Sleep duration is essential for heart health, according to new AHA recommendations

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The duration and quality of sleep are essential for cardiovascular health. Photo editing by Steve Kelly; Artur/Getty Images Debate
  • A new advisory released by the American Health Association (AHA) now includes sleep quality as one of the critical factors for optimal heart health.
  • The AHA’s previous advisory released in 2010 consisted of seven heart health assessment factors, including physical activity, smoking, blood sugar, cholesterol levels, body mass index, and blood pressure.
  • Four of the existing factors – diet, smoking, blood lipids and glucose – have been updated to also include nicotine via e-cigarettes and vapes.
  • The advice now also highlights the role of mental health and socio-economic and cultural factors such as racial discrimination in influencing heart health.

Cardiovascular disease (CVD) is the leading cause of death in the United States, accounting for 1 of 4 deaths each year. In particular, adopting healthier lifestyle practices can reduce the risk of CVD by approximately 80%.

A recent AHA Presidential Advisory published in the journal Trafficdescribes 8 lifestyle and health factors called Life’s Essential 8 that may help maintain optimal heart health and prevent cardiovascular disease.

The AHA publishes advisories that highlight the current state of knowledge about heart health and key areas for future research. Such opinions can help inform decision-making by clinicians and the formulation of healthcare guidelines. However, these notices are for informational purposes only and are not guidelines.

An AHA advisory published in 2010 described the construct or concept of cardiovascular health (CVH) to help promote the maintenance of optimal heart health throughout a person’s lifetime. This concept focuses on preventing cardiovascular disease and improving cardiovascular health.

The initial formulation of CVH included seven health factors and behaviors called Life’s Simple 7. These seven components included diet, physical activity levels, exposure to cigarette smoke, body mass index (BMI) , blood cholesterol, blood sugar and cholesterol levels.

According to the threshold values ​​defined by the AHA, an individual’s levels of each of these seven components have been classified as low, intermediate or ideal. An individual with ideal CVH would have ideal levels of all seven components.

Numerous studies conducted since 2010 have shown that people with the ideal CVH had a lower risk of cardiovascular disease. Additionally, studies suggest that optimal cardiovascular health is associated with longer lifespan and better overall health, including less risk of dementia, cancerand kidney disease.

Although these studies emphasize the validity of the CVH construct, scientists and clinicians have encountered some limitations when using the original formulation of CVH.

For example, some of the criteria used to assess CVH were too broad or lacked sensitivity to assess changes in CVH over time. Additionally, the original CVH construct did not include sleep and social factors.

This led the American Health Association to revise the concept of CVH. The new CVH construct includes sleep as the eighth component and is now called Life’s Essential 8.

An important contribution of this new construct is the inclusion of CVH endpoints in children and pregnant women. The new construct also incorporates evidence from studies showing that brain health and CVH are closely linked.

The changes included in the updated CVH build are outlined below.

The original CVH construct described the quantification of the seven health behaviors or factors using the categories of poor, intermediate, or ideal. However, using these categories rather than a continuous scoring system makes the concept less sensitive to changes in an individual’s health over time or to differences between individuals.

For example, the original construct categorizes individuals engaging in moderate to vigorous physical activity for 1–149 minutes as having intermediate levels of physical activity. However, the initial construction of CVH would have classified both individuals who engage in a few minutes of physical activity and those who engage in 149 minutes as having intermediate levels of physical activity.

To address this, the AHA has developed a continuous scale from 0 to 100 to better quantify the levels of each health factor or behavior. The average score of the eight components of health is then used to measure overall cardiovascular health on a scale of 0 to 100.


The 2010 Heart Health Concept focused on intake amounts of five nutrients, including whole grains, fish, fresh fruits and vegetables, sodium levels and sugary drinks. However, sodium or sugar intake can be difficult to track.

Instead, the updated CVH construct focuses on eating whole foods and healthy eating habits.

