory writing group.

"By following seven simple steps — Life's Simple 7 — not only can we prevent heart attack and stroke, we may also be able to prevent cognitive impairment," he said.


The seven steps consist of four ideal health behaviors and three ideal health factors as follows:

  1. Nonsmoking status

  2. Physical activity at goal level

  3. Body mass index less than 25 kg/m2

  4. Healthy diet consistent with current guidelines

  5. Untreated blood pressure less than 120/<80 mm Hg

  6. Untreated total cholesterol less than 200 mg/dL

  7. Fasting blood glucose less than 100 mg/dL

Previously, experts believed cognitive impairment caused by Alzheimer's disease and other similar conditions were entirely separate from stroke, but "over time we have learned that the same risk factors for stroke that are referred to in Life's Simple 7 are also risk factors for Alzheimer's disease and possibly for some of the other neurodegenerative disorders," Dr Gorelick noted.

The advisory, published online in Stroke on September 7, is based on a systemic review of the literature, with 182 published studies included.

The action items from Life's Simple 7, he explained, meet three practical rules the panel developed in pinpointing ways to improve brain health: that they could be measured, modified, and monitored. "Those three criteria make it possible to translate knowledge into action," he added.

The advisory also recommends to start following these seven steps as early as possible in life. "Studies are ongoing to learn how heart-healthy strategies can impact brain health even early in life," Dr Gorelick said. Although more research is needed, he said, "the outlook is promising."

Other Factors

The advisory acknowledges that other factors beyond Life's Simple 7 can also affect brain health by influencing stroke or dementia risk or by independent mechanisms. Examples include but are not limited to atrial fibrillation, low cardiac output leading to hypoperfusion dementia, acute or chronic brain diseases distinct from stroke or neurodegeneration, and head injury (which can in part be influenced by behavior).

"Although the importance of these factors with respect to optimal brain health is acknowledged, AHA's Life's Simple 7 was chosen to be the backbone of the definition of the metrics because of their relevance on individual and population levels, life-course perspective, and fit with the ability to monitor, measure, and modify, and because they further affect other established risk factors for brain health, including atrial fibrillation," the advisory states.

On the role of education or social engagement in brain health, the advisory says this relationship is "complex." It suggests that while education may affect brain health by enhancing the capacity to compensate for the effects of brain pathology on brain function (eg, cognitive reserve), a potential benefit of interventions to enhance social or cognitive lifestyle has thus far not convincingly been demonstrated. "Nevertheless, this remains an important area for further investigation."

It adds that a more detailed appraisal of other factors beyond AHA's Life's Simple 7 will be the focus of future brain health publications. "We anticipate that future publications from the AHA/ASA brain health writing group will expand the definition of optimal brain health and incorporate factors of interest."

The advisory notes that the AHA/ASA has set a Strategic Impact Goal by the year 2020 to improve the cardiovascular health of Americans by 20% while reducing deaths from cardiovascular diseases and stroke by 20%. As part of the effort to promote cardiovascular health, AHA/ASA is adding brain health to its overall strategic initiatives.

"Brain health is an important component of successful aging and one in which cardiovascular risks seem to play a key role. The main purpose of this document is to serve as the first step in defining optimal brain health and how to maintain it. Future work will serve to refine the definition, metrics, and strategies to maintain cognitive vitality," it concludes.

Stroke. Published online September 7, 2017.  Full text

For more Medscape Neurology news, join us on Facebook and Twitter


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.