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Adults are being urged to get between 7 and 9 hours of sleep per night. Valentina Barreto/Stocksy
  • With the inclusion of sleep, the Life’s Simple 7 model for cardiovascular health is now Life’s Essential 8.
  • Other factors such as dietary habits and nicotine exposure received updates.
  • Psychological health is foundational to cardiovascular health and underlies all 8 metrics.

When you think about keeping your heart healthy, you might imagine high-energy workouts to get it beating faster. But that’s not a complete picture of heart health.

Sometimes it’s in your best interest to give it a rest.

The American Heart Association (AHA) has updated its 2010 metrics for cardiovascular health to now include sleep. This new rubric is called Life’s Essential 8, named for its 8 components:

  • healthy diet
  • participation in physical activity
  • avoidance of nicotine
  • healthy sleep
  • healthy weight
  • healthy blood lipid levels
  • healthy blood glucose levels
  • healthy blood pressure

If you’ve noticed the abundant use of the word “healthy,” that’s on purpose. The AHA wants to focus your attention on achieving and maintaining cardiovascular health as opposed to simply avoiding disease.

So what’s new, what’s changed, and what do experts have to say about it?

The most obvious change to the cardiovascular health metrics is the addition of healthy sleep.

According to the AHA’s recommendations, the ideal amount of sleep for adults is at least 7 hours but less than 9 hours per night.

If your average nightly hours of sleep are above or below this range, it’s probably having a negative impact on your cardiovascular health.

This is a good start, but there’s more to healthy sleep than just duration.

Dr. Thomas M. Kilkenny, MS, FAASM, FCCP, the director of the Institute of Sleep Medicine at Staten Island University Hospital in New York, told Healthline that, “shift work, interrupted sleep, and circadian rhythm disorders all can detract from the quality of the sleep experience even if adequate hours of sleep are maintained.”

“It is very important to establish a repeatable routine that is followed every night. One must schedule their sleep time the same way we would schedule a meeting,” Kilkenny said. “Unfortunately, most Americans do the opposite and fit in sleep whenever they find time in their busy schedule.”

“I tell all my patients, you need to be ‘vertical’ during the day to sleep better ‘horizontally’ at night; this means outdoor time and physical activity,” Dr. Alex Dimitriu, an expert in psychiatry and sleep medicine and the founder of Menlo Park (California) Psychiatry & Sleep Medicine and BrainfoodMD, told Healthline.

Dimitriu advised that in order to get a good night’s sleep there are a few things you should avoid during the final hours leading up to bedtime. These include caffeine, alcohol, intense exercise, bright light, naps, and electronic devices.

Experts also suggest that if you’re lying alert in bed, it might actually help to get up.

This sounds counterintuitive, but you want to avoid associating your bed with being frustrated. Experts recommend doing something relaxing, such as reading a hardcover or paperback book, and go back to bed when you feel sleepy.

Another update made by the AHA simplified healthy eating recommendations by shifting the focus to whole foods instead of nutrients.

A Mediterranean diet — which emphasizes fruits, vegetables, whole grains, and heart-healthy fats, while minimizing dairy and meat — would closely match their guidelines.

It’s still important to take a thoughtful approach to your diet, though.

Dr. Rigved Tadwalkar, a cardiologist at Providence Saint John’s Health Center in Santa Monica, California, told Healthline, “I find it unrealistic… to completely cut out a specific type of food in order to be healthy.”

“Sustainability is the key to longer-term behavioral change when it comes to diet,” he added.

“Let’s be clear that red meats, high-sodium foods, and sugary desserts are not specifically conducive to a healthy lifestyle, but for many individuals, taking them away completely is challenging and may serve as a roadblock in their bigger-picture adherence to an overall healthier pattern of eating,” said Tadwalkar.

Dr. Natalie Bello, MPH, the director of hypertension research at the Cedars-Sinai Smidt Heart Institute in Los Angeles, told Healthline she agreed with that sentiment.

“Everything in moderation. We’re talking about avoiding things that are bad for us, not necessarily abstaining 100 percent. I certainly never tell people you can’t have cake on your birthday,” said Bello.

“I encourage people who are trying to eat a healthier diet to start small and maybe swap out one meal a week to be more green-focused and vegetable-focused. You want it to be easily incorporated into your life, otherwise, you’re setting yourself up for failure,” Bello added.

“If you can go to the grocery store and do your own shopping that’s really helpful,” she suggested. “Sometimes fresh fruits and vegetables are really expensive or unavailable in certain neighborhoods. There are good frozen options, but it’s important to find the fresh-frozen options that don’t have added sugars or sauces or butter.”

Nicotine usage is still something you should avoid according to the new guidelines, but the update now recommends avoiding vaping devices too.

It also takes secondhand smoke into account in calculating overall cardiovascular health.

Physical activity recommendations are unchanged but still important. Adults need at least 150 minutes of moderate-intensity activity per week, while children need 420 minutes.

And it’s never too early to start building healthy habits.

“Good or bad habits start at an early age. That’s not a gloom-and-doom message. It’s about empowering patients and their families to understand what their risk is — through no fault of their own — and to motivate them to make healthier choices,” said Bello.

The new guidelines also note that your body isn’t isolated from your mind.

“The [COVID-19] pandemic brought to the forefront how interconnected our mental health and physical health are. I applaud the AHA for calling out how anxiety, anger, stress, and depression can impact our physical health. We need to treat the whole person in order to be healthy,” said Bello.

Dr. Michael Goyfman, the chief of cardiology and director of echocardiography at Long Island Jewish Forest Hills hospital in Queens, New York, told Healthline that, “interventions to optimize mental health such as mindfulness, meditation, and yoga have been shown in numerous studies to have cardiovascular benefits at least as large if not better than therapies targeting blood pressure or cholesterol levels.”

The key now is to spread the word about these new guidelines to as many people as possible.

“It’s not just about individuals and their doctors, but it’s about society, our local governments, the [Centers for Disease Control and Prevention], and other national initiatives to improve the health of our whole population. We really need to improve equitable cardiovascular health and provide appropriate healthy interventions to all people in all communities and meet people where they’re at,” Bello said.