Top Things to Know: Life’s Essential Eight: Updating and Enhancing the American Heart Association’s Cardiovascular Health Construct
Published: June 29, 2022
Prepared by Radhika Rajgopal Singh, PhD, Sr VP Science and Medicine
- This Presidential Advisory presents a substantial update to the CVH construct, both in its definition and its measurement, to address the current context of public health and assist AHA and its partners in efforts to achieve greater health equity by promoting better CVH for all.
- Since 2010, there has been extensive evidence published on the prevalence, trends, outcomes, determinants, and mechanisms of CVH, necessitating a formal review and update of the original construct in light of lessons learned.
- Numerous studies have demonstrated that achievement and maintenance of high CVH, and improvement in CVH over time, are associated with substantially lower risks of cardiovascular disease (CVD), cancer, dementia, and numerous other chronic diseases of aging, as well as improved quality of life and greater healthy longevity. Psychological and social determinants of CVH provide critically important context for the ability of an individual or population to optimize their CVH.
- The Advisory provides six key reasons that support the updating and enhancement of the CVH construct from Life’s Simple Seven to Life’s Essential Eight. These include: (i) newer definitions and metrics for CVH components will provide credit for a broader range of health in each CVH component ; (ii) newer metrics will be more sensitive to inter-individual differences and intra-individual changes over time; (iii) updated metrics allow for more effective quantification and prediction of future risk for CVD and other health outcomes across the life course; (iv) updated metrics will promote CVH assessment in clinical practice and communities, and better inform targeted interventions to improve CVH; (v) the current evidence and availability of more reliable assessment now allow sleep to be included as an eighth metric in the CVH construct; and (vi) greater acknowledgment of the critically important context of social determinants of health (SDOH) and psychological health will catalyze broader policy discussions to accelerate change.
- Sleep health, defined initially as sleep duration, was added as an eighth metric to the formal definition of CVH given the strong evidence of sleep’s impact on CVD, the ease and increasing reliability of sleep measurement, and its comparable and independent contributions to overall and cardiometabolic health and health outcomes.
- Several of the original seven metrics have been redefined for consistency with newer clinical guidelines, to better represent their biological impact, or for compatibility with new measurement tools. These include changes to assessing diet, nicotine exposure, sleep health, blood lipids, and blood glucose, and an updated scoring system for all metrics, including physical activity, body weight and blood pressure.
- The Advisory provides specific directions on how to quantify CVH for each component metric, ranging on a scale of 0 to 100. In addition, a composite CVH score, also ranging from 0 to 100, can represent an individual’s or a population’s overall CVH status currently and over time. These scoring instructions will help app developers, health systems, and policy makers to incorporate the CVH construct into research, clinical/electronic health record, and public health settings for widespread implementation.
- The Advisory recommends that NHANES remains the main data source for tracking the US population’s CVH over time, with focused efforts to optimize other data sources, such as electronic health records and health information exchanges and leveraging data science and informatics. Newer health technology platforms and wearable devices offer the possibility of monitoring CVH across an individual’s lifespan as well as for population surveillance.
- Selected examples of successful and promising strategies across the social-ecological model are presented that, when taken together, can serve as roadmaps for the future development and translation of SDOH-informed, equitable solutions to ensure attainment of CVH equity for diverse populations. Implementing the CVH metric in clinical care is also discussed in detail.
- With this new measurement tool for CVH, AHA and its numerous multi-sector partners in schools, communities, government, health care, business, and beyond, have new opportunities to impact CVH by raising awareness of its importance, promoting platforms for its measurement, funding research on interventions, and disseminating successful strategies.
Citation
Lloyd-Jones DM, Allen NB, Anderson CAM, Black T, Brewer LC, Foraker RE, Grandner MA, Lavretsky H, Perak AM, Sharma G, Rosamond W; on behalf of the American Heart Association. Life’s essential 8: updating and enhancing the American Heart Association’s construct of cardiovascular health: a presidential advisory from the American Heart Association [published online ahead of print June 29, 2022]. Circulation. doi: 10.1161/CIR.0000000000001078