The AHA’s Updated Heart Health Checklist Now Includes Sleep

Want to do everything in your power to keep your heart healthy? You’re going to need to make sure to get a good night’s sleep.

The American Heart Association (AHA) has added sleep to its cardiovascular health checklist, which consists of eight factors a person can modify to stay healthy: diet, exercise, tobacco use, weight, cholesterol, blood sugar levels, blood pressure, and now, sleep. AHA published its new checklist, called “Life’s Essential 8,” in the journal Circulation on June 29. The old checklist, created in 2010, was known as “Life’s Simple 7.”

“Not only is sleep health related to the other things that play a role in heart health, it seems to also be directly related to cardiovascular health itself,” says Michael Grandner, PhD, the director of the sleep and health research program at the University of Arizona College of Medicine in Tucson, who helped draft the new AHA checklist.

“Sleep is changeable, and studies show that you can improve aspects of heart health just by improving sleep,” Dr. Grandner says.

Most adults need at least seven hours of sleep each night, according to the U.S. Centers for Disease Control and Prevention (CDC). More than one-third of adults under 65 years old get less sleep than this, CDC data shows.

People who get less than six hours a night are at increased risk for obesity, high blood pressure, type 2 diabetes, and worse mental and cognitive health, Grandner says. And those who sleep more than nine hours nightly are also less likely to be healthy and more likely to die prematurely, Grandner adds.

Life’s Essential 8 Checklist

The AHA’s new Life’s Essential 8 checklist scores people on a 100-point scale, with higher average scores across all eight items indicating better cardiovascular health. Overall, average scores below 50 points indicate poor heart health, while scores from 50 to 79 indicate moderate heart health and scores over 80 indicate high cardiovascular health. There’s an online tool to check your score.

Only about one in five adults have high cardiovascular health using this scale, according to a study published in the same issue of Circulation. More than three in five adults have moderate cardiovascular health, this study found.

Besides adding sleep to the checklist for the first time, the AHA included several other major changes in Life’s Essential 8 that weren’t there on its previous checklist. These include:

• Diet For individuals, a heart-healthy diet is now assessed according to how closely it follows a Mediterranean style eating pattern. Sixteen questions are used to gauge how often each week people consume olive oil, vegetables, berries, meat, fish, dairy, and grains.
• Nicotine exposure The checklist includes the use of e-cigarettes for the first time, instead of presuming nicotine exposure is from traditional combustible cigarettes.
• Cholesterol Instead of looking at total cholesterol, the checklist now includes only harmful fats in the blood such as triglycerides and low density lipoprotein (LDL) cholesterol.
• Blood sugar There’s a new option to look at results of blood tests showing so-called hemoglobin A1C levels, which reflect average blood sugar levels over about three months.

No changes were made to how the checklist assesses exercise, blood pressure, or body weight. People get high cardiovascular health scores with 150 minutes of moderate intensity exercise or 75 minutes of vigorous exercise each week; blood pressure below 120/80 mmHg; and a body mass index (BMI) of 18.5 to 24.9.

Tips for Getting a Good Night’s Sleep

To get top scores for sleep on the new checklist, adults need seven to nine hours of sleep each night. There’s some wiggle room to this, and people may fall anywhere in this range to have optimal heart health, says Marie-Pierre St-Onge, PhD, the lead author of AHA guidelines on sleep duration and quality issued in 2016 and the director of the Sleep Center of Excellence at Columbia University Irving Medical Center in New York City.

“Adults should strive to get at least seven hours of sleep per night, but there is no reason to stress over getting somewhat less or somewhat more than that,” says Dr. St-Onge.

Deviating too far from this range, however, can increase the risk of several markers of heart disease, including obesity, type 2 diabetes, and high blood pressure, according to the 2016 AHA guidelines that helped inform the new checklist.

If you feel rested, refreshed, and alert in the morning, you’re probably getting enough sleep, particularly if you’re within or close to the recommended number of hours, St-Onge says.

“Although one may feel perfectly fine on less than seven hours of sleep, it does not mean that other aspects of their health, that cannot be ‘felt,’ are not suffering — for example having higher blood glucose or blood pressure,” St-Onge says. “So, although there is some wiggle room around the seven to nine hours of sleep that’s recommended, I wouldn’t recommend straying too far from it.”

If you aren’t getting enough sleep or you wake up feeling exhausted, there are things you can do to try to improve things, says Kristen Knutson, PhD, a sleep researcher and associate professor at the Northwestern University Feinberg School of Medicine in Chicago.

“There are several strategies to improve sleep if someone is not sleeping well, such as avoiding caffeine and alcohol, maintaining a regular bedtime, keeping your bedroom sleep friendly — dark, quiet, cool, and comfortable — and allowing yourself a calming transition between active wakefulness and going to sleep,” Dr. Knutson advises.

If these approaches don’t help, talk to your doctor, Knutson says.

“Inclusion of sleep health in the new AHA measure is a strong message and endorsement for the importance of sleep for cardiovascular and overall health and well-being,” Knutson says. “I hope sleep becomes a standard topic of conversations between patients and physicians in the clinic.”