The Essential 8: Enhanced advice for a healthy heart

An estimated 80% of all heart attacks and strokes are preventable. Are you doing everything you can to avoid these life-threatening events? An online tool from the American Heart Association (AHA), called My Life Check, can help you find out.

The newly updated tool is based on Life's Essential 8 — the AHA's revamp of its Life's Simple 7 list of heart-healthy practices, created in 2010. The initial seven factors included maintaining a healthy weight, not smoking, being physically active, eating a healthy diet, and keeping blood pressure, blood sugar, and cholesterol at acceptable levels.

"Life's Simple 7 was an important pivot for the AHA because it moved the organization's focus beyond the treatment of cardiovascular disease to include ways to prevent it in the first place," says cardiologist Dr. Elliott Antman, professor of medicine at Harvard Medical School and past president of the AHA. Now, the association has added healthy sleep duration (seven to nine hours per night for adults) to the checklist, based on mounting evidence linking insufficient sleep to a range of cardiovascular-related risks (see "Too little sleep may be hard on your heart" in the August 2022 Heart Letter).

New scores and assessments

The domains of the Essential 8 are scored on a scale of 0 to 100, which are then used to generate a composite cardiovascular health score. To calculate your own score, go to My Life Check at the AHA website (www.mlc.heart.org). The 34-question survey takes just a few minutes to fill out, but you'll need to know your blood pressure, blood sugar, and total and HDL cholesterol values (also see "Score more points for your heart").

You have the option of entering either your fasting blood sugar value or your hemoglobin A1c value. The latter (which doesn't require you to fast) is actually a better measure of blood sugar control because it reflects your average blood sugar over the past three months, Dr. Antman explains. But unless you have diabetes, some primary care physicians don't regularly order this test, so you may need to request it.

Likewise, you may not need to fast before your cholesterol test. That's because the updated metric uses a non-HDL cholesterol measurement. And instead of simply asking if you smoke cigarettes, the new survey also asks about e-cigarettes or vaping devices and about exposure to secondhand smoke.

Finally, the diet assessment was broadened. The questions help determine how close your diet comes to a healthy Mediterranean-style eating pattern, which emphasizes whole, mostly plant-based foods and has been shown to prevent heart attacks and related problems.

Psychological health underlies everything

The details of Life's Essential 8 are described in an AHA Presidential Advisory published Aug. 2, 2022, in Circulation. The advisory also highlights the role of psychological health in cardiovascular disease. In line with this, the Life Check survey features a well-being assessment with questions about mental health, wellness, and social determinants of health.

For example, one question asks how many days per month you feel stressed or depressed. Another delves into potential contributing factors, asking whether you've experienced discrimination or bullying based on your race or ethnicity. Still others focus on social factors, such as whether you have access to high-quality medical care and live in a neighborhood with spaces to exercise safely and buy fresh produce.

As the authors explain, these traits are multidimensional and challenging to measure, which is why they're not included as a formal metric among the Essential 8. "Instead, we can think of these psychological factors as the foundation that underlies all the others," says Dr. Antman.

As an individual person, you can use My Life Check to help identify and improve your own heart health score. But to make real progress population-wide, we need policy changes at local, state, and national levels, Dr. Antman says. Examples include things such as increasing subsidies for healthier, less-processed food and creating accessible, safe places to exercise in parks and community centers.

Illustration courtesy of the American Heart Association