[NOTE: This article has been posted prior to peer review for use in an active research program. This content will be updated with a peer reviewed version as soon as it is available.]
The American Heart Association (AHA) has created a quantitative assessment of cardiovascular health metrics based on Life’s Essential 8 (LE8).1 The individual areas of are each scored from 0-100 and aggregated to an overall cardiovascular health score graded from 0-100.
These LE8 scores provide a comprehensive assessment of cardiovascular health with higher scores linked to improved physiological outcomes.1 LE8 scores have been found to improve lung function, with a 10-point increase in LE8 (on the 100-point scale) associated with an increase of 50 mL in first second of forced expiration (FEV1).2 This association is furthered by improvements in non-smoking status, good sleep health, sufficient physical activity, and optimal blood glucose levels.3 With improvements in individual health risk factors, the LE8 score can help in improving cardiovascular and chronic disease health, such as COPD.
Diet (DASH)
The Dietary Approaches to Stop Hypertension (DASH) eating plan emphasizes fruits, vegetable low-fat dairy, whole grains, and nuts. Another goal of the DASH diet is to reduce total and saturated fat, cholesterol, red and processed meats, and added sugars. As indicated by the name, the DASH diet was originally developed to treat hypertension but has shown benefits in lowering Coronary Heart Disease incidence (risk ratio = 0.79) and stroke incidence (risk ratio = 0.81).4 In addition, the DASH diet also has preventive benefits in lung health. Higher compliance with DASH diet is associated with lower risk of Chronic Obstructive Pulmonary Disease, COPD (odds ratio: 0.82; 95% CI: 0.68–0.98; P = 0.033).5
Physical Activity
US Department of Health and Human Services defines sufficient physical activity as at least 150 minutes of moderate-to-vigorous intensity aerobic physical activity for adults.6 A longitudinal study of 12,201 older Australian men found that higher percentage of physically active participants had lower hazard of death after 11 years (28.3% vs 40.5%) and were able to live without mood, functional, or cognitive impairment (34.9% vs 26.8%).7
Smoking Cessation
Compiling data from registries from United States, United Kingdom, Norway, and Canada between 1974 and 2018, a study found that nonsmokers had better survival compared with those who smoked (12 years less in women and 13 years less in men).8 Compared with never smokers, respiratory disease (hazard ratio 6.3 in men, 7.6 in women), vascular disease (2.9 in men, 3.1 in women) and cancer (3.1 in men, 2.8 in women) were more likely to be causes of death. Respiratory disease was the cause of death in 1562 never smokers, 4222 current smokers, and 2036 former smokers. Additionally, the hazard ratio for overall mortality for former versus never smokers (1.3) was half the corresponding hazard ratio for current smokers (2.7).
Sleep Health
Nation Sleep Foundation recommend 7 to 9 hours of sleep for young adults and adults and 7 to 8 hours of sleep for older adults.9 Improvements in sleep were linked to symptom improvement and were at a reduced risk for future exacerbations.10 Patients experienced weakened sleep and insomnia were associated with higher rates of outpatient visits, hospitalizations, and fills for corticosteroids, longer hospital length of stay, and $10,344 higher hospitalization costs in the 12 months after index date.11
Body Mass Index (BMI)
BMI is calculated by dividing body weight (kg) by height (m2). Maintaining a body weight of less than 25 kg/m2 is considered healthy. A health survey study in Norway found that each 5% increase in body weight is associated with approximately 20-30% higher risk of hypertension.12 Higher BMI can be associated with conditions like diabetes, gallstones, and breathing problems.13-15
Blood Lipid
There are two main types of cholesterol, or lipids, that clinicians test for: high-density lipoprotein (HDL) and low-density lipoprotein (LDL). American Heart Association calculates blood lipid as fasting plasma total cholesterol subtracted by HDL cholesterol. The difference is non-HDL cholesterol (mg/dL). A meta-analysis identified that higher total and HDL-C cholesterol and CVD mortality is a linear association (pooled HR (95% CI) was 1.27 (95% CI, 1.19–1.36) for total cholesterol, 1.21 (95% CI, 1.09–1.35) for low-density lipoprotein cholesterol (LDL-C), and 0.60 (95% CI, 0.50–0.72).16
Blood Glucose
Blood glucose can be a good indicator of health, and fasting blood glucose of below 100mg/dL is considered healthy.17 A prospective cohort study of over one million Korean adults determined that men and women with blood sugar of 140 mg/dL or greater had higher risk of atherosclerotic cardiovascular (hazard ratio [HR] = 1.75; HR = 1.80).18 Participants with similar blood sugar also had a greater risk of myocardial infarction (men HR = 2.13; women HR = 3.18).
