In 2010, the American Heart Association shifted its decades-long focus from merely reducing risks for cardiovascular disease (CVD) to actively optimizing overall cardiovascular health (CVH). This led to the “Life’s Simple 7” framework, which measured diet, physical activity, smoking, body weight, blood pressure, cholesterol, and glucose, with research confirming that high scores corresponded to lower rates of CVD, cancer, and dementia. In 2022, the AHA updated this framework to “Life’s Essential 8,” adding sleep health, revising the original metrics, and acknowledging the role of psychological and social factors. In observance of Heart Month, we will now define each component of Life’s Essential 8 and offer improvement tips.

Healthy Behaviors

Healthy behaviors are choices within our direct control that have a major impact on our cardiovascular and overall health. These behaviors are the most important contributors to our lifespan, more so than genetics, and they also influence the Health Factor components of Life’s Essential 8.

1. Healthy Diet 

A healthy diet is a key driver of cardiovascular health (CVH) and should include a high intake of whole foods like fruits, vegetables, grains, nuts, beans, and fish. It also means choosing liquid plant oils over solid fats and limiting ultra-processed foods high in sodium and sugar. Diet affects CVH by influencing the body’s systems that regulate cholesterol, blood pressure, body weight, blood glucose, inflammation, and more. According to the “Life’s Essential 8” metric, an ideal diet aligns with DASH, Mediterranean, or plant-based eating patterns. For a simple path to improvement, start by eating more vegetables and fruits, then switch to whole grains, and finally incorporate more plant-based proteins.

2. Physical Activity

A major predictor of a long life, physical activity improves blood pressure, blood glucose, inflammation, mental well-being, and muscle, bone, and sleep health. “Life’s Essential 8” considers activity levels IDEAL with 150 minutes of moderate-intensity exercise weekly, which can be as simple as 30 minutes of brisk walking five days a week. For busy individuals, this time can be split into shorter increments. A great strategy is to schedule two 15-minute sessions daily. Using a fitness tracker or smartwatch can also help you monitor your progress with real-time feedback.

3. Sleep Health

Science confirms that restful sleep is vital for brain and heart health, as it improves stress levels, blood pressure, and short-term memory while reducing the risk of heart disease and overall mortality. The “Life’s Essential 8” metric for IDEAL sleep is seven to nine hours per 24-hour period. Establishing a good sleep hygiene routine and using wearable devices to monitor your sleep patterns can help you consistently achieve this goal.

4. Nicotine Exposure

For those who use tobacco or vape, quitting is the fastest way to improve cardiovascular health. It helps lower blood pressure, reduce inflammation, raise HDL (good) cholesterol, and decrease the risk of blood clots, heart attacks, lung disease, and cancer. While the IDEAL metric for “Life’s Essential 8” is to have never smoked, a former smoker who has quit for five years scores nearly as high. Your primary care provider and employer may offer resources and classes to help you quit.

Health Factors: Know Your Numbers

5. Manage Weight

Losing excess weight significantly lowers your risk of diabetes, high blood pressure, and cardiovascular disease, while also reducing the psychological distress that can be associated with being overweight. While metabolic factors beyond your control can influence body weight, you can take effective steps by changing your diet (especially by restricting refined carbohydrates and added sugars), exercising regularly, and improving your sleep quality.

The “Life’s Essential 8” metric for an IDEAL body weight is a BMI below 25, although a BMI between 25 and 29.9 still earns a high score. For personalized support, you can work with a registered dietitian or discuss modern weight loss interventions with your primary care provider.

6. Control Cholesterol

Controlling your cholesterol is vital for cardiovascular health (CVH) and reducing your risk of a heart attack, as it is the second-highest risk factor in the U.S. Cholesterol levels are influenced by both genetics and diet, especially the intake of saturated fats and added sugars. The “Life’s Essential 8” metric for IDEAL cholesterol is a non-HDL level below 130 mg/dL (which is your total cholesterol minus your HDL or “good” cholesterol). If your cholesterol is high, you can improve it by limiting foods like butter, cheese, tropical oils, and fatty cuts of beef and pork. Medication is often recommended if your calculated 10-year risk of heart attack or stroke is over 7.5%, or if you have a family history of heart disease or evidence of calcified arteries.

