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Life's Essential 8: Updating and Enhancing the American Heart Association's Construct of Cardiovascular Health
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- This presidential advisory from the American Heart Association introduces an enhanced approach to assessing cardiovascular health: Life’s Essential 8, updated from a 2010 paradigm (Life’s Simple 7). Life's Essential 8 includes diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipids, blood glucose, and blood pressure. Each component has a scoring algorithm that can be combined to generate a composite cardiovascular health score.
- In this updated construct of cardiovascular health, the American Heart Association incorporates new evidence and the foundational contexts of social determinants of health and psychological health. This position statement also provides methods for implementing cardiovascular health assessment and discusses tools to promote widespread adoption in policy, public health, clinical, institutional, and community settings.
abstract
This abstract is available on the publisher's site.
Access this abstract nowIn 2010, the American Heart Association defined a novel construct of cardiovascular health to promote a paradigm shift from a focus solely on disease treatment to one inclusive of positive health promotion and preservation across the life course in populations and individuals. Extensive subsequent evidence has provided insights into strengths and limitations of the original approach to defining and quantifying cardiovascular health. In response, the American Heart Association convened a writing group to recommend enhancements and updates. The definition and quantification of each of the original metrics (Life's Simple 7) were evaluated for responsiveness to interindividual variation and intraindividual change. New metrics were considered, and the age spectrum was expanded to include the entire life course. The foundational contexts of social determinants of health and psychological health were addressed as crucial factors in optimizing and preserving cardiovascular health. This presidential advisory introduces an enhanced approach to assessing cardiovascular health: Life's Essential 8. The components of Life's Essential 8 include diet (updated), physical activity, nicotine exposure (updated), sleep health (new), body mass index, blood lipids (updated), blood glucose (updated), and blood pressure. Each metric has a new scoring algorithm ranging from 0 to 100 points, allowing generation of a new composite cardiovascular health score (the unweighted average of all components) that also varies from 0 to 100 points. Methods for implementing cardiovascular health assessment and longitudinal monitoring are discussed, as are potential data sources and tools to promote widespread adoption in policy, public health, clinical, institutional, and community settings.
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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], DM Lloyd-Jones, NB Allen, CAM Anderson, T Black, LC Brewer, RE Foraker, MA Grandner, H Lavretsky, AM Perak, G Sharma, W RosamondFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
This was an update on the 2010 paradigm of Life’s Simple 7, initially developed by an expert panel of approximately 170 surveyed scientists, by the American Heart Association for the maintenance of good cardiovascular health.1 Since the inception of the Simple 7, it has been studied extensively. Better scores have been associated with improved diabetes metrics, reductions in the rates of non-alcoholic fatty liver disease, peripheral artery disease, cardiovascular events, and heart failure among other outcomes.2-6 In the updated Essential 8, predictors of cardiovascular health are split into health behaviors of diet, physical activity, nicotine exposure (formerly smoking exposure), sleep duration (a new parameter), and health factors of body mass index, such as cholesterol and blood sugar levels and blood pressure.7 The updated tool is applicable to patients as young as 2 years old as cardiovascular disease accumulates over a lifetime. Updates in the tool are a scoring system on a 100-point scale for each parameter, a renewed measure to assess diet quality utilizing the validated Mediterranean eating pattern assessment for individuals, population-level dietary assessment based on the dietary approaches to stop hypertension diet, nicotine exposure (including vaping) replacing cigarette smoking, preferred lipid measure changing to non-HDL cholesterol from total cholesterol, blood sugar metric expansion to include fasting blood glucose and hemoglobin A1c and, perhaps most significantly, the addition of sleep duration as a parameter of cardiovascular health.7 The addition of low sleep duration is well-founded, as it has been repeatedly linked to many cardiovascular-related adverse health outcomes, including hypertension, cardiovascular mortality, diabetes, coronary calcifications, stroke, and all-cause mortality.8-11 No modifications were made to the assessment of body mass index, blood pressure, or physical activity from the prior iteration. The importance of psychological well-being and social determinants of health were also stated as important factors, however difficult to quantify, although methods to address these factors were discussed extensively in this position paper.7 Ultimately the updated position paper takes a more comprehensive view of cardiovascular health across the lifespan and now includes the important often overlooked parameter of sleep duration as a metric of cardiovascular well-being.
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