Sleep added to American Heart Association’s cardiovascular health checklist

Checklist for heart and brain health now has eight elements: Sleep, diet, nicotine exposure, exercise, weight, blood pressure, blood sugar and cholesterol.

By Michelle Ouellette, MD, FACC, FSCAI, Catholic Medical Center
American Heart Association New Hampshire Board President

At CMC’s New England Heart & Vascular Institute, we are passionate about heart disease. Cardiovascular disease (CVD) is the number one cause of death in the U.S. and globally. According to the American Heart Association’s 2022 Heart Disease and Stroke Statistics Update, approximately 121.5 million people in the U.S. have high blood pressure, 100 million have obesity, and more than 28 million people have type 2 diabetes.

Healthy lifestyle and management of known cardiovascular risk factors may prevent the majority of cardiovascular events. Many of you are familiar with the American Heart Association’s “Life’s Simple 7”, aimed at targeting important health and lifestyle factors that influence cardiovascular wellness; nicotine exposure, physical activity, diet, weight, blood glucose, cholesterol and blood pressure.

This year the American Heart Association (AHA) has added a new metric to the essentials – sleep. The new sleep metric suggests 7 to 9 hours of sleep daily for optimal cardiovascular health for adults and more for children depending on age. People who achieve less optimal sleep patterns have been observed to have higher cardiovascular risk scores – which correlate to high risk of cardiovascular events. Sleep also affects other parts of our health such as hunger control, energy levels and mood.

The updated checklist scoring can now be used for people ages 2 and older, and four components are measured in new ways: a guide to assess diet; nicotine exposure replaces cigarette smoking to include electronic cigarettes (vaping) and exposure to secondhand smoke; non-HDL cholesterol is suggested instead of total cholesterol; and the blood sugar measure is expanded to include hemoglobin A1c levels.

Life’s Essential 8™ is assessed by the My Life Check online tool. This updated scoring system gives users up to 100 points based on measures of each health and lifestyle factor.

I encourage you to learn more here and find out your risk for cardiovascular disease and how to prevent it. Working with you physician, you can reduce your risk and have a longer, healthier life.

Life’s Essential 8™ includes:

1. Diet (updated): A new guide to assess diet quality for adults and children at the individual level (for individual health care and dietary counseling) and at the population level (for research and public health purposes).

  • At the population level, dietary assessment is based on daily intake of elements in the Dietary Approaches to Stop Hypertension (DASH) eating pattern. The DASH-style diet score has eight components: high intake of fruits, vegetables, nuts and legumes, whole grains, low-fat dairy, and low intake of sodium, red and processed meats, and sweetened drinks.
  • For individuals, the Mediterranean Eating Pattern for Americans (MEPA) is used to assess and monitor cardiovascular health. The MEPA is a DASH-style eating pattern that can be measured with 16 yes or no questions about the weekly frequency of eating olive oil, vegetables, berries, meat, fish, dairy, grains, etc.

2. Physical activity (no changes): Activity is measured by the total number of minutes of moderate or vigorous physical activity per week. The optimal level is 150 minutes of moderate physical activity or more per week or 75 minutes per week of vigorous-intensity physical activity for adults; 420 minutes or more per week for children ages 6 and older; and age-specific modifications for younger children.

3. Nicotine exposure (updated): This metric now includes use of inhaled nicotine-delivery systems, which includes e-cigarettes or vaping devices, in addition to traditional, combustible cigarettes. This reflects the implications on long-term health for both adults and youth. Life’s Essential 8™ also includes second-hand smoke exposure for children and adults.

4. Sleep duration (new): Sleep duration is associated with cardiovascular health. Measured by average hours of sleep per night, the ideal level is 7-9 hours daily for adults. Ideal daily sleep ranges for children are 10-16 hours per 24 hours for ages 5 and younger; 9-12 hours for ages 6-12 years; and 8-10 hours for ages 13-18 years.

5. Body mass index (no changes): While body mass index (BMI) is an imperfect metric, it is easily calculated and widely available; therefore, BMI continues as a reasonable gauge to assess weight categories that may lead to health problems. BMI of 18.5–24.9 is associated with the highest levels of cardiovascular health. It should be noted that BMI ranges and the subsequent health risks associated with them may differ among people from diverse racial or ethnic backgrounds or ancestry. This aligns with the World Health Organization’s recommendations to adjust BMI ranges for people of Asian or Pacific Islander ancestry because recent evidence indicates their risk of conditions such as CVD or type 2 diabetes is higher at a lower BMI.

6. Blood lipids (updated): The metric for blood lipids (cholesterol and triglycerides) is updated to use non-HDL cholesterol as the preferred number to monitor, rather than total cholesterol. HDL is the “good” cholesterol. Other forms of cholesterol, when high, are linked to CVD risk. This shift is made because non-HDL cholesterol can be measured without fasting beforehand (making a blood sample easier to obtain) and reliably calculated among all people.

7. Blood glucose (updated): This metric is expanded to include the option of hemoglobin A1c readings or blood glucose levels for people with or without type 1 or type 2 diabetes or prediabetes. Hemoglobin A1c can better reflect long-term glycemic control.

8. Blood pressure (no changes): Blood pressure criteria remain unchanged from the Association’s 2017 guidelines that established levels less than 120/80 mm Hg as optimal, and hypertension defined as 130-139 mm Hg systolic pressure (the top number in a reading) or 80-89 mm Hg diastolic pressure (bottom number).

For more information, visit  Life’s Essential 8™ and use the My Life Check online tool to assess your own heart health and better understand your risk for heart disease and stroke.