7. Manage Blood Sugar

Over time, high blood sugar levels can damage your heart and other organs. For individuals with diabetes or prediabetes, monitoring hemoglobin A1c provides a long-term view of blood sugar control. A healthy diet and regular exercise are key to managing blood sugar. Take steps if you are found to have elevated blood glucose: eliminate added sugars and refined grains from the diet, increase walking exercise, and follow up with your PCP.

8. Manage Blood Pressure

Keeping your blood pressure within a healthy range is crucial for long-term health. Optimal blood pressure is less than 120/80 mm Hg. High blood pressure is defined as 130-139 mm Hg systolic (the top number) or 80-89 mm Hg diastolic (the bottom number). Reduce dietary sodium and alcohol, engage in more walking exercise, monitor your blood pressure at home, and arrange a follow-up with your primary care provider. 

Adopting “Life’s Essential 8” can feel like a significant undertaking, but you don’t have to change everything at once. By approaching it gradually and strategically, you can build lasting habits for better heart health and overall well-being. A highly effective method for this is setting SMART goals.

The SMART framework helps you create clear, manageable objectives:

• Specific: Clearly define what you want to accomplish.
• Measurable: Track your progress with numbers.
• Achievable: Set a realistic goal that you can reach.
• Relevant: Ensure the goal aligns with your broader objective of improving your health.
• Timely: Set a specific timeframe or deadline for achieving your goal.

A Step-by-Step Guide to Getting Started

Instead of trying to tackle all eight components simultaneously, focus on one or two health behaviors first, as improvements here often positively impact the health factors.

1. Choose One Area to Start

Select a single behavior that feels most manageable for you right now. Let’s use exercise and diet as examples.

Example: Be More Active

• Goal: Walk for 30 minutes on weekdays.
• Making it SMART:
  • Specific: I will walk briskly around my neighborhood or a local park.
  • Measurable: I will walk for 15 minutes during my lunch break and another 15 minutes after work, for a total of 30 minutes.
  • Achievable: Starting with 30 minutes a day is more attainable than aiming for an hour at the gym.
  • Relevant: This will help me meet the recommended 150 minutes of moderate exercise per week.
  • Timely: I will do this every weekday for the next three weeks and then reassess.

2. Build on Your Success

Once you’re comfortable with your first goal, you can gradually introduce another. The momentum from one positive change often makes the next one easier.

Example: Eat Better

• Initial Goal: Eat more fruits and vegetables.
• Making it SMART:
  • Specific: I will add one serving of vegetables to my dinner and have one piece of fruit as a snack each day.
  • Measurable: That’s a total of one vegetable and one fruit serving daily.
  • Achievable: This is a small, manageable addition rather than a complete diet overhaul.
  • Relevant: This is the first step toward a more plant-rich, heart-healthy diet.
  • Timely: I will stick to this for two weeks.

After two weeks, you can expand on this goal:

• Next Step: I will switch from white bread to 100% whole-grain bread for my sandwiches and start incorporating one fully plant-based meal, like lentil soup or a bean burrito bowl, into my week.

How Small Changes Create a Big Impact

You’ll quickly notice how these habits are interconnected. For instance, getting out for a walk and eating more nutritious food can significantly improve your sleep quality (“Get Healthy Sleep”). Better sleep, in turn, provides the energy for more activity and can reduce cravings for unhealthy foods, which helps with “Manage Weight.”

Seeking Support for Health Factors

For managing the clinical health factors—weight, cholesterol, blood sugar, and blood pressure, or for assistance with quitting tobacco, it’s crucial to partner with healthcare professionals. They can provide personalized guidance, monitor your progress, and connect you with valuable resources to help you achieve your health goals safely and effectively