New AHA Checklist: Only 1 in 5 Adults Have Optimal Heart Health

Megan Brooks

July 01, 2022

About 80% of US adults have low to moderate cardiovascular (CV) health based on the American Heart Association (AHA) checklist for optimal heart health, which now includes healthy sleep as an essential component for heart health.

With the addition of sleep, "Life's Essential 8" replaces the AHA's "Life's Simple 7" checklist.

Dr Donald Lloyd-Jones

"The new metric of sleep duration reflects the latest research findings: sleep impacts overall health, and people who have healthier sleep patterns manage health factors such as weight, blood pressure, or risk for type 2 diabetes more effectively," AHA President Donald M. Lloyd-Jones, MD, said in a news release.

"In addition, advances in ways to measure sleep, such as with wearable devices, now offer people the ability to reliably and routinely monitor their sleep habits at home," said Lloyd-Jones, chair of the department of preventive medicine at Northwestern University's Feinberg School of Medicine in Chicago.

The AHA Presidential Advisory — Life's Essential 8: Updating and Enhancing the American Heart Association's Construct on Cardiovascular Health — was published online June 29 in the journal Circulation.

A companion paper published simultaneously in Circulation reports the first study using Life's Essential 8.

Overall, the results show that CV health of the US population is "suboptimal, and we see important differences across age and sociodemographic groups," Lloyd-Jones said.

Refining Life's Simple 7

The AHA first defined the seven metrics for optimal CV health in 2010. After 12 years and more than 2400 scientific papers on the topic, new discoveries in CV health and ways to measure it provided an opportunity to revisit each health component in more detail and provide updates as needed, the AHA explains.

"We felt it was the right time to conduct a comprehensive review of the latest research to refine the existing metrics and consider any new metrics that add value to assessing cardiovascular health for all people," Lloyd-Jones said.

Four of the original metrics have been redefined for consistency with newer clinical guidelines or compatibility with new measurement tools, and the scoring system can now also be applied to anyone ages 2 and older. Here is a snapshot of Life's Essential 8 metrics, including updates:

1) Diet (updated): 

The tool includes a new guide to assess diet quality for adults and children at the individual and population level. At the population level, dietary assessment is based on daily intake of elements in the Dietary Approaches to Stop Hypertension (DASH) eating pattern. For individuals, the Mediterranean Eating Pattern for Americans (MEPA) is used to assess and monitor cardiovascular health.

2) Physical activity (no changes):

Physical activity continues to be measured by the total number of minutes of moderate or vigorous physical activity per week, as defined by the US Physical Activity Guidelines for Americans (2nd edition). The optimal level is 150 minutes (2.5 hours) of moderate physical activity or more per week or 75 minutes per week of vigorous-intensity physical activity for adults; 420 minutes (7 hours) or more per week for children ages 6 and older; and age-specific modifications for younger children.

3) Nicotine exposure (updated):

Use of inhaled nicotine-delivery systems, which includes e-cigarettes or vaping devices, has been added since the previous metric only monitored traditional, combustible cigarettes. This reflects use by adults and youth and their implications on long-term health. Second-hand smoke exposure for children and adults has also been added.

4) Sleep duration (new):

Sleep duration is associated with CV health. Measured by average hours of sleep per night, the ideal level is 7-9 hours daily for adults. Ideal daily sleep ranges for children are 10-16 hours per 24 hours for ages 5 and younger; 9-12 hours for ages 6-12 years; and 8-10 hours for ages 13-18 years.

5) Body mass index (no changes):

The AHA acknowledges that body mass index (BMI) is an imperfect metric. Yet, because it's easily calculated and widely available, BMI continues as a "reasonable" gauge to assess weight categories that may lead to health problems. BMI of 18.5–24.9 is associated with the highest levels of CV health. The AHA notes that BMI ranges and the subsequent health risks associated with them may differ among people from diverse racial or ethnic backgrounds or ancestry. This aligns with the World Health Organization recommendations to adjust BMI ranges for people of Asian or Pacific Islander ancestry because recent evidence indicates their risk of conditions such as CVD or type 2 diabetes is higher at a lower BMI.

6) Blood lipids (updated):

The metric for blood lipids (cholesterol and triglycerides) is updated to use non-HDL cholesterol as the preferred number to monitor, rather than total cholesterol. This shift is made because non-HDL cholesterol can be measured without fasting beforehand (thereby increasing its availability at any time of day and implementation at more appointments) and reliably calculated among all people.

7) Blood glucose (updated):

This metric is expanded to include the option of hemoglobin A1c readings or blood glucose levels for people with or without type 1 or 2 diabetes or prediabetes.

8) Blood pressure (no changes):

Blood pressure criteria remain unchanged from 2017 guidance that established levels less than 120/80 mm Hg as optimal, and defined hypertension as 130-139 mm Hg systolic pressure or 80-89 mm Hg diastolic pressure.

"Concerning" New Data

Results of the first study using Life's Essential 8 show that the overall CV health of the US population is "well below ideal," with 80% of adults scoring at a low or moderate level, the researchers report.

Data for the analysis came from 2013-2018 US National Health and Nutrition Examination surveys (NHANES) of more than 13,500 adults, ages 20-79 years, and nearly 9900 children, ages 2-19 years. Among the key findings:

  • The average CV health score based on Life's Essential 8 was 64.7 for adults and 65.5 for children — in the moderate range on the 0 to 100 scale.

  • Only 0.45% of adults had a perfect score of 100; 20% had high CV health (score of 80+), 63% moderate (score of 50 to 79), and 18% had low CV health (score of less than 50).

  • Adult women had higher average CV health scores (67) compared with men (62.5).

  • In general, adults scored lowest in the areas of diet, physical activity, and BMI.

  • CV health scores were generally lower at older ages.

  • Non-Hispanic Asian Americans had a higher average CV health score than other racial/ethnic groups. Non-Hispanic Whites had the second highest average CV health score, followed, in order, by Hispanic (other than Mexican), Mexican, and Non-Hispanic Blacks.

  • Children's diet scores were low, at an average of 40.6.

  • Adult sociodemographic groups varied notably in CV health scores for diet, nicotine exposure, blood glucose, and blood pressure.

"These data represent the first look at the cardiovascular health of the US population using the AHA's new Life's Essential 8 scoring algorithm," Lloyd-Jones said.

"Life's Essential 8 is a major step forward in our ability to identify when cardiovascular health can be preserved and when it is suboptimal. It should energize efforts to improve cardiovascular health for all people and at every life stage," Lloyd-Jones added.

"Analyses like this can help policymakers, communities, clinicians, and the public to understand the opportunities to intervene to improve and maintain optimal cardiovascular health across the life course," he said.

This research had no commercial funding. The authors have no reported no relevant financial relationships.

Circulation. Published online June 29, 2022. Presidential Advisory, Study

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