Life's Essential 8: Updating and Enhancing the American Heart Association's Construct of Cardiovascular Health: A Presidential Advisory From the American Heart Association

Abstract

In 2010, the American Heart Association defined a novel construct of cardiovascular health to promote a paradigm shift from a focus solely on disease treatment to one inclusive of positive health promotion and preservation across the life course in populations and individuals. Extensive subsequent evidence has provided insights into strengths and limitations of the original approach to defining and quantifying cardiovascular health. In response, the American Heart Association convened a writing group to recommend enhancements and updates. The definition and quantification of each of the original metrics (Life's Simple 7) were evaluated for responsiveness to interindividual variation and intraindividual change. New metrics were considered, and the age spectrum was expanded to include the entire life course. The foundational contexts of social determinants of health and psychological health were addressed as crucial factors in optimizing and preserving cardiovascular health. This presidential advisory introduces an enhanced approach to assessing cardiovascular health: Life's Essential 8. The components of Life's Essential 8 include diet (updated), physical activity, nicotine exposure (updated), sleep health (new), body mass index, blood lipids (updated), blood glucose (updated), and blood pressure. Each metric has a new scoring algorithm ranging from 0 to 100 points, allowing generation of a new composite cardiovascular health score (the unweighted average of all components) that also varies from 0 to 100 points. Methods for implementing cardiovascular health assessment and longitudinal monitoring are discussed, as are potential data sources and tools to promote widespread adoption in policy, public health, clinical, institutional, and community settings.

Keywords: AHA Scientific Statements; health promotion; healthy lifestyle; life change events; public health; social determinants of health.

Figure 1.. Life’s Essential 8.

Life’s Essential 8 includes the 8 components of cardiovascular health: healthy diet, participation in physical activity, avoidance of nicotine, healthy sleep, healthy weight, and healthy levels of blood lipids, blood glucose, and blood pressure.

Figure 2.. The foundational context of CVH.

As depicted in the social-ecological model in the base of the figure 8, a variety of socioeconomic and structural determinants of health provide the foundational framework that affects an individual’s or a community’s ability to optimize cardiovascular health (CVH). Several interacting factors provide critical context for CVH, including structures and systems (general socioeconomic, cultural, and environmental conditions), community resources (ie, education, agriculture, food production, employment, water and sanitation, health care, and housing), institutions and organizations (in which people learn, grow, eat, sleep, play, and pray), interpersonal social and community networks, and individual genetic and behavioral factors. These foundational social-ecological factors work through and alongside an individual’s psychological health (represented at the top of the 8 in the figure) to provide the context for what is possible in improving or maintaining CVH. There is a continuous interplay of brain-mind-heart-body connections that can positively and negatively affect CVH, which is represented by the 8 component metrics (diet, physical activity, nicotine exposure, sleep, body mass index, blood lipids, blood glucose, and blood pressure) as interacting gears.

Figure 3.. Example presentation of CVH score.

The figure provides an example of how to represent an individual’s cardiovascular health (CVH) assessment with the new Life’s Essential 8. The gauge at the top corresponds to the individual’s overall CVH score (which can range from 0–100 points), with higher scores shown toward the right (a “full tank” of CVH) in green. The individual’s status for each of the 8 component metrics is shown below, thus identifying health behaviors and risk factors on which the individual can focus to achieve and maintain a full tank of overall CVH. The overall CVH score is the unweighted average of the 8 component metric scores.

Figure 4.. Life course of CVH.

The figure describes sensitive periods and transitions for cardiovascular health (CVH) across the life span, along with example opportunities for intervention to preserve or promote CVH at each age or stage. Opportunities to improve CVH occur across public health and policy, institutional, neighborhood- and community-level, and clinical contexts. Red arrow indicates the feedback loop of primordial prevention strategies that can maintain CVH through early life, leading to healthier parents before conception and a subsequent generation of healthier children.