There are many formulas out there to find the balance that brings a person closer to a healthier, longer, happy life — but accomplishing that goal can be a continuous, lifelong struggle. The American Heart Association (AHA) has provided the foundation for a science-based recipe for people to achieve just that.
Life’s Essential 8 (with the addition of sleep as that eighth component) made its debut in summer 2022 when the AHA updated its guidelines. The advice offer four health behaviors and four health factors as the eight most important factors for cardiovascular health. Along with sleep, the other seven are: eating better, being more active, quitting tobacco usage, managing weight, controlling cholesterol, managing blood sugar and managing blood pressure.
“Being able to have a long and productive life means that there are aspects to behavior that we need to adopt, but more importantly, it impacts everyone from the youngest child all the way across the life continuum,” says Dr. Ivor J. Benjamin, M.D., FAHA, FACC, professor and director of Cardiovascular Center at Medical College of Wisconsin.
“The burden of cardiovascular disease is substantial, and as a result of that, we’ve invested a fair amount of time to study the science to better understand the risk factors. We know what some of those are, but what the American Heart Association has done is to use the benefit of science over the decades. That science has in turn informed what are the major areas for us to invest in.”
The efforts point toward one common goal, Benjamin says. “The impact is to ultimately see a future state — probably not in my lifetime — free of heart disease and stroke,” he said. “The science we’re learning, and the ways we’re engaging with our community, means we have to be a relentless force to be able to accomplish that."
Here’s a closer look at each of Life’s Essential 8.
Healthy Sleep: The AHA’s new guidance states that most adults need seven to nine hours a night, while babies and children need even more. Poor sleep can put you at risk of cardiovascular disease, cognitive decline and dementia, depression, high blood pressure, blood sugar and cholesterol and obesity.
“Sleep is essential for good health and survival,” says Brittany Meyer, MD, a specialist in sleep medicine with ProHealth Care’s Sleep Center in Delafield and ProHealth Care’s Heart and Vascular Center in Waukesha. “Getting eight hours of restorative, restful sleep is one of the best ways to maintain health overall, boost immunity and counteract stress. Adequate sleep can help provide energy, help improve memory and cognitive function and regulate metabolism. Sleep is essential for repairing and healing the body and regulating the endocrine system and circadian rhythms. It also can help improve immunity.”
The negative effects to a lack of sleep, she explains, include hampering cognitive function and contributing to hypertension, diabetes, heart attacks and strokes. Along with putting people at risk for weight gain and obesity, poor sleep patterns may also factor into psychological and behavioral issues, depression and even suicidal thoughts, she notes.
The most effective remedy to a lack of sleep? Getting in front of the problem with professional help, Meyer says.
“It’s best to see a physician when a sleep problem persists over a period of weeks, when it affects quality of life, and when you start to worry about sleep,” she says. “The earlier you report the problem to your primary care physician or a sleep specialist, the sooner you can figure out a solution and get back to normal sleep.”
There’s also a difference between just sleep and “high-quality” sleep, when our bodies are gaining the most significant benefit from getting that necessary rest, Benjamin adds — and snoring is a good indicator there may be something going on.
Following a healthy sleeping pattern can pay positive dividends, Meyer and Benjamin say: Benefits include healing and repairing cells, tissues and blood vessels; a stronger immune system; improved mood and energy; better brain function; and less risk of chronic disease.
Controlling Blood Pressure: The AHA considers a “normal” blood pressure at 120/80. “The first number [systolic] indicates the pressure that blood exerts against artery walls as the heart beats,” explains Marcus Perry, M.D., internal medicine physician with ProHealth Medical Group. “The second number, diastolic, indicates the pressure that blood exerts against artery walls when the heart is at rest between beats.”
Some daily activities people can adopt to keep that blood pressure in a good place, according to the AHA, are:
- Eat smart
- Move more
- Manage weight
- No nicotine
- Sleep well
“The first line of treatment is a healthy diet, weight loss, exercising at least 150 minutes a week and limiting alcohol,” Perry says. “A healthy diet would be a DASH or Mediterranean diet, low in sodium and high in potassium. If improved lifestyle and diet don’t control the blood pressure, then there are many classes of medications that can help lower blood pressure.”
Where the situation can take a dramatic turn is when a patient begins showing signs of hypertension, Perry says. The American Heart Association considers a blood pressure of 130-139/80-89 as Hypertension Stage 1 and 140-higher/90-higher as Stage 2.
A hypertension “crisis” is defined as a systolic blood pressure of higher than 180 and/or a diastolic blood pressure higher than 120. “Uncontrolled hypertension is one of the leading causes of developing heart failure, heart attacks, strokes and kidney disease,” Perry says. “The higher your blood pressure, the more likely you are to develop complications from it.” The only way to know if you’re at risk, Perry says, is to have your blood pressure checked at least yearly after age 18, and possibly more often than that if you exhibit any other risk factors.
Eat Better: It’s often been said that we can’t outwork a poor diet. No matter how many hours you exercise, if you’re putting bad food into your body, you won’t see the benefits.
The AHA recommends creating a healthy eating pattern, reading nutrition labels, watching calories, cooking at home and looking for that heart-check label on foods.