Additionally, there are cultural differences in eating habits, and the new CVH construct notes that there are several different strategies for achieving healthy eating habits.

The new construct emphasizes the benefits of DASH and Mediterranean-style eating habits, which have been shown to reduce CVD risk.

Blood glucose

The new CVH construct now includes measurements of glycated hemoglobin (HbA1c) as well as blood glucose levels, which were included in the original formulation. Hemoglobin is a protein that allows red blood cells to carry oxygen to different parts of the body.

Glucose can also bind to hemoglobin to form glycated hemoglobin (HbA1c), and HbA1c levels reflect blood sugar levels over the previous 2-3 months.

High HbA1C levels are seen in people with diabetes and are associated with an increased risk of CVD.

The inclusion of HbA1C along with blood glucose levels thus provides a more comprehensive measure of cardiovascular health.

Cholesterol level

The original construct recommended the use of total cholesterol levels to assess CVH. Cholesterol in the blood includes high density lipoproteins (HDL), low density lipoproteins (LDL), very low density lipoproteins (VLDL), and triglycerides.

High levels of HDL are associated with lower cardiovascular risk, whereas no HDL cholesterol, which includes LDL, VLDL and lioprotein (a), is associated with an increased risk of CVD.

Life’s Essential 8 consists of non-HDL levels, instead of total cholesterol, as one of the 8 components to better reflect cardiovascular health.

Nicotine exposure, BMI and blood pressure

The original construct only included cigarette smoking as an indicator of cardiovascular health. The measurement of nicotine exposure has now been expanded to include e-cigarettes, vaping, and exposure to second-hand smoke.

Life’s Essential 8 retained the original definitions of ideal BMI and blood pressure described in Life’s Simple 7. The only change is that these parameters are now rated on a scale of 0 to 100.

The novelty: sleep

Studies have shown that insufficient or excessive sleep is associated with an increased risk of coronary heart disease. Although sleep duration is associated with the seven components included in the original construct, sleep quality can independently predict cardiovascular event risk.

There is also evidence to suggest that altering sleep duration may help modify the risk of cardiovascular disease.

AHA President, Dr. Donald Lloyd-Joneswho led the editorial advisory group, says:

“The new measure of sleep duration reflects the latest research findings: sleep impacts overall health, and people with healthier sleep habits more effectively manage health factors such as weight, blood pressure or risk of type 2 diabetes.”

“Additionally, advances in ways to measure sleep, such as with wearable devices, now provide people with the ability to reliably and regularly monitor their sleep patterns at home,” he adds.

In addition to these eight factors, the new concept also highlights the role of psychological health and social factors in achieving cardiovascular health.

Stress and depression are associated with poor cardiovascular health, most likely due to increased difficulty achieving a high cardiovascular health score, although depression itself can have a direct impact on heart health. In contrast, positive mental health is linked to better cardiovascular health.

Additionally, social factors such as socioeconomic position, racial discrimination, level of education, employment status, social isolation, and access to health care can also impact health. cardiovascular.

“We carefully considered the social determinants of health in our update and determined that more research is needed on these components to establish their measurement and inclusion in the future,” says Dr Lloyd-Jones.

“[S]Social and structural determinants, as well as psychological health and well-being, are critical and fundamental factors in an individual or community’s ability to maintain and improve cardiovascular health.
— Dr. Donald Lloyd-Jones

Dr. Sonia Anand, professor of medicine at McMaster University, noted that the advisory was comprehensive, but some topics should receive more attention.

“The diet is always controversial and very contextual; they rely on US data and measurements, but this also limits the application to the US population. They also mention the importance of considering social factors, including ethnicity and race, as well as diverse backgrounds, and add a call for more research in this area. It is very important and for some, urgent,” she said.

“[The key gaps described by the advisory included information] on population diversity/health equity, [and] this should be emphasized to ensure that funders of research and health promotion engage these communities to work within them to fill these gaps,” she added.

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