Life’s Essential 8: Updating the AHA’s Construct of Cardiovascular Health

Lloyd-Jones DM, Allen NB, Anderson CA, et al.
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 2022;Jun 29:[Epub ahead of print].

The following are key points to remember from this American Heart Association (AHA) Presidential Advisory on Life’s Essential 8: Updating and Enhancing the AHA’s Construct of Cardiovascular Health (CVH):

  1. In 2010 the AHA defined CVH based on seven health behaviors, including diet quality, physical activity, exposure to cigarette smoke, and health measures (body mass index [BMI], blood glucose, total cholesterol, and blood pressure). These were termed Life’s Simple Seven.
  2. Life’s Simple Seven has been associated with increased and inverse associations between ideal metrics and cardiovascular disease (CVD), including CVD mortality. Yet the prevalence of ideal CVH is low across a range of age groups, from childhood to older adults. Ideal CVH is inversely associated with lower socioeconomic position.
  3. This AHA presidential statement proposes to update current definitions, rescore the original seven metrics, and add an eighth related to sleep. A new method for assessment of diet is proposed; the modified Mediterranean Eating Pattern for Americans (MEPA) is recommended for dietary assessment. A dietary pattern consistent with the DASH or Mediterranean dietary pattern is recommended for CVH. Nicotine exposure is an expanded metric to include other forms of nicotine consumption beyond combustible cigarette use, such as vaping.
  4. Other metrics include blood lipids with new recommendations to consider non–high-density lipoprotein rather than total cholesterol. Blood glucose is recommended to measure glycated hemoglobin A1c to better reflect glycemic control among diabetic patients.
  5. Physical activity, BMI, and blood pressure are recommended to be assessed using the same metrics as outlined in Life’s Simple Seven.
  6. Sleep health is an eighth metric recommended to be measured through the self-reported average number of hours of sleep per night.
  7. Implementation of these metrics warrants the inclusion of AHA or health system platforms for patients and providers to assess CVH longitudinally. Using a learning health care system to integrate the electronic medical record with tools to promote CVH in all populations is recommended. Training clinicians to provide effective counseling is also recommended.
  8. Psychological health and well-being were considered important for CVH yet difficult to measure and thus were considered foundational to all these CVH metrics.
  9. Social determinants of health with five key domains (economic stability, neighborhood and built environment, education, social and community context, and health and health care) impact one’s ability to optimize CVH yet remain difficult to assess. The statement recommends continued research on the best methods to measure social determinants of health in the context of CVH and consider CVH when developing policies and programs to improve CVH.
  10. Improvement of CVH across social-ecological contexts warrants a multilevel, multidisciplinary approach. Policy to reduce tobacco products and promote access to healthy foods and areas for physical activity complement public health programs and institutional efforts to increase opportunities for improving CVH in all environments, from schools and playgrounds to homes and work. Neighborhood and community partnerships can enhance efforts to improve these metrics.

Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Lipid Metabolism, Nonstatins, Diet, Exercise, Smoking, Sleep Apnea

Keywords: Blood Glucose, Blood Pressure, Body Mass Index, Cholesterol, Cigarette Smoking, Delivery of Health Care, Diabetes Mellitus, Diet, Economic Factors, Exercise, Glycated Hemoglobin A, Glycemic Control, Healthy Lifestyle, Life Change Events, Lipids, Nicotine, Nutrition Assessment, Primary Prevention, Public Health, Sleep, Social Determinants of Health, Tobacco Products, Vaping

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