This everyday behavior is essential to preventing heart disease

In 2010, the American Heart Association debuted Life’s Simple 7, a set of seven behaviors to help prevent heart disease and live a healthier life. On June 29, 2022, seven became eight, with a few updates to the existing guidelines.

The newest, evidence-based hack to improve your health is something we all do everyday, though probably not enough: Sleep.

The original seven are as follows:

• Diet: The AHA recommends eating hearty fruits, vegetables, lean protein, whole grains, and cooking in olive and canola oil.
• Physical activity: Kids should have active play for an hour a day and adults should take part in moderate exercise for two and a half hours a week.
• Nicotine exposure: Limiting direct and secondhand exposure to nicotine with traditional cigarettes and vapes greatly decreases one's risk of heart disease.
• Weight: Maintaining a healthy weight range optimizes cardiovascular health, and disregarding unhealthy weights can lead to an increased risk of long-term diseases.
• Cholesterol: Keeping LDL cholesterol low keeps the heart and circulatory system happy and healthy.
• Blood sugar: Monitoring blood sugar levels can prevent diseases like diabetes and damage to the heart, kidneys, eyes, and nerves.
• Blood pressure: Levels below 120/88 mm Hg are key to long-term health.

Now together with sleep, these are Life’s Essential 8, health pillars upholding cardiovascular wellness.

The guidelines recommend that in a 24-hour period, adults sleep 7 to 9 hours a night, children ages 5 and under sleep 10 to 16 hours, children ages 6 to 12 sleep for 9 to 12 hours, and teens ages 13 to 18 sleep for 8 to 10 hours. “Adequate sleep promotes healing, improves brain function, and reduces the risk for chronic diseases,” the AHA notes on its site.

The AHA also applied this updated rubric to the National Health and Nutrition Examination Survey, evaluating Americans’ overall heart health. With the release of Life’s Essential 8, they published the study’s findings in their journal Circulation on June 29, 2022. The findings show Americans have room to improve on both heart and holistic health.

LONGEVITY HACKS is a regular series from Inverse on the science-backed strategies to live better, healthier, and longer without medicine. Get more in our Hacks index.

Science in action — The researchers followed a sampling of people from 2013 to 2018 and calculated their overall cardiovascular health score according to Life’s Essential 8. The 23,409 participants between ages 2 and 79 were not pregnant or kept in a prison or hospital long-term, and who were heart disease-free.

Because health and healthcare access varies widely depending on race, class, gender, where one lives, and many other factors, the AHA tried to account for the demographic breakdown. Researchers who recruit patients for the survey “very thoughtfully and mindfully select individuals who will represent their socio-demographic groups across the country in aggregate,” Donald Lloyd-Jones, president of the American Heart Association and the study’s first author, tells Inverse. So while more than 23,000 people participated, recruiters worked to over-represent marginalized populations that are often ignored. The paper notes that the survey’s patients proportionally represent more than 201 million adults and 74 million children, excluding those who are pregnant and/or institutionalized.

That said, one’s demographics determine the likelihood of developing certain diseases. Black Americans were 30 percent more likely to die of heart disease in 2018 than non-Hispanic white Americans. A 2019 study shows a link between stress-related brain activity in people from low-income backgrounds, inflammation, and a higher risk of heart problems.

Accounting for demographics informs the country’s average heart health, but it’s important to keep in mind that some groups are more vulnerable to heart disease than others not because they’re predisposed to heart disease, but because they may be denied or do not have access to healthcare.

The average cardiovascular health score was 64.7 out of 100 among adults based on all eight metrics, and 65.5 out of 100 for kids aged 2 to 19 based on only three metrics that were available for young people. Women on average had a better score than men (67.0 vs. 62.5) and based on one’s race or ethnicity cardiovascular health scores ranged between 59.7 and 68.5

Why it’s a hack — Adding sleep to this rubric finally quantifies a crucial aspect of health. Lloyd-Jones says that back in 2010, factors like sleep and stress were hard to quantify, and so their impact was hard to measure. Since then, sleep science has quantified measurements a bit more.

“Years later, not only do we have more information about how those things relate to the original Simple Seven, but particularly sleep is now measured more routinely, we understand more about what sort of the optimal levels are and so we felt that it was time to include it because it really is related,” Lloyd-Jones says.

Parents of newborns, toddlers, and teens might roll their eyes at the amount of recommended sleep for their age group. Babies aren’t easy sleepers, and teenagers might alternate between pulling all-nighters and sleeping the entire weekend. Adding sleep as a guideline isn’t a hard and fast rule, but something to strive for.

Lloyd-Jones says that one of the criticisms of the Simple 7 was that although they were important they weren’t simple. “That's why I think you have the Essential 8 rather than the Easy 8.”

Sufficient and reliable sleep is a privilege. Those who work two or three jobs and care for their family may be running on less than 7 hours of sleep within a day. Perhaps some people live in places where it’s difficult to sleep, and others may have conditions that make sleep hard to come by. In 2014, the Centers for Disease Control found that more than 35 percent of adults in the US sleep less than seven hours. People of color and single parents are also more likely to sleep less than what’s recommended.

How it affects longevity — Sleep isn’t just about restoring energy, but healing the body and mind. There’s a link between sleep disorders like obstructive sleep apnea and insomnia with heart disease.

Truncated sleep also changes the way the body functions. Studies associate insufficient sleep with inflammation, diabetes, heart attack, and stroke. Losing sleep may even lead to increased insulin resistance.

Unfortunately, there’s also a risk factor associated with too much sleep. “There’s sort of a Goldilocks about sleep,” Lloyd-Jones says. “There is a ‘just right,’ which seems to be in the seven to nine hours of sleep.” Researchers have observed decreased health benefits when folks sleep outside the “just right” zone.

As with everything, genetics have some say over this part of our health. Lloyd-Jones mentions the Artherosclerosis Risk in Communities (ARIC) study, which he says “should give people hope.” Atherosclerosis comes from plaque and fatty deposits building up in the arteries. ARIC looked at a person’s risk factors for cardiovascular disease based on their genetics as well as their lifestyle. Those who had a high genetic risk but a healthy lifestyle had better cardiovascular health scores than those with low genetic risk but a less healthy lifestyle. Lloyd-Jones says on average the former outlived the latter by 11 years.

So the good and bad news? Our health is in our hands.

Hack score — 😴😴😴😴😴😴/10 (6 out of 10 people snoozing toward better cardiovascular health)