“I’m not saying that every now and again, you wouldn’t be able to [treat yourself at a fast-food place],” Benjamin says. “Finding that optimal sweet spot for the type of calories that we can ingest is critical.”
Be More Active: Reaching your goal of getting necessary exercise could be as simple as taking a stroll around the block or hitting the gym. The AHA recommends 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic (or a combination of both) activity for adults. For kids and teenagers, the goal is at least 60 minutes of physical activity daily.
How do we get there? The guidelines offer a variety of tips:
- Set goals
- Keep going
- Walk more
- Stay active
- Add it up
- Make a habit
Finding that balance, and more importantly what works best, is a key, says Jayne Capriotti, exercise physiologist at Advocate Aurora in Kenosha, who works daily with patients after they’ve had a cardiac procedure. And the plans that she uses for her patients can certainly help those who don’t fit into either category.
“If [the guidelines] seem daunting, it’s, ‘Let’s break it down to make it more manageable,’” she says. “Exercise can be 30 minutes a day, five days a week. If you don’t have the endurance or the stamina, try 10 minutes, three times a day.
“You can just get up and walk around the house. If the weather isn’t good, it doesn’t have to be that you have to get a gym membership or you have to buy your own treadmill — just get up and move.
“You don’t really need any specialized equipment for it,” she continues. “Just strap on some comfortable shoes, and just get out as you’re able to, even going to big box stores. You can walk around the perimeter.”
Even a simple walk around your back yard will do you wonders, she says. “Getting that fresh air and oxygenation to your brain can help stave off things like Alzheimer’s and dementia,” she says. “It’s so important for your whole well-being.”
Quit Tobacco: Education and making a plan to quit are two key components of the AHA guidelines regarding tobacco use. Some facts to consider about the health impacts of quitting smoking, vaping and the use of tobacco:
Within one year of quitting, your risk of heart disease goes down by half.
Smoking is the most preventable cause of death in the U.S. and is linked to about one-third of all deaths from heart disease and more than 90 percent of lung cancers.
Smoking damages your circulatory system and increases your risk of multiple diseases.
Cigarettes, e-cigarettes and tobacco products contain many toxic chemicals, as do their smoke, vapor and liquids.
Tobacco use and nicotine addiction is a growing crisis for teens and young adults.
About half of U.S. children ages 3 to 11 are exposed to secondhand smoke and vapor.
“Ever since the Surgeon General report came out in relation to tobacco consumption going back several decades now, we know that smoking has a huge impact,” Benjamin says. “I used to have a high school teacher, who would say just before he lit up, ‘Don’t start.’ We get it. We understand it. Secondhand smoking is a key and important thing, particularly for young kids.”
It also goes without saying that attempting to quit and succeeding can be two very different things, but according to the Association, there are many avenues a person can take if they’re ready to kick the habit: Being ready to deal with urges, getting active, finding a way to handle stress, getting support and sticking with the plan.
Manage Weight: The path to weight control is rarely straight. Simply put, it’s important to track daily calories, which in turn will help you figure out where you need to cut back so a healthy weight can be reached.
One aspect is knowing your Body Mass Index, Benjamin says, which is a numerical value of your height in relation to your weight. The Association lists a healthy BMI at 25.
“Maintaining an optimal BMI is critically important,” he says.
Living at a healthy weight should be a result of positive gains in the other seven parts of Life’s Essential 8, he notes — they all fit together toward one common goal.
For those on the weight loss journey, try to keep goals within range, Capriotti adds. “When you see the numbers on the scale start drop, it’s like, ‘OK, I can do this,’” she says. “You get that self-motivation and are able to continue on with your plan.”
Control Cholesterol: Cholesterol is divided into high-density lipoprotein (HDL) and low-density lipoprotein (LDL), also more commonly known as “good” and “bad” cholesterol.
It’s the HDL’s “job” to keep the bad (LDL) from sticking to artery walls and to reduce plaque buildup. That process helps lower the risk of heart disease and stroke (heart.org/atherosclerosis).
Cholesterol can be controlled by a healthy diet, consistent physical activity, knowing the fats we eat, avoiding nicotine and taking any prescribed medications, according to the Heart Association’s guidelines.
“We now have phenomenal medications, so it’s so important to meet with your primary care doctor, to get that annual visit and understand what your cholesterol is,” Benjamin says. “I tell my patients, ‘The same way you know your age, you need to know what your cholesterol is.’”
Manage Blood Sugar: The first step is understanding what makes our blood sugar levels rise.
The carbohydrates and sugars we consume turn into glucose in the stomach and digestive system, which then can enter the blood stream. When people develop Type 2 diabetes, glucose has built up in the blood instead of going into the cells.
Once that happens, the body develops “insulin resistance,” and can’t use the insulin it makes effectively. That causes the pancreas to gradually lose its ability to produce insulin, which can then lead to a high blood glucose level.
“Especially in certain segments of our population, we know there’s a higher prevalence of diabetes in families,” Benjamin says. MKE
The American Heart Association has a variety of resources that directly relate to Life’s Essential 8 at www.heart.org/lifes8. You can also take a life check quiz by visiting mlc.heart.org.