7.9.2: Risk Factors/Protective Factors
The American Heart Association has compiled evidence-based metrics for cardiovascular health (CVH) into 8 different categories they call “Life’s Essential 8”. Ideal cardiovascular health includes:
- Nutrition: eating in a pattern close to the Dietary Approaches to Stop Hypertension (DASH) recommendations or a Mediterranean diet
- Physical Activity: achieving the CDC recommended minimum amount of physical activity for adults each week - 150 minutes of moderate physical activity, or 75 minutes of vigorous physical activity, or some combination. (The recommendations now also include two days of muscle strengthening activities).
- Smoking: avoiding exposure to tobacco smoke whether it be firsthand or secondhand.
- Sleep: getting at least 7 hours of sleep per night.
- Body weight: not being in the overweight or obese categories for body mass index (BMI).
- Blood lipids: keeping total cholesterol, LDL cholesterol and triglycerides low, while maintaining healthy levels of HDl cholesterol.
- Blood glucose: maintaining a healthy blood sugar level as measured by fasting blood glucose or A1C.
- Blood pressure: maintaining a healthy resting blood pressure reading of below 120/80 mmHg.
Conversely, smoking, obesity, sedentarism, poor nutrition, a consistent lack of sleep (and resulting elevated chronic stress), hypertension, diabetes and pre-diabetes, and high cholesterol are all risk factors for cardiovascular disease. Each of these health behaviors and factors is independently associated with an increased risk of cardiovascular disease, even though the behaviors and factors can be related. Several different types of research have shown that a low to moderate level of cardiovascular health as measured by these “Life’s Essential 8” contribute to 70% of CVD events, and maintaining high levels of CVH over time decreases lifetime risks of various cardiovascular diseases - perhaps even prolonging life by 4-5 years. A high level of CVH during pregnancy was also correlated with better cardiovascular health of the kids years later. The benefits of “Life’s Essential 8” are similar across all race and ethnicity demographics, yet it should also be recognized that the social determinants of health contribute to disparities in CVH measures and the likelihood of achieving these protective factors (Tsao et al., 2023).