Sleep essential for heart health, in addition to 7 other key factors

Proper sleep is essential, and a widely used scoring system for heart and brain health is being redefined to reflect that.

Since 2010, the American Heart Association had said seven modifiable components — maintaining a healthy weight, not smoking, being physically active, eating a healthy diet and controlling blood pressure, cholesterol and blood sugar — were key to ideal cardiovascular health.

Those components, dubbed Life’s Simple 7, became a common way to rate and discuss heart and brain health.

Now, the American Heart Association has added sleep duration to a revised scoring tool, now called Life’s Essential 8, published as an advisory in the journal Circulation.

The update is about much more than adding sleep, said Dr. Donald Lloyd-Jones, a cardiologist and epidemiologist who chairs the department of preventive medicine at Northwestern University Feinberg School of Medicine and who, as the heart association’s president, led the expert panel that wrote the advisory.

American Heart Association

The new score incorporates 12 years of research and enhances its evaluation of diet, exercise and more, Lloyd-Jones said.

“We’re hoping that this will, in fact, be a moment of empowerment, a moment of optimism for people to think positively about their health,” Lloyd-Jones said.

Adults should average seven to nine hours of sleep a night, the advisory says. For children, the amount varies by age.

Lloyd-Jones, who led the creation of the original seven categories in 2010, said sleep’s importance was clear even then. But it was difficult to agree on how to score it because sleep information wasn’t being collected in large national databases.

“Now, it is,” Lloyd-Jones said, and “the science has shown us how sleep is part and parcel of cardiovascular health.”

The advisory says too much sleep and too little sleep both are associated with heart disease and that poor sleep health is linked to poor psychological health, an important driver of heart disease.

“And, of course, sleep affects all the other seven metrics here as well,” Lloyd-Jones said.

Cheryl Anderson, dean of the Herbert Wertheim School of Public Health and Human Longevity Science at the University of California San Diego, called Life’s Essential 8 “a big deal” both for health care professionals and people who want to understand their cardiovascular health.

Anderson, who co-wrote the advisory, said the update is “a really good recognition of how science has changed and our ability to adapt according to the changes.”

The revisions introduce a 100-point measure of heart health, which can be taken online at www.heart.org/lifes8. The new score replaces a 14-point scale and tweaks several of the original categories.

On smoking, for example, the old measure considered only traditional cigarette use. The new score includes nicotine use and exposure from e-cigarettes as well as the effects of secondhand exposure.

The new score also shifts from emphasizing total cholesterol toward measuring non-HDL cholesterol. It’s now calculated by subtracting “good” HDL cholesterol from total cholesterol, leaving a measurement of the “bad” types of cholesterol.

The new tool also expands how blood glucose can be evaluated.

The system allows for a more precise evaluation of exercise levels, Lloyd-Jones said. And it looks at diet in a new way.

“Before, we had five very clunky yes-or-no metrics to say whether someone had a healthy diet or not,” Lloyd-Jones said. “And that wasn’t really appropriate for all different types of eating patterns and cultures.”

Anderson said the new diet component rates how closely someone follows a Dietary Approaches to Stop Hypertension, or DASH, type of diet.

But although the measure broadens the foods evaluated, people shouldn’t focus on any single item, Anderson said.

Some key components of heart health, such as stress, aren’t part of the new score.

“Stress is real,” Lloyd-Jones said. “It’s an important part of all of our lives. But it’s hard to measure how we internalize that stress and what the effect is on our health status.”

The advisory discusses the importance of psychological health and the societal and environmental factors known as the social determinants of health, which include access to healthy food, medical care and a safe place to exercise. Lloyd-Jones called them “foundational” for heart health but said such factors couldn’t be boiled down to fit the scoring system.

Good heart health begins with talking with a doctor to know how you’re doing in all eight categories, Lloyd-Jones said. Improvement in any of them helps.

“The data show us that picking and improving one thing will actually have a measurable impact on improving your health and improving your health outcomes,” Lloyd-Jones said. “It doesn’t really matter which one you pick. Pick the one that you’re going to succeed on. And that’s the way to move your cardiovascular health forward.”