Sleep added to American Heart Association’s list of heart disease health factors

In 2010, the American Heart Association (AHA) defined “Life’s Simple 7TM,” the seven health behaviors and factors people can improve to help achieve optimal cardiovascular health. And now they’re adding an eighth: sleep.

“Sleep is related to every single one of the other seven elements-it’s closely tied to weight, blood pressure, glucose metabolism, what we choose to eat,” said AHA president Dr. Donald Lloyd-Jones, chair of the department of preventive health at Northwestern University Feinberg School of Medicine. “But sleep is both correlated and also independent. There’s newer research that shows when we take the old seven and add sleep, we can predict cardiovascular disease and stroke even better.”

Now called “Life’s Essential 8TM,” the full list of the AHA’s important health factors includes blood pressure management, cholesterol control, blood sugar reduction, maintaining a healthy weight, increased physical activity, healthier eating, avoiding nicotine in all forms and now sleep duration.

Although some individuals have a harder time modifying their sleep hygiene, such as those working two jobs or on the night shift, Lloyd-Jones said an important contributor to better cardiovascular health is focusing on ways to get the healthiest amount of sleep (seven to nine hours a night on average) by avoiding caffeine, screens and bright light for several hours before bedtime, putting away your phone and creating a more regular schedule.

A paper on Life’s Essential 8 and the status of cardiovascular health in U.S. adults and children will be published June 29 in Circulation, the flagship journal of the AHA.

‘Healthier kids become healthier adults’

A key focus of the re-invigorated list of risk factors is the importance of measuring and monitoring children’s cardiovascular health and learning how to maintain it as they age, Lloyd-Jones said.

“When we create healthier kids, they become healthier adults who then go on to have healthier pregnancies, and the benefits continue with their kids being healthier simply because their parents were healthier,” Lloyd-Jones said. “We get this virtuous cycle of improvement of cardiovascular health generation by generation.”

Additional research published online in Circulation at the same time evaluated the cardiovascular health of U.S. children and adults. Those results showed that as U.S. children ages 2 to 5 grew into the 12- to 19-year-old age group, the healthy diet score fell markedly from 61 to 28 (out of 100 possible points).

“We’re losing a lot of cardiovascular health in the eating patterns as our kids age into later childhood and adolescence,” Lloyd-Jones said. “That doesn’t have to be, but we’re not serving them well…pun intended.”

He said school food programs focused on healthier eating, improving the health of our food supply, helping children choose water over sugary drinks and taxing sugar-sweetened beverages are proven strategies the U.S. can be taking to maintain and improve cardiovascular health in children.

2,500 scientific papers since 2010

The introduction of “Life’s Simple 7” in 2010 was novel, Lloyd-Jones said.

“No one had really tried to quantify health as a concept before that, and it’s been transformative for public health advocacy and for individuals to think about their long-term health,” said Lloyd-Jones, who also is a Northwestern Medicine cardiologist.

Since 2010, more than 2,500 scientific papers have been published about the AHA’s cardiovascular health construct and what it means for improving lifelong health.

“We’ve learned a ton about how important it is to have higher cardiovascular health at every stage of life,” he said. “It affects your risk of stroke, heart attack, cancer, dementia, cognitive functioning, pretty much everything we care about.”

This “cutting-edge research” has paved the way for adding the eighth element of sleep.

More sensitive tools to measure heart health

Also, since 2010 scientists have developed more sensitive tools to determine a person’s cardiovascular health, such as better questionnaires that measure eating patterns in different populations (i.e. the DASH diet versus the Mediterranean diet), Lloyd-Jones said. The new scoring system, he explained, will also better give credit to people who are working to improve their cardiovascular health-something the old scoring system did not do well.

Two elements that affect cardiovascular health are not included in the measurement system: social determinants of health and psychological health characteristics such as optimism, purpose in life, environmental mastery, perceived reward from social roles and resilient coping. Scientists also now know more about how social determinants of health (education, neighborhood environment, community, economic security, access to health care) can affect people’s opportunity for better cardiovascular health. Lloyd-Jones said while policymakers, clinicians and individuals should be mindful of these elements, they’re difficult to quantify and are, therefore, not part of the list of Life’s Essential 8.

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