American Heart Association Debuts Life's Essential 8, Adds Sleep to Life's Simple 7

Donald Lloyd-Jones, MD, ScM

Goodbye Life’s Simple 7™ and hello Life’s Essential 8™. The American Heart Association (AHA) has announced a new addition to its list of essential components for ideal health and brain health: Sleep.

Announced on June 29, Life’s Essential 8, which also includes updates to the sections pertaining to diet, lipids, and more, was debuted in a new Presidential Advisory and can be assessed using the My Life Check tool created by the AHA.

“Life’s Essential 8™ is a major step forward in our ability to identify when cardiovascular health can be preserved and when it is sub-optimal. It should energize efforts to improve cardiovascular health for all people and at every life stage,” said American Heart Association President Donald M. Lloyd-Jones, MD, ScM, FAHA, AHA president and chair of the department of preventive medicine and professor of preventive medicine, medicine and pediatrics at Northwestern University’s Feinberg School of Medicine, in a statement from the AHA.

Created in 2010, Life’s Simple 7 was the AHA’s attempt to defined ideal cardiovascular health based on risk factors patient can improve through lifestyle changes. As more data has emerged regarding optimal cardiovascular health, a volunteer writing group was composed to address this growing knowledge base. At 26 pages in length, the presidential advisory was prepared by Lloyd-Jones and a volunteer writing group that included Norrina B. Allen, PhD, MPH, Cheryl A. M. Anderson, PhD, MPH, MS, Terrie Black, DNP, MBA, CRRN, LaPrincess C. Brewer, MD, MPH, Randi E. Foraker, PhD, MA, Michael A. Grandner, PhD, MTR, Helen Lavretsky, MD, MS, Amanda Marma Perak, MD, MS, Garima Sharma, MD, and Wayne Rosamond, PhD, MS.

The new section on sleep outlines the ideal level at 7-9 hours daily for adults and also provides ideal sleep ranges for children, which ranges from 10-16 hours per 25 hours among children 5 and younger, 9-12 hours for those aged 6-12 years, and 8-10 hours for those aged 13-18 years. In addition to the section outlining sleep, the presidential advisory also includes a new scoring algorithm ranging from 0-100 points to allow for creation of a composite cardiovascular health score.

As part of their debut of Life’s Essential 8™, the AHA also updated 4 of the items included in Life’s Simple 7™ to reflect new information, with the sections for diet, cigarette smoking, blood lipids, and blood glucose all receiving updates and the sections dedicated to physical activity, BMI, and blood pressure undergoing no changes.

Updated Sections in Life’s Essential 8™:

Diet

• Updates to the section pertaining to diet include a new guide to assess diet quality for adults and children at an individual and population level. At the population level, dietary assessment is based on the DASH eating patterns. At the individual level, MEPA eating pattern is used to assess and monitor cardiovascular health.

Nicotine exposure

• With the increased popularity of inhaled nicotine-delivery systems, updates to this section include renaming of the section, with nicotine exposure replacing cigarette smoking to include electronic cigarettes (vaping) and exposure to secondhand smoke.

Blood Lipids

• The metric for blood lipids is updated to use non-HDL cholesterol as the preferred number to monitor rather than total cholesterol. Authors noted this shift is due to the ability to measure non-HDL cholesterol without fasting beforehand and can be reliably calculated across patient groups.

Blood Glucose

• This metric has been updated to allow the inclusion of HbA1c reading or blood glucose levels in those with or without type 1 or type 2 diabetes or predates. The writing group noted HbA1c and better reflect long-term glycemic control.

“The new metric of sleep duration reflects the latest research findings: sleep impacts overall health, and people who have healthier sleep patterns manage health factors such as weight, blood pressure or risk for type 2 diabetes more effectively,” Lloyd-Jones added. “In addition, advances in ways to measure sleep, such as with wearable devices, now offer people the ability to reliably and routinely monitor their sleep habits at home.”

This AHA presidential advisory, titled “Life’s Essential 8: Updating and Enhancing the American Heart Association’s Construct of Cardiovascular Health: A Presidential Advisory From the American Heart Association,” was published in Circulation.