Life’s Essential 8 Steps for A Healthy Heart

On June 29, 2022, the American Heart Association (AHA) updated its guidance for a healthy cardiovascular lifestyle. The document details eight things that we can do to optimize our heart health. It is a significant update of the previous seven recommendations published in 2010 titled, “Life’s Simple 7.” The original seven are now “Life’s Simple 8,” or the “Elite 8” because a new and important risk factor has been added--the amount of sleep we get!

What and how were these recommendations determined?

The AHA has focused for many years on our proven ability to ensure our own cardiovascular health. Heart disease remains a leading killer worldwide, but the science clearly shows that we can live longer and better through our own actions. One of the major strategies of the AHA, its member physicians, and scientists to reduce the burden of heart attack and stroke has been an emphasis on PREVENTION, not just advanced treatments once disease is already present.

In 2010 the AHA evaluated research in prevention to identify 7 heart-healthy steps that could be taken to prevent heart attacks and strokes and published the “Life’s Simple 7” guidelines. In the ensuing 12 years, researchers evaluated the benefits and effectiveness of these recommendations for improving cardiovascular health. These 7 factors are easy for patients and clinicians to identify. Individuals can easily assess how well they are doing in preventing cardiovascular disease and predict their long-term risk of heart attack and stroke. Since 2010, research has clearly demonstrated that sleep patterns also significantly impact cardiovascular risk, so now we have 8 strategies to optimize our cardiovascular health.

What are Life’s Essential 8 and how do we measure them?

Table 1 lists the 8 cardiovascular health variables and the points for how well you are doing with each variable. For the full table please go to: Life's Essential 8 | American Heart Association. The health variables are: 1) diet, 2) physical exercise 3) nicotine exposure, 4) sleep health, 5) body mass index, 6) blood lipids, 7) blood glucose, and 8) blood pressure. Note in the table that each variable has a point system that enables you to compute a score of how well you are performing in the category. You can score yourself using the pertinent data and add your scores on each of the 8 variables and divide the sum by 8 to compute an overall cardiovascular score. Please see the Figure 1.

 

How to use your evaluation?

It is helpful to review your evaluation with your primary care physician or your cardiologist. Very few individuals score a perfect 100, and there are likely strategies that can improve your heart health within your control. The purpose of the eight is to give you a score in each category, as well as goals to improve your score in each.

Diet and Exercise

We have discussed two of the variables, diet and exercise, in many previous columns on healthy aging. Simply put, there are two diets that have been proven to help prevent heart attacks, strokes, and related high blood pressure. The two diets are the DASH and Mediterranean diets. The DASH diet plan can be reviewed at: DASH Eating Plan: MedlinePlus and the Mediterranean at: Mediterranean diet: MedlinePlus Medical Encyclopedia. They consist of low salt, fruits, vegetables, and avoidance of saturated fats and sugar. Exercise, as Table 1 indicates, consists of more than 150 minutes a week of moderate- or greater- intensity activity. The other categories are self-explanatory: see Table 1.

The Bottom Line

The AHA continues to help us live healthier lives. The AHA’s latest recommendations for the Elite 8 health principles gives us new tools to empower all individuals to maintain a healthy cardiovascular system.

Table 1: The eight domains for cardiovascular health

Metrics allow computation of a score for each category. Then the score for each category is added to compute a composite score. See Figure 1 for where the score places an individual from low health to high. From: Life’s Essential 8: Updating and Enhancing the American Heart Association’s Construct of Cardiovascular Health: A Presidential Advisory From the American Heart Association | Circulation (ahajournals.org).

Diet

MEPA score (see text for link)
15-16 = 100
12-14 = 80
8-11 = 50
4-7 = 25
0 = 0

Physical Exercise

Self-reported (minutes/week of moderate exercise)
>150 = 100
120-149 = 90
90-119 = 80
60-89 = 60
30-59 = 40
1-29 = 20
0 = 0

Nicotine Exposure

Self-reported
Never smoked = 100
Quit >5 yrs. = 75
Quit 1-< 5yrs = 50
Quit <1y or inhaler NDS = 25
Smoke now = 0

Sleep Health

Self-reported (hours per night)
7-<9 = 100
9-<10 = 90
6-<7 = 70
5-<7 or > 10 = 40
4-<5 = 20
0 = 0

Body Mass Index

Weight (kg) divided by height (meters squared)
< 25 = 100
25-29 = 70
30-34 = 30
35-39 = 15
>40 = 0

Body Mass Index

Weight (kg) divided by height (meters squared)
< 25 = 100
25-29 = 70
30-34 = 30
35-39 = 15
>40 = 0

Blood Lipids

Blood non-HDL cholesterol (mg/dl)
<130 = 100
130-159 = 60
160-189 = 40
190-219 = 20
>220 = 0
If drug treated subtract 20

Blood glucose

Fasting blood glucose
(FBG) or HbA1c FBG <100 or HbA1c <5.7 = 100
FBG 100-125 or HbA1c 5.7-6.4 = 60
Diabetes with HbA1c 5.7-6.4 = 40
Diabetes with HbA1c 7.0-7.9 = 30
Diabetes with HbA1c 8.0-8.9 = 20
Diabetes with HbA1c 9.0-9.9 = 10 Diabetes with HbA1c >10 = 0

Blood Pressure

Systolic over diastolic (mmHg)
<100/<80 = 100
120-129/<80 = 75
130-139 or /80-90 = 50
140-159 or /90-99 = 25
>160 or / >100 = 0