Life’s Essential 8 (LE8) is a set of eight key aspects of cardiovascular health established by the American Heart Association (AHA): healthy eating, physical activity, smoking cessation, sleep hygiene, weight management, cholesterol control, glycemic control, and hypertension management.1 These components are also important for maintaining overall health and can improve outcomes for other aspects of health and conditions, including chronic obstructive pulmonary disease (COPD),2 lung functioning,3 diabetes,4 arthritis,5 mental health,6 and neurological health.7
In 2010, the AHA developed a set of seven key measures for heart health, known as Life’s Simple 7, which included factors like diet, exercise, body mass index (BMI), smoking, cholesterol, blood pressure, and fasting blood glucose.8 The development of Life’s Simple 7 reflects a shift in the approach to cardiovascular health, moving away from a traditional focus on managing existing cardiovascular disease (CVD) toward a more proactive strategy aimed at preventing disease through the formation of healthy habits and the management conditions such has high cholesterol, diabetes, and hypertension.1 By emphasizing these key behavior and health factors, the AHA aimed to equip individuals with effective tools to prevent CVD.
Life’s Simple 7 was developed from evidence that individuals who participate in healthy behaviors including moderate-to-vigorous daily physical activity, healthy diet, not smoking, healthy BMI, and moderate alcohol consumption have at least 50% reduced risk of heart disease compared with individuals who did not engage in aforementioned healthy behaviors.9,10 An analysis of 84,129 women in the Nurses’ Health Study followed from 1980 to 1994 found that with greater prevalence of low-risk factors, incidence of coronary events or stroke decreased.9 Among those who ate a healthy diet, were nonsmoking, and engaged in ≥30 minutes of moderate-to-vigorous exercise each day, incidence of cardiovascular events (CVEs) was 0.99% (RR 0.46). Among those who met all those criteria and also had a BMI <25, incidence of CVEs was 0.73% (RR 0.38), and for those who had a BMI <25 and had moderate alcohol consumption, incidence was 0.46% (RR 0.25).
A 2007 analysis of data from 24,444 postmenopausal women from a population-cohort study had similar findings.10 Those who ate a healthy diet and had minimal alcohol consumption had a 0.59% incidence rate of myocardial infarction (MI) (Relative Risk [RR] 0.53). Those who ate a healthy diet, had minimal alcohol consumption, and were nonsmokers had a 0.53% incidence of MI (RR 0.47). Those who additionally were physically active had 0.41% incidence (RR 0.35), and those who additionally both exercised and had a lower waist to hip ratio had 0.25% incidence (RR 0.22).
In 2022, the AHA updated and expanded upon the earlier Life’s Simple 7 framework into LE8. Development of reliable metrics and new evidence that indicate the impact of sleep on health lead to incorporation of sleep as a cardiovascular health measure.11-13 Additional changes to the guidelines also included more nuanced metrics to quantify intrapersonal improvement behavior or interpersonal differences in health behavior.
The benefits of LE8 extend beyond reduction of CVD risk. Adherence to LE8 has also been associated with reduced noncommunicable disease multimorbidity. An analysis of data from the National Health and Nutrition Examination Survey (NHANES) 2007-2018 (n=24,455) compared the incidence of a variety of noncommunicable disease among those with high, moderate, or low cardiovascular health (CVH) as defined by LE8.5 Compared to those with high CVH, those with low CVH were more likely to have noncommunicable disease multimorbidity (43.5% vs 13.4%, p<0.001). After adjusting for potential covariates, those with moderate CVH had significantly higher rates of with arthritis (70.93% vs 10.39%), asthma (66.21% vs 18.12%), gout (71.17% vs 7.28%), emphysema (66.82% vs 3.16%), thyroid problems (67.88% vs 17.37%), kidney stones (71.88% vs 11.93%), weak or failing kidneys (69.80% vs 8.67%), and chronic bronchitis (68.34% vs 8.24%).
