Sleep duration is now considered an essential component for ideal heart and brain health, the American Heart Association has said.
Life’s Essential 8 cardiovascular health score replaces Life’s Simple 7, according to ‘Life’s Essential 8 – Updating and Enhancing the American Heart Association’s Construct on Cardiovascular Health’.
The presidential advisory was published on June 29 in Circulation, the association’s flagship, peer-reviewed journal.
Other updates to the measures of optimal cardiovascular health, now for anyone ages two and older, include a new guide to assess diet, and accounting for exposure to secondhand smoke and vaping.
Also using non-HDL cholesterol instead of total cholesterol to measure blood lipids, and expanding the blood sugar measure to include haemoglobin A1c, a key measure to assess type two diabetes risk.
Cause of death
Cardiovascular disease is the number one cause of death in the US and globally.
According to the Association’s 2022 Heart Disease and Stroke Statistics Update, about 121.5 million people in the US have high blood pressure, 100 million have obesity, more than 28 million people have type two diabetes.
Only one in four adults reported achieving the physical activity and exercise recommended in the US Department of Health and Human Services’ Physical Activity Guidelines for Americans, second edition.
Various research studies over the past two decades indicate more than 80 per cent of all cardiovascular events may be prevented by healthy lifestyle and management of known cardiovascular risk factors.
Seven metrics
The association first defined the seven metrics for cardiovascular health in 2010 to identify the specific health behaviours and health factors that drive optimal heart and brain health.
Brain health in relation to cardiovascular health was defined in a 2017 American Heart Association Presidential Advisory.
It was further acknowledged as an important component of optimal cardiovascular health in the Association’s January 2021 Scientific Statement on the mind-heart-body connection.
Findings from both papers are incorporated into Life’s Essential 8.
After 12 years and more than 2,400 scientific papers on the topic, new discoveries in heart and brain health and in the ways to measure cardiovascular health provided an opportunity to revisit each health component in more detail.
Four of the original metrics have been redefined for consistency with newer clinical guidelines or compatibility with new measurement tools.
Also, the scoring system can now be applied to anyone ages two and older.
Health behaviours and factors
The Life’s Essential 8 components of optimal cardiovascular health are divided into two major areas – health behaviours and health factors.
Health behaviors include diet, physical activity, nicotine exposure and sleep. Health factors are body mass index, cholesterol levels, blood sugar and blood pressure.
“The idea of optimal cardiovascular health is important because it gives people positive goals to work toward at any stage of life,” said American Heart Association President Donald M Lloyd-Jones.
“Life’s Simple 7 has served as a proven, powerful tool for understanding how to achieve healthy ageing and ways to improve cardiovascular health while decreasing the risks of developing heart disease and stroke, as well as cancer, dementia and many other chronic diseases,” he said.
“Given the evolving research, it was important to address some limitations to the original metrics, particularly in ways they’ve been applied to people from diverse racial and ethnic populations.”
Sleep duration
Sleep duration is associated with cardiovascular health. According to Life’s Essential 8, measured by average hours of sleep per night, the ideal level is seven to nine hours daily for adults.
Ideal daily sleep ranges for children are 10 to 16 hours per 24 hours for ages five and younger; nine to 12 hours for ages six to 12 years; and eight to 10 hours for ages 13 to 18 years.
“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,” said Lloyd-Jones.
Lloyd-Jones led the advisory writing group and is chair of the department of preventive medicine, the Eileen M Foell Professor of Heart Research and professor of preventive medicine, medicine and paediatrics at Northwestern University’s Feinberg School of Medicine in Chicago.
“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.”
Comprehensive review
Lloyd-Jones explained that some of the previous metrics, such as diet, were not as sensitive to differences among people, or as responsive to changes over time within a single individual.
“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.”
Each component of Life’s Essential 8, which is assessed by the My Life Check tool, has an updated scoring system ranging from 0 to 100 points.
The overall cardiovascular health score from 0 to 100 points is the average of the scores for each of the eight health measures.
Overall scores below 50 indicate ‘poor’ cardiovascular health, and 50-79 is considered ‘moderate’ cardiovascular health. Scores of 80 and above indicate ‘high’ cardiovascular health.
Life’s Essential 8
The advisory recommends measuring cholesterol, blood sugar, blood pressure, height and weight at least every five years for the most complete and accurate Life’s Essential 8 score.
The writing group also reviewed data about the impacts of stress, mental health and social determinants of health, such as access to health care, income or education level, and structural racism, which are critical to understanding the foundations of health, particularly among people from diverse racial and ethnic populations.
“We considered social determinants of health carefully in our update and determined more research is needed on these components to establish their measurement and inclusion in the future,” said Lloyd-Jones.
“Nonetheless, social and structural determinants, as well as psychological health and well-being, are critical, foundational factors in an individual’s or a community’s opportunity to preserve and improve cardiovascular health.
“We must consider and address all of these issues for people to have the opportunity for a full, healthy life as measured by Life’s Essential 8.”
A major step forward
“Life’s Essential 8 is a major step forward in our ability to identify when cardiovascular health can be preserved and when it is sub-optimal.
“It should energise efforts to improve cardiovascular health for all people and at every life stage,” Lloyd-Jones concluded.
This advisory was prepared by a volunteer writing group on behalf of the American Heart Association. American Heart Association Presidential Advisories promote greater awareness about cardiovascular diseases and stroke issues and help facilitate informed health care decisions.
Presidential advisories outline what is currently known about a topic and what areas need additional research.
While these statements inform the development of guidelines, they do not make treatment recommendations.
American Heart Association guidelines provide the association’s official clinical practice recommendations.
