L’American Heart Association a ajouté un sommeil sain comme élément essentiel d’une santé cardiovasculaire optimale.
L’American Heart Association ajoute le sommeil à la liste de contrôle de la santé cardiovasculaire.
- L’American Heart Association a mis à jour sa liste de contrôle pour mesurer la santé cardiovasculaire. Elle s’appelle désormais Life’s Essential 8 et ajoute un sommeil sain comme élément essentiel d’une santé cardiovasculaire optimale.
- Les autres facteurs de santé et de mode de vie de la liste de contrôle, qui faisaient partie de l’ancien outil de notation à 7 éléments, sont l’activité physique, le poids, l’exposition à la nicotine, le régime alimentaire, le cholestérol, la glycémie et la pression artérielle.
- La nouvelle mesure du sommeil suggère que 7 à 9 heures de sommeil par jour sont optimales pour la santé cardiovasculaire des adultes, et plus pour les enfants en fonction de leur âge.
- La mise à jour de la notation peut désormais être utilisée pour les personnes âgées de 2 ans et plus, et quatre composantes sont mesurées de nouvelles manières : un nouveau guide d’évaluation de l’alimentation ; l’exposition à la nicotine remplace le tabagisme pour inclure les cigarettes électroniques (vapotage) et l’exposition à la fumée secondaire ; le cholestérol non-HDL est suggéré au lieu du cholestérol total ; et la mesure de la glycémie est élargie pour inclure les niveaux d’hémoglobine A1c.
- Life’s Essential 8 est évalué par l’outil en ligne My Life Check, qui dispose d’un système de notation mis à jour pour donner aux utilisateurs un score allant jusqu’à 100 points basé sur une moyenne des scores pour chaque facteur de santé et de mode de vie.
L’image Life’s Essential 8 de l’American Heart Association est une forme de roue avec 8 coins représentant les 8 éléments essentiels à la santé cardiovasculaire. Crédit : Copyright American Heart Association 2022
La durée du sommeil est désormais considérée comme un élément essentiel pour une santé cardiaque et cérébrale idéale. Le score de santé cardiovasculaire Life’s Essential 8 remplace le Life’s Simple 7, selon un nouvel avis présidentiel, Life’s Essential 8 – Mise à jour et amélioration de la structure de l’American Heart Association en matière de santé cardiovasculaire.publié aujourd’hui (29 juin 2022) dans le magazine .Circulationla revue phare de l’association, évaluée par des pairs.
D’autres mises à jour des mesures de la santé cardiovasculaire optimale, désormais destinées à toute personne âgée de 2 ans et plus, comprennent un nouveau guide d’évaluation de l’alimentation, la prise en compte de l’exposition au tabagisme passif et au vapotage, l’utilisation du cholestérol non-HDL au lieu du cholestérol total pour mesurer les lipides sanguins, et l’élargissement de la mesure de la glycémie pour inclure l’hémoglobine A1c, une mesure clé pour évaluer le risque de diabète de type 2.
Les maladies cardiovasculaires sont la première cause de décès aux États-Unis et dans le monde. Selon la mise à jour 2022 des statistiques sur les maladies cardiaques et les accidents vasculaires cérébraux de l’Association, environ 121,5 millions de personnes aux États-Unis souffrent d’hypertension artérielle, 100 millions sont obèses, plus de 28 millions sont atteintes de diabète de type 2 et seulement 1 adulte sur 4 a déclaré pratiquer l’activité physique et l’exercice recommandés par le ministère américain de la Santé et des Services sociaux .Physical Activity Guidelines for Americans, 2nd édition. Diverses études menées au cours des deux dernières décennies indiquent que plus de 80 % de tous les événements cardiovasculaires peuvent être évités grâce à un mode de vie sain et à la prise en charge des facteurs de risque cardiovasculaire connus.
” La nouvelle métrique de la durée du sommeil reflète les dernières conclusions de la recherche : le sommeil a un impact sur la santé globale, et les personnes qui ont des habitudes de sommeil plus saines gèrent plus efficacement les facteurs de santé tels que le poids, la pression artérielle ou le risque de diabète de type 2 “, a déclaré le président de l’American Heart Association, Donald M. Lloyd-Jones, M.D., Sc, FAHA, qui a dirigé le groupe consultatif de rédaction et qui est président du département de médecine préventive, titulaire de la chaire Eileen M. Foell de recherche sur le cœur et professeur de médecine préventive, de médecine et de pédiatrie à Northwestern University’s Feinberg School of Medicine in Chicago. “In addition, advances in ways to measure sleep, such as with wearable devices, now offer people the ability to reliably and routinely monitor their sleep habits at home.”