A 2009 prospective analysis of data from the Cardiovascular Health Study (n=4,883) found that adherence to LE8 low-risk lifestyle behaviors decreased the risk of new-onset diabetes mellitus.14 Among those who ate a healthy diet and were physically active, the incidence of diabetes was 22.3% (Hazard Ratio [HR] 0.54). Among those who ate a healthy diet, were physically active, and were nonsmoker, the incidence of diabetes was 12.0% (HR 0.42). Among those who additionally drank in moderation, incidence was 12.8% (HR 0.32), and for those who drank in moderation and also had a BMI <25 or waist circumference in the healthy range, incidence was 3.4% (HR 0.11).
References
- Lloyd-Jones DM, Allen NB, Anderson CAM, et al. Life's Essential 8: Updating and Enhancing the American Heart Association's Construct of Cardiovascular Health: A Presidential Advisory From the American Heart Association. Circulation. Aug 2 2022;146(5):e18-e43. doi:10.1161/CIR.0000000000001078
- Liu Y, Li W, Tang J, Gao S. Association of life's essential 8 with chronic obstructive pulmonary disease: a population-based analysis of NHANES 2007-2018. BMC Public Health. Nov 13 2024;24(1):3144. doi:10.1186/s12889-024-20534-5
- Zhang W, Zou M, Liang J, et al. Association of lung health and cardiovascular health (Life's Essential 8). Front Med (Lausanne). 2025;12:1481213. doi:10.3389/fmed.2025.1481213
- Ueno K, Kaneko H, Okada A, et al. Association of four health behaviors in Life's Essential 8 with the incidence of hypertension and diabetes mellitus. Prev Med. Oct 2023;175:107685. doi:10.1016/j.ypmed.2023.107685
- Zhang Y, Sun M, Wang Y, et al. Association of cardiovascular health using Life's Essential 8 with noncommunicable disease multimorbidity. Preventive Medicine. 2023/09/01/ 2023;174:107607. doi:https://doi.org/10.1016/j.ypmed.2023.107607
- Xu Y, Ning W, Zhang Y, et al. Associations Between Cardiovascular Health (Life's Essential 8) and Mental Disorders. Clin Cardiol. Sep 2024;47(9):e70019. doi:10.1002/clc.70019
- Clocchiatti-Tuozzo S, Rivier CA, Renedo D, et al. Life's Essential 8 and Poor Brain Health Outcomes in Middle-Aged Adults. Neurology. Nov 26 2024;103(10):e209990. doi:10.1212/wnl.0000000000209990
- Lloyd-Jones DM, Hong Y, Labarthe D, et al. Defining and Setting National Goals for Cardiovascular Health Promotion and Disease Reduction. Circulation. 2010;121(4):586-613. doi:doi:10.1161/CIRCULATIONAHA.109.192703
- Stampfer MJ, Hu FB, Manson JE, Rimm EB, Willett WC. Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med. Jul 6 2000;343(1):16-22. doi:10.1056/nejm200007063430103
- Akesson A, Weismayer C, Newby PK, Wolk A. Combined effect of low-risk dietary and lifestyle behaviors in primary prevention of myocardial infarction in women. Arch Intern Med. Oct 22 2007;167(19):2122-7. doi:10.1001/archinte.167.19.2122
- Yang X, Chen H, Li S, Pan L, Jia C. Association of Sleep Duration with the Morbidity and Mortality of Coronary Artery Disease: A Meta-analysis of Prospective Studies. Heart Lung Circ. Dec 2015;24(12):1180-90. doi:10.1016/j.hlc.2015.08.005
- Grandner MA. Sleep and obesity risk in adults: possible mechanisms; contextual factors; and implications for research, intervention, and policy. Sleep Health. Oct 2017;3(5):393-400. doi:10.1016/j.sleh.2017.07.014
- St-Onge MP, Grandner MA, Brown D, et al. Sleep Duration and Quality: Impact on Lifestyle Behaviors and Cardiometabolic Health: A Scientific Statement From the American Heart Association. Circulation. Nov 1 2016;134(18):e367-e386. doi:10.1161/cir.0000000000000444
- Mozaffarian D, Kamineni A, Carnethon M, Djoussé L, Mukamal KJ, Siscovick D. Lifestyle risk factors and new-onset diabetes mellitus in older adults: the cardiovascular health study. Arch Intern Med. Apr 27 2009;169(8):798-807. doi:10.1001/archinternmed.2009.21
