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How Good is Your Heart Health?

In an article published on June 29, 2022, in the journal Circulation, the American Heart Association (AHA) Presidential Advisory defines optimal cardiovascular (CV) health along 8 parameters. In 2010 they outlined 7 parameters, but more recently added sleep as a component for a healthy heart, noting that "sleep impacts overall health, and people who have healthier sleep patterns manage health factors such as weight, blood pressure, or risk for type 2 diabetes more effectively."

Since 2010, and the publication of the original 7 parameters of a healthy heart lifestyle, there have been over 2400 scientific papers on the topic, new discoveries in CV health, and new ways to measure it. Here's a rundown on the 8 components of optimal CV health:

(1) DIET -- this component was updated from the 2010 guidelines. The DASH (Dietary Approaches to Stop Hypertension) eating pattern is used to assess population level health. MEPA (Mediterranean Eating Pattern for Americans) is used to monitor and assess CV health of individuals.

(2) PHYSICAL ACTIVITY (no changes from 2010) -- measured by total number of minutes of moderate or vigorous physical activity per week. Optimal level is 150 minutes (2.5 hours) of moderate physical activity or more per week OR 75 minutes per week of vigorous-intensity physical activity for adults. The numbers are higher for children.

(3) NICOTINE EXPOSURE (updated from 2010) -- the use of e-cigarettes or vaping devices has been added to the previous metric of traditional cigarettes. Second-hand smoke exposure has been added.

(4) SLEEP DURATION (new) -- measured by average hours of sleep per night. Ideal level is 7-9 hours daily for adults. Ages 5 and younger is 10-16 hours; 6-12 years of age is 9-12 hours; 13-18 years of age is 8-10 hours of sleep per night.

(5) BODY MASS INDEX (no changes from 2010) -- although it is acknowledged that BMI is an imperfect metric, it is still an easily calculated gauge to assess weight categories that put one at risk of poor CV health. A BMI of 18.5 to 24.9 is associated with the highest levels of CV health. Racial and ethnic backgrounds may affect these guidelines.

(6) BLOOD LIPIDS (updated from 2010) -- metric for blood lipids (cholesterol and triglycerides) updated to a preference to monitor non-HDL cholesterol rather than total cholesterol. Non-HDL cholesterol can be monitored without fasting, making it easier to collect and more reliably calculated.

(7) BLOOD GLUCOSE (updated from 2010) -- expanded to include option to test hemoglobin A1c readings.

(8) BLOOD PRESSURE (no changes from 2010) -- criteria remained unchanged from 2017 guidance that established levels less then 120-80 mm Hg as optimal. Hypertension is defined as 130-139 mm Hg systolic pressure or 80-89 mm Hg diastolic pressure.

Sadly, survey data collected over the years 2013-2018 from 13,500 adults, aged 20-79 and approximately 9900 children, aged 2-19 years, indicated that about 80% of adults scored at a low to moderate level of CV health. Less than a half of 1% of adults achieved a score of 100 and 20% scored 80 or above (high CV health). The lowest scores were in the areas of diet, physical activity, and BMI -- all areas that can be altered through life-style changes.

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