Using AHA's Essential 8, New Study Details Need for Optimized Cardiovascular Health in US

Donald Lloyd-Jones, MD, ScM

On the heels of the American Heart Association (AHA)’s debut of Life’s Essential 8, new research using the metric suggests just 1-in-5 individual in the US had scores indicative of optimal heart health.

The first study using the AHA’s new scoring algorithm for measuring cardiovascular health, results of the study, which included data from more than 23,000 adults and children from the National Health and Nutrition Examination Surveys (NHANES), demonstrate the overall cardiovascular health among both adults and children in the US was well below optimal levels and provides potential targets at individual- and population-levels opportunities to preserve and improve cardiovascular health.

"These data represent the first look at the cardiovascular health of the US population using the AHA's new Life's Essential 8 scoring algorithm,” said lead investigator Donald M. Lloyd-Jones, MD, ScM, president of the AHA and chair of the department of preventive medicine at Northwestern University’s Feinberg School of Medicine, in a statement. “Overall, the cardiovascular health of the U.S. population is suboptimal, and we see important differences across age and sociodemographic groups. Analyses like this can help policy makers, communities, clinicians, and the public to understand the opportunities to intervene to improve and maintain optimal cardiovascular health across the life course.”

A revamped version of Life’s Simple 7 with a new section dedicated to sleep’s role in cardiovascular health, Life’s Essential 8 also includes an updated scoring system that allows for grading of individual aspects as well as the creation of a composite score for overall cardiovascular health. The new scoring algorithm allows for 100-point scores at each level of the original 14-point score in adults included in Life’s Simple 7. Spurred by the creation of Life’s Essential 8, the current study was designed by investigators to assess current trends in cardiovascular health among patients in the US using the updated metric.

To do so, the study was designed as a cross-sectional analysis of data from the NHANES survey cycles occurring from 2013-2018. Using this as a data source, investigators identified 13,521 adults and 9,888 children for inclusion in their analyses, which was representative of 201,728,000 adults and 74,435,000 children, respectively. The overall mean cardiovascular health score among the analytic cohort was 64.7 (95% CI, 63.9-65.6) among adults using all 8 metrics and 65.5 (95% CI, 64.6-66.6) for the 3 metrics, diet, physical activity, and BMI, available among children and adolescents aged 2-19 years of age.

Upon analysis, significant differences were observed in mean overall cardiovascular health scores by sex (women, 67.0 vs men, 62.5), age (range of mean values, 62.2-68.7), and racial/ethnic group (range 59.7-68.5). Investigators pointed out mean scores were lowest for diet, physical activity, and BMI metrics. Additionally, large differences were observed in scores across demographic groups for diet (range, 23.8-47.7), nicotine exposure (range, 63.1-85.0), blood glucose (range, 65.7-88.1), and blood pressure (range, 49.5-84.0).

Among children, diet scores were low and were progressively lower in higher age groups, with a mean score of 61.1 at ages 2-5 years and 28.5 at ages 12-19 years. Investigators also noted large differences were observed for mean physical activity (range, 63.1-88.3) and BMI (range, 74.4-89.4) scores by sociodemographic group.

Further analysis indicated the scores observed for Life’s Essential 8 were similar to those when using Life’s Simple 7. However, investigators noted there was a broad range of scores within each point level of the original Life’s Simple 7 score and there was wide variation in scores assigned to individuals within each of the original poor, intermediate, and ideal categories of the diet and lipid scores.

This study, “Status of Cardiovascular Health in US Adults and Children Using the American Heart Association’s New “Life’s Essential 8” Metrics: Prevalence Estimates from the National Health and Nutrition Examination Survey (NHANES), 2013-2018,” was published in Circulation.