The American Heart Association (AHA) has for the first time defined "ideal cardiovascular health" and linked it to seven simple measures ("Life's Simple 7") that people can influence through diet and lifestyle changes to move from poor and intermediate to ideal health.

Details of the seven health factors and lifestyle behaviors were published online before print on 20 January in Circulation: Journal of the American Heart Association in an AHA scientific statement about the new goals for defining and setting national goals for cardivascular health and disease prevention.

Lead author Donald M. Lloyd-Jones, chair of the Department of Preventive Medicine and associate professor of Preventive Medicine and Medicine at Northwestern University Feinberg School of Medicine in Chicago, said that improvements in the seven health factors and lifestyle behaviors can greatly affect quality of life and life span, as well as dramatically reduce the financial burden of the Medicare-eligible population.

"If we reach people in middle age and even younger with this message, we could change American health for the better for decades to come," said Lloyd-Jones.

The AHA recently did a survey where they found 39 per cent of Americans think they have ideal heart health yet 54 per cent reported being told by a health professional that they had a risk factor for heart disease or needed to make a lifestyle change to improve their heart health. They concluded this showed that most Americans don't link important risk factors such as being inactive and having a poor diet with cardiovascular disease.

The AHA has launched a new two-pronged national goal to:
  • Improve the cardiovascular health of all Americans by 20 per cent by 2020, and
  • Reduce deaths from cardiovascular diseases and stroke by 20 per cent by 2020.
To reflect the conclusion of the survey, the goal has a new prevention focus compared to previous strategies and is the first time the AHA has adopted better health as a principal goal.

In support of this, the association has identified seven measures: health factors and lifestyle behaviors, that people can work towards to improve their heart health.

They suggest that "ideal cardiovascular health" is being able to describe oneself as meeting "Life's Simple 7" measures, that is being able to say the following seven things about onself, all of which can be influenced through lifestyle and diet:

Life's Simple 7
  1. Never smoked, or quit more than a year ago.

  2. Having a BMI (body mass index) of less than 25 kg/m2.

  3. Exercising at a moderate level for at least 150 minutes, or at an intense level for 75 minutes per week.

  4. Meeting four to five of the key components of a healthy diet in line with current AHA guidelines.

  5. Having a total cholesterol of less than 200 mg/dL.

  6. Blood pressure below 120/80 mm Hg.

  7. Fasting blood glucose below 100 mg/dL.
BMI or body mass index is the ratio of a person's weight in kilos to their height in metres squared. For instance, a person 6 ft tall (1.83 m) weighing 13 stone (82.6 kg) has a BMI of 24.8, while a person who is a foot shorter (5 ft tall, 1.5 m) would have to be 3 stone (19.1 kg) lighter (9 stone, 57.2 kg) to have about the same BMI.

AHA Healthy Diet

The AHA defines the key components of a healthy diet (based on a 2,000 calories a day diet) as:
  • 4.5 cups a day of fruits and vegetables: diets rich in these are linked to lower risk of cardiovascular diseases as well as lower rates of obesity and high blood pressure.

  • Two or more 3.5 ounce (100 gm) servings a week of fish (preferably oily such as salmon or mackerel, since these are high in omega-3 fatty acids). Eating fish is linked with lower risk of sudden cardiac death, and diets high in omega-3 fatty acids may reduce triglycerides in some people.

  • Less than 450 kcal a week of sugar-sweetened beverages (a 330 ml, 12 fl oz, can of coke is 139 kcal). The more sweetened beverages you consume, the greater the chance that you are displacing necessary nutrients from your diet that should come from healthier foods. High sugar diets are linked with obesity, and more recently, high blood pressure.

  • Three or more 1-ounce (28 gm) servings a day of whole grains. These are high in fiber, which helps lower cholesterol, and they also contain essential vitamins, minerals and other nutrients. Diets high in whole grains are linked to lower risk of cardiovascular disease and help you reach and maintain a healthy body weight.

  • Less than 1,500 mg of sodium a day. The US Centers for Disease Control and Prevention suggests nearly 70 per cent of US adults exceed this.
President of the AHA, Dr Clyde W. Yancy, who is medical director of the Baylor Heart and Vascular Institute at Baylor University Medical Center in Dallas, said:

"To date, there has been great success in reducing disability and death from heart disease and stroke in part through aggressive improvements in the diagnosis and treatment of these diseases and in limited uptake of measures to prevent heart disease and stroke."

"We achieved our 2010 goal of reducing death by heart disease and stroke by 25 percent -- earlier and by a wider margin than we had targeted." said Yancy, adding that:

"However, too many people continue to have unrelenting exposure to known important risk factors for heart disease and stroke to the point that we are likely to begin seeing an increase in these diseases -- and at an earlier age. That is a cause for alarm and a trend we need to stop now."

Lloyd-Jones said that "Ideal" health can be difficult to achieve, partly because our genes play an important role in several of the health factors, but he said everyone should strive to reach his or her own optimal level of heart health.

The first step, said Lloyd-Jones, is to know your numbers: what are your levels of cholesterol, blood pressure, glucose? What do they mean? Then try to reach as close to the "ideal" as you can.

"Essentially, everyone is a candidate to take at least one step forward in these metrics, from poor to intermediate or intermediate to ideal, to move a substantial portion of the population and have a real impact on cardiovascular health," said Lloyd-Jones.

The AHA has set up a website to help people start doing what Lloyd-Jones suggests: http://www.heart.org/MyLifeCheck.

Yancy said the AHA's "Life's Simple 7" is a step by step approach that "delivers on the hope we all have - to live a long, productive, healthy life".

"Any favorable movement on these proven measures will lead to better outcomes. The payoff here is that with even modest improvements in health, the benefit of a longer, healthier life free of disease is real," said Yancy.

Yancy said the goals are "aggressive" and to this end the AHA will team up with healthcare, government and other agencies to change policy and other measures to help Americans achieve ideal cardiovascular health.

Yancy said the best way to treat heart disease and stroke is to avoid disease altogether: we should not just be focusing on reducing the burden of disease but also preventing it. That should be a cornerstone of health reform, and "should matter to everyone", he said.

" Defining and Setting National Goals for Cardiovascular Health Promotion and Disease Reduction. The American Heart Association's Strategic Impact Goal Through 2020 and Beyond."
Donald M. Lloyd-Jones, Yuling Hong, Darwin Labarthe, Dariush Mozaffarian, Lawrence J. Appel, Linda Van Horn, Kurt Greenlund, Stephen Daniels, Graham Nichol, Gordon F. Tomaselli, Donna K. Arnett, Gregg C. Fonarow, P. Michael Ho, Michael S. Lauer, Frederick A. Masoudi, Rose Marie Robertson, Véronique Roger, Lee H. Schwamm, Paul Sorlie, Clyde W. Yancy, Wayne D. Rosamond, and on behalf of the American Heart Association Strategic Planning Task Force and Statistics Committee.
Circulation 2010: published online before print January 20, 2010.
DOI: 10.1161/CIRCULATIONAHA.109.192703

Source: AHA.

Written by: Catharine Paddock, PhD