A 2022 presidential advisory from the American Heart Association (AHA) announces “Life’s Essential 8” which describes the eight components that contribute to cardiovascular (CV) health.

Lloyd-Jones DM, Allen NB, Anderson CAM, 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;146(5):e18–e43.

This advisory is an update from the 2010 version, which only included seven components, and reflects new evidence accumulated since the 2010 publication.

 

The health behaviors include diet, physical activity, nicotine exposure, and sleep. The health factors are body mass index (BMI), blood lipids, blood glucose, and blood pressure. The goal is for clinicians to measure and monitor their patients’ status of these eight components, with guidance for this provided by the advisory.

 

The four health behaviors

 

Diet: Assessment of patient dietary quality is based on the daily intake of food in the DASH diet, also known as the Dietary Approaches to Stop Hypertension diet.

Clinicians can measure these factors in patients using the Mediterranean Eating Pattern for Americans (MEPA) tool, which incorporates the DASH diet elements and has 16 yes or no screening questions.

Cerwinske LA, Rasmussen H, Lipson S, et al. Evaluation of a dietary screener: The Mediterranean Eating Pattern for Americans tool. University of Nebraska – Lincoln. Nutrition and Health Sciences – Faculty Publications. 2017.

 

Physical activity: Patient physical activity is measured by how many minutes per week of moderate or vigorous activity in which they engage. The optimal level is 150 minutes for adults, with various modifications for children. 

Nicotine exposure: Exposure to second-hand smoke should be assessed in each patient (both adults and children). In addition to traditional combustible cigarettes, physicians can ask patients about their use of inhaled nicotine-delivery systems, such as e-cigarettes or vaping devices.

Sleep health: Sleep is a new metric introduced in the 2022 advisory, highlighted in the associated press release.

American Heart Association adds sleep to cardiovascular health checklist [press release]. American Heart Association. June 29, 2022.

Sleep health is defined in terms of sleep duration, which is also associated with CV health. The ideal amount of sleep is 7 to 9 hours daily for adults, with longer hours for children, depending on their age group. 

 

 

The four health factors

 

BMI: The advisory notes that BMI is not a perfect metric, but because it is easily calculated and well-known, it is a reasonable gauge to assess if a patient’s weight could lead to health problems. An optimal BMI is 18.5 to 24.9.

This means that a lower BMI might be more beneficial only for some groups.

Blood lipids: This metric uses non-HDL cholesterol as the preferred number to monitor, instead of total cholesterol—an update from the 2010 version.

Blood glucose: As hemoglobin A1c can best reflect long-term glycemic control, the advisory recommends this measurement for people with or without type-1 or type-2 diabetes, or prediabetes.

Blood pressure: Blood pressure criteria in the advisory are based on the AHA 2017 guidelines, which establishes that levels lower than 120/80 mm Hg are optimal, and hypertension is defined as 130 mm Hg to 139 mm Hg for systolic.

 

Implementing Life’s 8 in clinical practice

 

The AHA has created patient-friendly PDFs

Professional Heart Daily. American Heart Association.

that can be printed out and provided to patients for additional guidance.

 

There is also an online heart health scoring tool, as noted in the press release, that clinicians can give to patients. Each component of Life’s Essential 8 has a score ranging from 0 to 100 points in the My Life Check tool. Scores under 50 are considered poor, 50 to 79 is considered moderate, and scores more than 80 indicate good CV health. The AHA recommends measuring these eight metrics in all patients at least every 5 years for optimal results.