AHA: Updated ‘Life’s Essential 8’ scoring shows most Americans have suboptimal CV health
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An updated American Heart Association checklist that now includes sleep health metrics showed about 80% of U.S. adults have low to moderate CV health, with lowest scores occurring in the areas of diet, physical activity and BMI.
The enhanced Life’s Essential 8 measurement tool — formerly known as Life’s Simple 7 — was revamped to allow improved means for measuring and monitoring CV health to achieve greater health equity, and now includes the entire life course. Metrics include health behaviors like diet, physical activity, nicotine exposure and sleep, and health factors like body weight, lipids, blood glucose and BP. A person’s overall CV health score, which can range from 0 to 100, is the unweighted average of the eight component metric scores.
The researchers found that 19.6% of U.S. adults had “high” CV health; 62.5% had “moderate” and 17.9% had “low” CV health. Adult women had higher average CV health scores of 67, compared with men who had an average score of 62.5.
The algorithm was published as a presidential advisory in Circulation.
"These data represent the first look at the cardiovascular health of the U.S. population using the AHA's new Life’s Essential 8 scoring algorithm,” Donald M. Lloyd-Jones, MD, ScM, FAHA, president of the AHA and chair of the department of preventive medicine at Northwestern University Feinberg School of Medicine, said in a press release. “Overall, the cardiovascular health of the U.S. population is suboptimal, and we see important differences across age and sociodemographic groups. Analyses like this can help policymakers, communities, clinicians and the public to understand the opportunities to intervene to improve and maintain optimal cardiovascular health across the life course.”
A ‘need to reevaluate’
The concept of CV health was introduced for the first time as Life’s Simple 7 in 2010 and during the last 12 years, with more experience and knowledge, Life’s Simple 7 was adopted widely, according to Garima V. Sharma, MD, FACC, FACP, assistant professor of medicine and director of the cardio-obstetrics program at Johns Hopkins University School of Medicine and a Cardiology Today Editorial Board Member.
“It has been well validated and studied and seems to predict CVD outcomes; however, we have gained knowledge of some other factors such as mental health, sleep and social determinants of health that have also been associated with suboptimal CV health,” Sharma, also a co-author of the new algorithm, told Healio. “There was a need to reevaluate the definition and improve the metric by adding to it. It should be noted that sleep health is also known to be associated with poor mental health and social determinants of health, important drivers of adverse CV health.”
Sleep as new component
Epidemiological studies have identified poor habitual sleep as a risk factor for all-cause mortality and subsequent research has explored potential mechanisms, including implications for cardiometabolic health, the researchers wrote.
“Population-level studies have shown that inappropriate sleep duration (either shorter or longer than ideal) is associated with coronary heart disease,” the researchers wrote. “Sleep duration is associated with each of the original seven components of CV health and with overall CV health score. Recent trends toward decreased sleep health in the population appear to account for some of the variance in changing cardiometabolic risk prevalence.”
The updated algorithm assesses self-reported average hours of sleep at night, with the highest score for an average of 7 to 9 hours per night, and suggests considering sleep or actigraphy data from wearable technology if available.
“Recent evidence suggests that sleep metrics add independent predictive value for CVD events over and above the original seven CV health metrics,” the researchers wrote. “It should be noted that poor sleep health is also known to be associated with poor psychological health and social determinants of health, important contextual drivers of CV health; therefore, for some individuals, sleep health assessment and intervention may require customized approaches that consider the surrounding context.”
Changes to the existing seven metrics include that diet is measured by adherence to the Dietary Approaches to Stop Hypertension (DASH) eating pattern at the population level and the Mediterranean Eating Pattern for Americans (MEPA) at the individual level; cigarette smoking is replaced by nicotine exposure to capture vaping and exposure to secondhand smoke; non-HDL is now the cholesterol metric instead of total cholesterol; and the blood sugar metric now includes HbA1c levels.
Implementing metrics in diverse groups
The Life’s Essential 8 algorithm also updated some of the previous version’s metrics to be more sensitive to differences among groups of people, the researchers wrote. In adults, overall CV health is calculated for each individual by summing the scores for each of the eight metrics together and dividing the total by 8, to provide a Life’s Essential 8 score ranging from 0 to 100. Overall scores below 50 indicate “low,” 50 to 79 indicate “moderate” and scores of 80 and above indicate “high” CV health.
The researchers found that Asian Americans had a higher average CV health score compared with other race groups. Non-Hispanic white people had the second highest average CV health score, followed by Hispanic (other than Mexican), Mexican and Black individuals.
The researchers noted that universal efforts and tailored, culturally appropriate methods will be needed to direct individuals to resources for improving or maintaining CV health, potentially ameliorating the negative impacts of social determinants of health and psychological health and promoting positive social and psychological assets.
“Cardiologists need to take every opportunity to educate their patients and empower them with the new knowledge,” Sharma told Healio. “If we don’t ask about these metrics, we cannot assess them. If we do not assess them, then we cannot provide any guidance to mitigate their effects. Awareness, education and patient empowerment is the key. We also need to ask about mental health and basic information on social determinants of health. Listen to your patients.”
For more information:
Garima V. Sharma, MD, FACC, FACP, can be reached at gsharma8@jhmi.edu.
Perspective
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Joshua Shatzkes, MD, MS
This AHA statement is recognizing the importance of sleep itself as well as how sleep connects to all of the other health markers included in the updated “Essential 8.” For example, a person who is not getting as much sleep tends to feel more tired during the day — they may have less healthy dietary habits to maintain their energy during the day; less motivation and time to exercise. Poor sleep habits are also often associated with stress, which can lead to less heart-healthy behaviors. Sleep apnea is an example of an actual sleep disorder that is associated with cardiovascular problems such as hypertension and coronary artery disease.
This checklist provides a list of things people can do to improve CV health that do not require a doctor. However, social determinants of health affect the ability to control those things. It is wonderful to want to eat a diet rich in fruits, vegetables and whole grains; however, those foods are not always readily available or affordable to everyone. It’s easy to tell a patient to exercise but many people don’t have the time or opportunity to spare. We as cardiologists must recognize that our job is not just to take care of a person’s health. How can we help patients beyond prescribing a therapy? This brings a much larger conversation to the forefront about what the medical community should be doing for patients. This checklist, and raising social awareness, shows we have a responsibility to teach our patients about heart-healthy behaviors and help them find the solutions to achieve them.
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