The Association first defined the 7 metrics for cardiovascular health in 2010 to identify the specific health behaviors and health factors that drive optimal heart and brain health. Brain health in relation to cardiovascular health was defined in a 2017 American Heart Association Presidential Advisory. It was further acknowledged as an important component of optimal cardiovascular health in the Association’s January 2021 Scientific Statement on the mind-heart-body connection. Findings from both papers are incorporated into Life’s Essential 8™.
After 12 years and more than 2,400 scientific papers on the topic, new discoveries in heart and brain health and in the ways to measure cardiovascular health provided an opportunity to revisit each health component in more detail. Four of the original metrics have been redefined for consistency with newer clinical guidelines or compatibility with new measurement tools. Also, the scoring system can now be applied to anyone ages 2 and older.
The Life’s Essential 8™ components of optimal cardiovascular health are divided into two major areas – health behaviors and health factors. Health behaviors include diet, physical activity, nicotine exposure and sleep. Health factors are body mass index, cholesterol levels, blood sugar and blood pressure. “The idea of optimal cardiovascular health is important because it gives people positive goals to work toward at any stage of life,” said Lloyd-Jones.
“Life’s Simple 7™ has served as a proven, powerful tool for understanding how to achieve healthy aging and ways to improve cardiovascular health while decreasing the risks of developing heart disease and stroke, as well as cancer, dementia and many other chronic diseases,” he said. “Given the evolving research, it was important to address some limitations to the original metrics, particularly in ways they’ve been applied to people from diverse racial and ethnic populations.”
Lloyd-Jones explained that some of the previous metrics, such as diet, were not as sensitive to differences among people, or as responsive to changes over time within a single individual. “We felt it was the right time to conduct a comprehensive review of the latest research to refine the existing metrics and consider any new metrics that add value to assessing cardiovascular health for all people.”
Life’s Essential 8™ includes:
- Diet (updated): A new guide to assess diet quality for adults and children at the individual level (for individual health care and dietary counseling) and at the population level (for research and public health purposes).
- At the population level, dietary assessment is based on daily intake of elements in the Dietary Approaches to Stop Hypertension (DASH) eating pattern. The DASH-style diet score has eight components: high intake of fruits, vegetables, nuts and legumes, whole grains, low-fat dairy, and low intake of sodium, red and processed meats, and sweetened drinks.
- For individuals, the Mediterranean Eating Pattern for Americans (MEPA) is used to assess and monitor cardiovascular health. The MEPA is a DASH-style eating pattern that can be measured with 16 yes or no questions about the weekly frequency of eating olive oil, vegetables, berries, meat, fish, dairy, grains, etc. The MEPA screener does not include consumption of sugar-sweetened beverages, so clinicians are encouraged to ask at the time of assessment.
- Physical activity (no changes): Activity is measured by the total number of minutes of moderate or vigorous physical activity per week, as defined by the U.S. Physical Activity Guidelines for Americans, 2nd edition. The optimal level is 150 minutes of moderate physical activity or more per week or 75 minutes per week of vigorous-intensity physical activity for adults; 420 minutes or more per week for children ages 6 and older; and age-specific modifications for younger children.
- Nicotine exposure (updated): Use of inhaled nicotine-delivery systems, which includes e-cigarettes or vaping devices, is added since the previous metric only monitored traditional, combustible cigarettes. This reflects use by adults and youth and their implications on long-term health. Life’s Essential 8™ also includes second-hand smoke exposure for children and adults.
- Sleep duration (new): Sleep duration is associated with cardiovascular health. Measured by average hours of sleep per night, the ideal level is 7-9 hours daily for adults. Ideal daily sleep ranges for children are 10-16 hours per 24 hours for ages 5 and younger; 9-12 hours for ages 6-12 years; and 8-10 hours for ages 13-18 years.
- Body mass index (no changes): The writing group acknowledges that body mass index (BMI) is an imperfect metric, yet it is easily calculated and widely available; therefore, BMI continues as a reasonable gauge to assess weight categories that may lead to health problems. BMI of 18.5–24.9 is associated with the highest levels of cardiovascular health. The writing group notes that BMI ranges and the subsequent health risks associated with them may differ among people from diverse racial or ethnic backgrounds or ancestry. This aligns with the World Health Organization’s recommendations to adjust BMI ranges for people of Asian or Pacific Islander ancestry because recent evidence indicates their risk of conditions such as CVD or Type 2 diabetes is higher at a lower BMI.
