For decades, the American Heart Association was focused on reducing the risk factors for preventable cardiovascular diseases (CVDs) first established in the 1960s. However, in 2010, it introduced a new framework or construct, called “cardiovascular health” (CVH), aimed at not just reducing CVD risk factors, but optimizing CVH in ourselves, our families, and the population through risk factor control and healthy behaviors.
Called “Life’s Simple 7,” the initial framework included measures of diet quality, physical activity, cigarette smoking, body weight, blood pressure, blood cholesterol and blood glucose, with each graded as poor, intermediate or ideal based on simple but established metrics. Research subsequently found that individuals with ideal scores for most of the seven CVH factors had a fraction of the population burden of CVD, and lower rates of cancer and dementia. In 2022, the American Heart Association revised Life’s Simple 7 to update the definitions of ideal for each, and added a third science-based health behavior, Sleep Health, renaming the CVH framework “Life’s Essential 8.” It also recognized the impact of psychological health and social determinants on CVH. During Heart Month, we present the updated health behaviors and factors that make up Life’s Essential 8, define each, and provide tips on how to move the needle towards ‘ideal’ for each.
Life's Essential 8
This graphic from the American Heart Association shows the 8 components of cardiovascular health: a healthy diet, physical activity, nicotine avoidance, healthy sleep, healthy weight, and healthy cholesterol, blood glucose, and blood pressure levels. These eight elements fall into two categories. The first four make up the "Healthy Behaviors" category, while the latter four fall under "Health Factors."
Healthy Behaviors
Healthy behaviors are the things that we can directly control and that have an immense impact on our cardiovascular and overall health. In fact, healthy behaviors are the #1 contributor to our lifespan and matter more than our genetics. These behaviors also impact the Health Factor components of Life’s Essential 8.
Healthy Diet
A healthy diet has become a major driver of CVH, including a high intake of whole fruits, vegetables, whole grains, nuts, beans, lentils and marine fish, liquid plant oils in place of solid fats, and low amounts of high sodium, high sugar, ultra-processed foods. Diet impacts CVH through numerous body pathways including those that regulate cholesterol, blood pressure, body weight, blood glucose, inflammation, blood clotting, gut health, brain function and cravings, and the immune system. The Life’s Essential 8 metric for an IDEAL diet is one aligned with the DASH diet (highest in fruits-vegetables and lowest in processed foods), Mediterranean diet (measured via the Mediterranean Eating Pattern for Americans (MEPA) score), or a plant-based diet. To improve your diet, eat more vegetables and whole fruits as a first step, then make the switch to whole grains, then to more plant proteins.
Physical Activity
Physical activity is a major predictor of longevity, and improves blood pressure, blood glucose and triglycerides, inflammation, mental health, muscle and bone health, and sleep. Life’s Essential 8 grades physical activity as IDEAL when we’re engaging in 150 minutes of moderate-intensity activity each week—or roughly 30 minutes of brisk walking five days a week. Good news for busy folks—it doesn't have to be all at once. The best way to improve physical activity is to schedule 15 minutes during every lunch hour and again at another time of the day. Self-monitoring via a FitBit or smartwatch may improve your physical activity as it provides immediate, real-time feedback.
Sleep Health
Science is now clear: A good night's rest is a vital part of our brain and heart health and will improve stress levels, blood pressure, short term memory, and risk of heart disease and total mortality. The Life’s Essential 8 metric for IDEAL sleep is seven to nine hours in a 24-hour period. Setting up a good sleep hygiene routine can help you achieve this more regularly. Wearable devices may also help you self-monitor your sleep pattern and quality.
Nicotine Exposure
If you smoke tobacco or vape, the fastest way to improve CVH is to quit. Quitting nicotine will improve high blood pressure, inflammation, HDL-cholesterol, and lower the risk of blood clots, heart attack, lung disease and cancer. The Life’s Essential 8 metric for IDEAL Nicotine Exposure is a “never smoker,” but a former smoker quit for five years is assigned a number almost as high. Your primary care provider can help you find smoking cessation classes, but also see if your employer offers similar resources.
Health Factors
While healthy behaviors are things you can control, health factors are often influenced by family history and genetics. However, you can eventually control them through lifestyle habits and often medications.
Body Weight
Losing excess weight will lower your risk of diabetes, lower your blood pressure and lower your risk for developing cardiovascular disease. There is more psychological distress from being overweight than other health behaviors or factors. However, metabolic factors not under your control are likely influencing your body weight. Steps that you can take include diet change (especially restricting refined carbohydrates and added sugars), engaging in regular exercise, and improving sleep quality. The Life’s Essential 8 metric for IDEAL body weight is a BMI below 25 (100 points), but a BMI from 25-29.9 is still associated with a high score (70 points). Work with a registered dietitian nutritionist to help with weight loss, or discuss newer weight loss interventions with your primary care provider.
High Cholesterol
Controlling high cholesterol will improve your CVH and reduce your heart attack risk, as it is the second highest risk factor for heart attack in the U.S. Cholesterol levels are driven by genetics and dietary factors (usually high intake of dietary saturated fats and added sugars). The Life’s Essential 8 metric for IDEAL cholesterol is a non-HDL-cholesterol under 130 mg/dl (calculated by Brown University Health Laboratories, it is total cholesterol minus HDL-cholesterol). If your cholesterol is higher, limit butter, cheese, tropical oils, and beef and pork fat. Treating high cholesterol with medications is recommended if your calculated 10-year risk of heart attack or stroke is above 7.5 percent, or you have a family history of heart disease or calcified arteries on an imaging study.
High Blood Pressure
Controlling high blood pressure will also improve your CVH as it is the number one risk factor for heart attack and stroke in the U.S. Blood pressure is also influenced by genetics and dietary factors (especially high sodium foods and alcohol). Life’s Essential 8 classifies IDEAL blood pressure as under 120/80 mmHg. Take immediate steps if you are found to have high blood pressure; consistently more than 130/80 mmHg or higher. Reduce dietary sodium and alcohol, engage in more walking exercise, monitor your blood pressure at home, and arrange a follow-up with your primary care provider.
High Blood Sugar
Controlling blood sugar is essential to CVH, as pre-diabetes and diabetes affect most other risk factors and will increase risk of heart, eye and kidney disease. Life’s Essential 8 classifies IDEAL diabetes markers as no history of diabetes or fasting glucose more than 100 mg/dl or Hgb A1c level of more than 5.7 percent. Take steps if you are found to have elevated blood glucose: eliminate added sugars and refined grains from the diet, increase walking exercise, and follow up with your PCP.
Getting started with Life's Essential 8
Improving the cardiovascular health factors above may seem like a lot of change to work into your daily life, but it doesn't have to be. Use the SMART behavior change strategy by making changes that are Specific, Measurable, Achievable, Relevant to your goal, and Timely. Choose one healthy behavior to focus on for a few weeks—for exercise, try walking for 15 minutes during your lunchtime and another 15 minutes later in the day or in the early morning. For diet, eat more whole fruits and vegetables as a first step, then change to whole grains, then add plant-based meals throughout the week. Because you got out for a walk and started eating better, you may find it easier to fall asleep at night. For smoking cessation, weight loss and treatment of high cholesterol, blood pressure or blood sugar, get help from your care team and take advantage of all the resources Brown University Health has to offer.
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