For years we were told to “eat well and exercise” to keep our hearts healthy. While these two lifestyle factors are very important to maintaining health, they are not the only essential elements that contribute to keeping our hearts healthy. The American Heart Association (AHA) recently released “Life’s Essential 8.” This “checklist for lifelong good health” incorporates all the latest data on how to maintain cardiovascular health and reduce risk for heart disease, stroke, dementia, and other major health problems. Let’s take a look at these eight essential lifestyle and health factors. (See For Brain Health, Protect Your Heart on page 1 of this issue for information on how these factors also contribute to reducing risk for Alzheimer’s disease and other dementias.)
1. Diet: What we eat and drink has perhaps the largest overall impact on our health. Beyond just influencing weight and body fat, our food also helps us meet essential nutrient needs and sustain a healthy gut microbiome. Additionally, a healthy dietary pattern helps control numerous major risk factors for disease, including blood pressure, glucose, cholesterol, and inflammatory marker levels.
An overall healthy dietary pattern includes whole or minimally processed fruits and vegetables, legumes, nuts, seeds, whole grains, fish and seafood, fermented dairy like yogurt, and plant oils rich in unsaturated fats such as olive, soybean, or canola. Such diets can also contain poultry, eggs, and unprocessed red meats in moderation. Highly processed foods (especially foods high in refined grains and added sodium and sugars), sugar-sweetened drinks, and processed meats should be limited.
2. Physical Activity: “Exercise” should be thought of as any physical activity, rather than (or in addition to) a formal, regimented exercise plan (see Small Amounts of Physical Activity Can Have Big Benefits on page 4 of our September issue). Current guidelines recommend adults should aim for at least two-and-a-half hours of moderate or 75 minutes of vigorous physical activity every week. Muscle-strengthening activities are recommended at least twice a week (any activities that involve resistance, such as lifting heavy items or doing yoga, strengthen muscles). In recent years, emerging evidence suggests sitting too long at one time is not good for health, even in people who meet the physical activity recommendations. Get up and move regularly throughout your day, whether it’s a short after-meal walk, a stretch break, or some household chores between shows.
Kids and teens need more exercise: play and structured activities should add up to at least 60 minutes every day.
3. Tobacco: Smoking causes tremendous damage to your circulatory system. According to the AHA, about a third of all U.S. deaths from heart disease are linked to smoking. And smokers are not only harming themselves: about a third of U.S. children ages three to 11 are exposed to secondhand smoke.
If you smoke, make a plan to quit and seek professional help if necessary. Within one year after quitting, your risk of heart disease goes down by half.
4. Sleep: A growing body of science is driving home the importance of getting enough good quality sleep. While we sleep, our bodies are busy recovering from the stresses of the day. Adequate sleep promotes healing, strengthens immunity, and improves brain function, mood, and energy. Poor sleep is associated with increased risk for obesity, cardiovascular disease, cognitive decline, dementia, depression, and high blood pressure, blood sugar, and cholesterol (see Are Your Sleeping Habits Affecting Your Weight? on page 6 of this issue for more information).
The current recommendation is that most adults should get seven to nine hours of sleep each night. Children ages five and younger need 10 to 16 hours, including naps. That number decreases to nine to 12 hours for ages six to 12 and eight to 10 hours for ages 13 to18.
5. Weight: Achieving and maintaining a healthy weight has many benefits. Unsustainable, unhealthy, or short-term “fad” diet or activity programs are not the answer. Finding healthy choices that work for you in the long term is key. Researchers are beginning to understand there is more to weight control than “calories in versus calories out”—focus on eating healthy minimally processed foods, being more active, and avoiding or reducing portions of unhealthy choices. Even losing five percent of your body weight can have a big impact on chronic health conditions, including type 2 diabetes.
Body mass index (BMI), a numerical value of your weight in relation to your height, is a useful gauge. You can calculate your BMI online (see Resources) or ask your healthcare provider.
6. Blood Cholesterol: Cholesterol is a waxy, fat-like substance that has many uses in the body. It travels in the bloodstream in the form of lipoprotein particles. High-density lipoprotein (HDL) particles help remove cholesterol from the body, so they are often called “good” cholesterol. High levels of low-density lipoprotein (LDL) and other non-HDL particles deliver cholesterol to parts of the body where it shouldn’t accumulate, like the walls of the blood vessels. This results in stiff, narrowed arteries that impede blood flow, which can lead to heart disease, strokes, kidney disease, peripheral vascular disease, and dementia.
Blood cholesterol levels are measured by a blood test called a lipid panel. This test provides levels of HDL and LDL cholesterol, as well as triglycerides (the most common type of fat in the body).
The healthy lifestyle factors discussed so far (a healthy dietary pattern, moving more, not smoking, and losing excess body fat) are all good for improving cholesterol levels. Replacing refined carbohydrates and saturated fats in your diet with unsaturated fats is also beneficial. If your blood cholesterol levels cannot be controlled by lifestyle changes, speak to your doctor about medication options.
7. Blood Sugar: The main energy source for most tissues in the body is a sugar called glucose, which circulates in the bloodstream to provide fuel for our cells. When we eat quick-digesting carbohydrates (refined starch, sugar), blood sugar rises quickly. In response, the pancreas makes a hormone called insulin, which is responsible for moving that glucose from the blood into cells of the body. If the cells don’t fully respond to insulin (become “resistant”), blood sugar levels will rise. The pancreas may also lose its ability to produce adequate amounts of insulin, decreasing the body’s ability to control blood sugar levels. Over time, high levels of blood sugar can damage your blood vessels, leading to problems with your heart, kidneys, eyes, brain, and nerves.
Your healthcare provider can test your fasting blood sugar levels and hemoglobin A1c (a measure of average blood sugar over the past several months). If your fasting blood glucose level is 126 milligrams per deciliter (mg/ dL) or higher or your A1c is over 6.5 percent, you will be classified as having type 2 diabetes. A level between 100 to 125 mg/dL or A1c between 5.7 and 6.4 percent is classified as prediabetes, which, if not treated, frequently leads to type 2 diabetes.
A healthy diet, physical activity, and a healthy weight are the best ways to both prevent and treat high blood sugar and type 2 diabetes. Medications may also be necessary if lifestyle improvements are not enough.
8. Blood Pressure: Blood pressure measures the force that your blood exerts on your artery walls. The top number—the systolic blood pressure—measures the pressure on the artery walls as blood is pumped out of the heart. The bottom number—the diastolic blood pressure—measures the pressure when the heart is at rest between beats. A reading of over 130 for systolic or over 80 for diastolic is considered “hypertension.” (Both numbers do not have to be high.) Higher blood pressure levels are associated with increased risk for stroke, heart attack, and vascular dementia. Levels less than 120/80 are optimal.
As high blood pressure rarely causes any symptoms, the only way to know if you have this condition is to have your blood pressure measured. This can be done by a healthcare provider, at the pharmacy, or at home with a machine designed for that use. Limiting sodium intake, consuming a healthy dietary pattern rich in fruits and vegetables, moving more, managing weight, avoiding tobacco, and getting seven to nine hours a night of good quality sleep all lower blood pressure in most people.
More information and advice for achieving “Life’s Essential 8” is available at the AHA website (see Resources).