Breaking Down AHA’s Life’s Essential 8 Checklist from Fitterfly’s Webinar

The American Heart Association (AHA) has outlined a comprehensive checklist of 8 essential health factors to promote optimal cardiovascular health and reduce heart disease and stroke risk. Cardiologists recommend patients incorporate these health tips for the heart into their daily routines.

Since the global burden of cardiovascular disease is rising exponentially (19.8 million deaths in 2022), embracing the AHA-recommended healthy lifestyle practices holds significant promise in preventing heart disease complications and reducing hospital admissions.

Fitterfly hosted an insightful webinar led by Dr Vivek Baliga [MBBS MRCP PhD MBA PGDLM, Consultant Physician and Cardiologist; Director, Baliga Diagnostics] and Dr Manthan Mehta (Program Head for Hypertension & CV Health, Fitterfly) to highlight the significance of adopting health tips for the heart to prevent cardiovascular diseases. The focal points of the discussion related to AHA’s Life’s Essential 8 Checklist are encompassed below:

Fig 1: Eminent speakers at the Fitterfly’s webinar

Heart-Healthy Food Consumption

AHA recommends consuming fresh fruits, vegetables, whole grains, plant-based proteins, lean animal proteins, seafood, and nuts as a heart-healthy tip. It also advocates limiting red and processed meats, refined carbohydrates, and sodium. 

A review by Dagfinn Aune et al., including 45 studies (64 publications), found that an increase in whole grain consumption by 90 g/day per day could reduce the risk for coronary heart disease by 19% and cardiovascular disease by 22%. 

Another 2020 study by Long Ge et al. involving 121 eligible trials with 21942 candidates revealed that low carbohydrate and low-fat diets successfully reduced systolic pressure by 5.14 mmHg and diastolic pressure by 3.21 mmHg (in comparison to standard diet) following 6 months of continuous consumption.

Regular Workouts

The AHA recommends either 150 minutes of moderate aerobic activity per week, or alternatively, 75 minutes of vigorous aerobic activity per week, or a combination of both. Aerobic exercises like brisk walking, cycling, hiking, running, climbing stairs, and swimming use aerobic metabolism to extract muscle energy. They promote lipid metabolism, cardiac remodeling, post-MI heart failure, insulin resistance, and endothelial function. 

Anaerobic exercises like sprinting and powerlifting improve BMI levels, reduce blood pressure, and lower triglycerides and LDL levels. High-intensity intermittent exercise is beneficial because it considerably improves cardiovascular health within a shorter time (3-4 sessions/week).

Fig 2: AHA recommended Life’s Essential 8 Checklist for a healthy heart

Quitting Tobacco

Smoking is linked to about ⅓ of all cardiovascular disease mortality and 90% of lung cancers. Emily Banks et al. performed a study on 188,167 CVD and cancer-free candidates in the age group ≥ 45 years to find out of the 36 most common specific CVD subtypes. Smokers demonstrated a higher incidence of 29 subtypes. The cardiovascular death hazard ratio among current smokers who smoke 4 to 6 cigarettes per day was 1.92, while for those who smoke 25 or more cigarettes per day was 4.90.

Quality Sleep

7-9 hours of quality sleep is crucial for adults to maintain optimal cardiovascular health. A study involving 60,586 adults aged 40 years or older pointed out that participants sleeping less than 6 hours daily demonstrated an increased risk of coronary heart disease. Researchers concentrated on two types of Sleep Scores (multiplicative and additive) for this study.

Candidates in the lowest multiplicative and additive Sleep Scores quartile demonstrated a hazard ratio of 1.31.  Participants exhibiting dreamy sleep and difficulty falling asleep/use of sleeping pills showed increased heart disease risk.

Managing Weight

Maintaining a healthy BMI range between 18.5 kg/m2 and 24.9 kg/m2 is crucial in achieving optimal cardiovascular health. A long-term weight loss study by V J Stevens et al. pointed out that up to 4.5 kg weight loss could significantly reduce blood pressure and relative hypertension risk.

The intervention group achieving 4.5 kg weight reduction at 6 months (n = 595) showed a hypertension risk ratio of 0.58 at 6 months, 0.78 at 18 months, and 0.81 at 36 months.

Managing Cholesterol

The Journal of the American College of Cardiology (JACC) recommends total cholesterol of ﹤200 mg/dL, high-density lipoprotein cholesterol (HDL-C) of 60 mg/dL or higher, low-density lipoprotein cholesterol (LDL-C) of﹤100 mg/dL, and triglycerides of﹤149 mg/dL.

Eujene Jung et al. systematically reviewed 14 independent reports, including 1,055,309 candidates and 9457 events. The result revealed that the hazard ratio was 1.27 for total cholesterol, 1.21 for LDL-C, and 0.60 for HDL-C. It presented a linear relationship between serum cholesterol (TC, HDL-C) levels and CVD deaths during the meta-analysis.

Controlling Blood Sugar

Clinical data suggest that diabetes patients are more likely to develop cardiovascular complications if their blood sugar does not remain within the standard range. A review by Peter E.H. Schwarz et al. suggested that intensive glucose lowering can decrease micro- and macrovascular morbidities and CV deaths. It also demonstrated that diabetes medications, including GLP-1 RA and SGLT-2 inhibitors, deliver better glycemic control and CV outcomes than traditional BP-lowering drugs.

Controlling Blood Pressure

Maintaining blood pressure below 120/80 mmHg helps reduce the risk of heart attack, stroke, and hospitalisations. Multiple epidemiological data point out that lowering blood pressure may decrease myocardial infarction risk by 20% – 25%, stroke by 35%-40%, and heart failure by 50%.

Antihypertensive treatment that blocks the renin-angiotensin-aldosterone system (RAAS) can decrease heart disease risks independent of BP reduction.

Adherence to AHA’s Life’s Essential 8 Checklist

In conclusion, adhering to the AHA’s Life’s Essential 8 Checklist is a proactive and effective approach to mitigating heart disease risk. Patients can take charge of their cardiovascular health by focusing on these eight key health tips for the heart —smoking cessation, physical activity, healthy diet, body weight, blood pressure, cholesterol levels, blood sugar, and medication adherence.

 Dr Baliga also advocated following these health tips for the heart according to the Indian perspective to reduce CVD risk. Check out the webinar video on YouTube for a detailed explanation of these eight key factors.