AHA guidelines for 'Life's Essential 8': Metrics to predict longevity

By Carol Nathan | Fact-checked by Barbara Bekiesz
Published February 6, 2024

Key Takeaways

  • The American Heart Association's “Life’s Essential 8” describes the eight components that contribute to cardiovascular health. 

  • The “Essential 8” include health behaviors, such as diet and activity, as well as health factors, such as BMI and blood pressure, among other factors.

  • The advisory provides guidance to clinicians on how to help patients incorporate positive measures into daily life, with recommendations for monitoring and measuring the patient's status.

A presidential advisory from the American Heart Association (AHA) announces “Life’s Essential 8,” which describes the eight components that contribute to cardiovascular (CV) health.[] This advisory is an update from the 2010 version, which only included seven components, and reflects new evidence accumulated since the 2010 publication.

The eight components of CV health in the advisory are divided into “health behaviors” and “health factors.”

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.

This includes a high intake of fruits, vegetables, nuts and legumes, whole grains, and low-fat dairy, and a low intake of sodium, red and processed meats, and sweet beverages. 

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.[]

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.[] 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.

However, the advisory notes that BMI ranges and health risks may differ among patients, depending on their racial or ethnic background.

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.

This recommendation is based on the fact that non-HDL cholesterol can be measured without the need for patients to fast, meaning it is reliable regardless of when a patient’s appointment is scheduled.

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 advisory suggests discussing these metrics with patients in a positive manner, explaining that optimal CV health benefits everyone.

The AHA has created patient-friendly PDFs[] 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. 

What this means for you

The new advisory is a substantial update from the 2010 version, and all clinicians can find value in incorporating these new concepts into clinical practice. Improved CV health is known to contribute to lower risk of heart disease, stroke, and other major health problems.

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