Blood Pressure
Systolic blood pressure measures the pressure of the heart contracting and diastolic blood pressure measures the pressure when the heart is resting between beats. Normal blood pressure is below 120 (systolic) and 80 (diastolic). A meta-analysis found that 10 mmHg reduction in systolic blood pressure is associated with reduced risk of coronary heart disease (relative risk [RR] = 0.83) and all-cause mortality (RR = 0.87).19 High blood pressure, or hypertension, also exacerbates chronic kidney disease.20
Table 1. Life's Essential 8 Cardiovascular Health Score Definitions and Distributions
|
LE8 component
|
Method of measurement
|
Criteria
|
Points
|
|
Diet
|
Harvard food frequency questionnaire; quantiles of DASH score
|
1st–24th percentile DASH
|
0
|
|
25th–49th percentile DASH
|
25
|
|
50th–74th percentile DASH
|
50
|
|
75th–95th percentile DASH
|
80
|
|
≥95th percentile DASH
|
100
|
|
Physical activity
|
Accelerometry measured minutes of moderate or vigorous activity in primary analyses (questionnaire‐based physical activity assessment evaluated in sensitivity analyses)
|
0 min of MPVA per wk
|
0
|
|
1–29 min of MPVA per wk
|
20
|
|
30–59 min of MPVA per wk
|
40
|
|
60–89 min of MPVA per wk
|
60
|
|
90–119 min of MPVA per wk
|
80
|
|
120–149 min of MPVA per wk
|
90
|
|
≥150 min of MPVA per wk
|
100
|
|
Nicotine exposure
|
Self‐reported use of cigarettes or inhaled NDS
|
Current smoker
|
0
|
|
Former smoker, quit <1 y, living with indoor smoker
|
5
|
|
Former smoker, quit <1 y, or using inhaled NDS
|
25
|
|
Former smoker, quit 1–<5 y, living with indoor smoker
|
30
|
|
Former smoker, quit 1–<5 y
|
50
|
|
Former smoker, quit ≥5 y, living with indoor smoker
|
55
|
|
Former smoker, quit ≥5 y
|
75
|
|
Never smoker, living with indoor smoker
|
80
|
|
Never smoker
|
100
|
|
Sleep health
|
Self‐reported hours of sleep per night
|
<4 h
|
0
|
|
4–<5 h
|
20
|
|
5–<6 or >10 h
|
40
|
|
6–<7 h
|
70
|
|
9–<10 h
|
90
|
|
7–<9 h
|
100
|
|
BMI
|
Body weight (kg) divided by height (m2)
|
>40.0 kg/m2
|
0
|
|
35.0–39.9 kg/m2
|
15
|
|
30.0–34.9 kg/m2
|
30
|
|
25.0–29.9 kg/m2
|
70
|
|
<25 kg/m2
|
100
|
|
Blood lipids
|
Plasma total and HDL cholesterol with calculation of non‐HDL cholesterol
|
>220 or 190–219 mg/dL and using medication
|
0
|
|
190–219 or 160–189 mg/dL and using medication
|
20
|
|
160–189 or 130–159 mg/dL and using medication
|
40
|
|
130–159 mg/dL
|
60
|
|
<130 mg/dL and using medication
|
80
|
|
<130 mg/dL
|
100
|
|
Blood glucose*
|
HbA1c (%)
|
Diabetes with HbA1c≥10.0
|
0
|
|
Diabetes with HbA1c 9.0–9.9
|
10
|
|
Diabetes with HbA1c 8.0–8.9
|
20
|
|
Diabetes with HbA1c 7.0–7.9
|
30
|
|
Diabetes with HbA1c<7.0
|
40
|
|
No diabetes and HbA1c 5.7–7
|
60
|
|
No diabetes and HbA1c < 5.7
|
100
|
|
Blood pressure
|
Systolic and diastolic BPs (mm Hg)
|
≥160 or ≥100 mm Hg
|
0
|
|
140–150 or 90–99 mm Hg and using medication
|
5
|
|
140–150 or 90–99 mm Hg
|
25
|
|
130–139 or 80–89 mm Hg and using medication
|
30
|
|
130–139 or 80–89 mm Hg
|
50
|
|
120–129/<90 mm Hg and using medication
|
55
|
|
120–129/<90 mm Hg
|
75
|
|
<120/<80 mm Hg and using medication
|
80
|
|
<120/< 80 mm Hg
|
100
|
|
We defined diabetes as either currently taking diabetes medications or having a history of diabetes. We defined no diabetes as not currently taking diabetes medication and having no history of diabetes. For 60 points, we used “No diabetes and HbA1c 5.7–7” rather than “No diabetes and HbA1c 5.7–6.4” to avoid having individuals who did not fit in any category. BMI indicates body mass index; BPs, blood pressures; DASH, Dietary Approaches to Stop Hypertension; HbA1c, hemoglobin A1c; HDL, high‐density lipoprotein; LE8, Life's Essential 8; MVPA, moderate‐to‐vigorous physical activity; and NDS, nicotine‐delivery system.
|
References
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