- Blood lipids (updated): The metric for blood lipids (cholesterol and triglycerides) is updated to use non-HDL cholesterol as the preferred number to monitor, rather than total cholesterol. HDL is the “good” cholesterol. Other forms of cholesterol, when high, are linked to CVD risk. This shift is made because non-HDL cholesterol can be measured without fasting beforehand (thereby increasing its availability at any time of day and implementation at more appointments) and reliably calculated among all people.
- Blood glucose (updated): This metric is expanded to include the option of hemoglobin A1c readings or blood glucose levels for people with or without Type 1 or Type 2 diabetes or prediabetes. Hemoglobin A1c can better reflect long-term glycemic control.
- Blood pressure (no changes): Blood pressure criteria remain unchanged from the Association’s 2017 guidelines that established levels less than 120/80 mm Hg as optimal, and hypertension defined as 130-139 mm Hg systolic pressure (the top number in a reading) or 80-89 mm Hg diastolic pressure (bottom number).
Each component of Life’s Essential 8™, which is assessed by the My Life Check tool, has an updated scoring system ranging from 0 to 100 points. The overall cardiovascular health score from 0 to 100 points is the average of the scores for each of the 8 health measures. Overall scores below 50 indicate “poor” cardiovascular health, and 50-79 is considered “moderate” cardiovascular health. Scores of 80 and above indicate “high” cardiovascular health. The advisory recommends measuring cholesterol, blood sugar, blood pressure, height and weight at least every five years for the most complete and accurate Life’s Essential 8™ score.
The writing group also reviewed data about the impacts of stress, mental health, and social determinants of health, such as access to health care, income or education level, and structural racism, which are critical to understanding the foundations of health, particularly among people from diverse racial and ethnic populations.
“We considered social determinants of health carefully in our update and determined more research is needed on these components to establish their measurement and inclusion in the future,” said Lloyd-Jones. “Nonetheless, social and structural determinants, as well as psychological health and well-being, are critical, foundational factors in an individual’s or a community’s opportunity to preserve and improve cardiovascular health. We must consider and address all of these issues for people to have the opportunity for a full, healthy life as measured by Life’s Essential 8™.”
“Life’s Essential 8™ is a major step forward in our ability to identify when cardiovascular health can be preserved and when it is sub-optimal. It should energize efforts to improve cardiovascular health for all people and at every life stage,” Lloyd-Jones concluded.
This advisory was prepared by a volunteer writing group on behalf of the American Heart Association. American Heart Association Presidential Advisories promote greater awareness about cardiovascular diseases and stroke issues and help facilitate informed health care decisions. Presidential Advisories outline what is currently known about a topic and what areas need additional research. While these statements inform the development of guidelines, they do not make treatment recommendations. American Heart Association guidelines provide the Association’s official clinical practice recommendations.
Reference: “Life’s Essential 8: Updating and Enhancing the American Heart Association’s Construct of Cardiovascular Health: A Presidential Advisory From the American Heart Association” by Donald M. Lloyd-Jones, Norrina B. Allen, Cheryl A.M. Anderson, Terrie Black, LaPrincess C. Brewer, Randi E. Foraker, Michael A. Grandner, Helen Lavretsky, Amanda Marma Perak, Garima Sharma and Wayne Rosamond and on behalf of the American Heart Association, 29 June 2022, Circulation.
DOI: 10.1161/CIR.0000000000001078
Co-authors are Norrina B. Allen, Ph.D, M.P.H., FAHA; Cheryl A. M. Anderson, Ph.D., M.P.H., M.S., FAHA; Terrie Black, D.N.P., M.B.A., C.R.R.N., FAHA; LaPrincess C. Brewer, M.D., M.P.H., Randi E. Foraker, Ph.D., M.A., FAHA; Michael A. Grandner, Ph.D., M.T.R.; Helen Lavretsky, M.D., M.S.; Amanda Marma Perak, M.D., M.S., FAHA; Garima Sharma, M.D.; and Wayne Rosamond, Ph.D., M.S., FAHA. Authors’ disclosures are listed in the manuscript.
The Association receives funding primarily from individuals. Foundations and corporations (including pharmaceutical, device manufacturers, and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers, and health insurance providers, and the Association’s overall financial information are available here.
