Suboptimal Heart Health in the United States: Concerns and Solutions

The definition of cardiovascular health is based on 7 health behaviors and factors, including diet, physical activity, cigarette smoking, body mass index (BMI), total cholesterol, blood pressure, and blood glucose.¹ These were called “Life’s Simple 7.” Recently, the American Heart Association published an updated algorithm with the additional metric of sleep, called “Life’s Essential 8.”² Data from a new analysis suggest they may be essential but are not simple to achieve and maintain! 

In a study³ conducted at the Northwestern University Feinberg School of Medicine, 23,409 participants from the 2013-20118 National Health and Nutrition Examination Surveys, aged 2-79 years, had their cardiovascular health (CVH) scores assessed by age, sex, race/ethnicity, family income, and depression.

Using all 8 metrics, the overall mean CVH score was 64.7 (95% CI: 63.9-65.6) among adults. Women had higher scores. Only 19.2% of adults had high scores, 62.5% had moderate scores, and 17.9% had low CVH. Diet, physical activity, and BMI were the lowest average scores. The conclusion of the study was that overall CVH in the United States remains well below optimal levels and there is a need to improve CVH across life metrics in both individuals and the population.³

In another study⁴ from Brigham Young University, 13,802 US adults showed a 10-year weight gain of 4.2±0.2kg, or a 6.6%±0.2% gain.⁴ Fifty-one percent of the participants gained at least 5% of body weight, 36% of participants gained at least 10%, and 16% of participants gained at least 20% across the 10 years. Study authors adjusted for age and race and found 10-year weight gain was significantly greater for women (5.4±0.3 kg) vs men (2.6±0.2 kg) (P < .0001). Non-Hispanic Black individuals gained more weight and Asian individuals gained less weight than people of other races.  

Sleep disorders affect mortality, morbidity, safety, performance, and mood.⁵ A single-center, randomized clinical trial⁶ involved 80 participants aged 21-40 years with a BMI between 25.0 and 29.9 who had habitual sleep duration of less than 6.5 hours per night. Sleep duration increased by approximately 1.2 hours per night when participants were randomized to sleep hygiene counseling without any prescribed changes in diet or physical activity.⁶

The clear message from these studies is that the US population’s CVH needs improvement. The data support that most Americans need to focus on their CVH. Reducing sedentary behavior by less than 1 hour per day shows benefit across several cardiac biomarkers.⁷ Increasing light-intensity and moderate to vigorous physical activity (19 and 24 minutes, respectively) will assist in cutting sedentary behavior, may improve BMI, and contribute to better sleep.

Pharmacists have an opportunity to ask patients about their social determinants of health and then counsel patients about CVH and good health behaviors.

References:

1. Lloyd-Jones DM, Hong Y, Labarthe D, et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: The American Heart Association’s strategic Impact Goal through 2020 and beyond. Circulation. 2010;121(4):586-613. doi:10.1161/CIRCULATIONAHA.109.192703
2. Lloyd-Jones DM, Allen NB, Anderson CAM, et al. Life’s Essential 8—Updating and enhancing he American Heart Association’s construct of cardiovascular health: A presidential advisory from the American Heart Association. Circulation. 2022;146(5):e18-e43. doi:10.1161/CIR.0000000000001078
3. Lloyd-Jones DM, Ning H, Labarthe D, et al. Status of cardiovascular health in US adults and children using the American Heart Association’s New “Life’s Essential 8” metrics: Prevalence estimates from the National Health and Nutrition Examination Survey (NHANES) 2013-2018. Circulation. Published online June 29, 2022. doi:10.1161/CIRCULATIONAHA.122.060911
4. Tucker LA, Parker K. 10-year weight gain in 13,802 US Adults: The role of age, sex, and race. J Obesity. Published online May 6, 2022. doi:10.1155/2022/7652408
5. Kryger M, Roth T, Goldstein CA, eds. Principles and Practice of Sleep Medicine. 7th ed. Elsevier; 2022.
6. Tasali E, Wroblewski K, Kahn E, Kilkus J, Schoeller DA. Effect of sleep extension on objectively assessed energy intake among adults with overweight in real-life settings: A randomized clinical trial. JAMA Intern Med. 2022;182(4):365-374. doi:10/1001/jamaintrmed.2021.8098
7. Dunstan DW, Dogra S, Carter SE, Owen N. Sit less and move more for cardiovascular health: emerging insights and opportunities. Nat Rev Cardiol. 2021;18(9):637-648. doi: 10.1038/s41569-021-00547-y