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Life's essential 8: updating and enhancing the American Heart Association's construct of cardiovascular health: a presidential advisory from the American Heart Association
Open accessAbstract
In 2010, the American Heart Association defined a novel construct of cardiovascular health to promote a paradigm shift from a focus solely on disease treatment to one inclusive of positive health promotion and preservation across the life course in populations and individuals. Extensive subsequent evidence has provided insights into strengths and limitations of the original approach to defining and quantifying cardiovascular health. In response, the American Heart Association convened a writing group to recommend enhancements and updates. The definition and quantification of each of the original metrics (Life’s Simple 7) were evaluated for responsiveness to interindividual variation and intraindividual change. New metrics were considered, and the age spectrum was expanded to include the entire life course. The foundational contexts of social determinants of health and psychological health were addressed as crucial factors in optimizing and preserving cardiovascular health. This presidential advisory introduces an enhanced approach to assessing cardiovascular health: Life’s Essential 8. The components of Life’s Essential 8 include diet (updated), physical activity, nicotine exposure (updated), sleep health (new), body mass index, blood lipids (updated), blood glucose (updated), and blood pressure. Each metric has a new scoring algorithm ranging from 0 to 100 points, allowing generation of a new composite cardiovascular health score (the unweighted average of all components) that also varies from 0 to 100 points. Methods for implementing cardiovascular health assessment and longitudinal monitoring are discussed, as are potential data sources and tools to promote widespread adoption in policy, public health, clinical, institutional, and community settings.
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“Preventing the development of hypertension reduces risk more than treating existing hypertension.36,37”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [36]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Regular assessments of lipids, glycemia, and kidney function (eg, eGFR) are recommended with increasing frequency for higher CKM stages, as the risk for progressive metabolic and kidney disease increases along the CKM spectrum.13,18–21”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [21]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Ultimately, adverse SDOH have downstream consequences on cardiovascular and all-cause mortality11,14 and contribute to disparities in CVD mortality.21”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [21]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Because the exact relative importance of each CVD risk factor was unclear in this specific population, we used the unweighted average of the four CVD risk factors, which is also common for a composite CVD risk score generation.14”
From Aerobic, resistance, or combined exercise training and cardiovascular risk profile in overweight or obese adults: the CardioRACE trial (2024) · cites this paper as [14]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“These four traditional CVD risk factors are often included in routine composite CVD risk algorithms to predict future CVD in clinical practice.10,11,14,22”
From Aerobic, resistance, or combined exercise training and cardiovascular risk profile in overweight or obese adults: the CardioRACE trial (2024) · cites this paper as [14]
Experimental — accuracy not yet measured
The check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“One small, randomized crossover trial among 44 adults with diabetes and food insecurity found that a medically tailored meal delivery program improved dietary quality and food insecurity and reduced hypoglycemia.21”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [21]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“MBS, the most potent weight loss therapy, has become safer, with less invasive surgical options over time.20,21”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [21]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Greater amounts of intentional weight loss are associated with more substantial improvement in CKM risk factors,20 with some possible reductions in CVD risk with ≥10% weight loss.21”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [21]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Time-restricted eating, the most popular form of which is intermittent fasting, has demonstrated some weight loss efficacy,33,34 but studies indicate it is no more effective than a calorie-limited approach in promoting weight loss or improving cardiovascular risk.35,36”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [36]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“CKM risk factor remission is superior with RYGB bypass compared with LSG.20,21”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [21]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Counseling on dietary or combined dietary and exercise modifications effectively facilitates weight loss in postpartum women with GDM.6,19–21”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [21]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“population-based analyses demonstrating that the overwhelming majority of individuals with CKD and T2D or albuminuria have a 10-year PREVENT-CVD score ≥7.5%.21”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [21]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Clinical trials have indicated a lack of heterogeneity in the effects of each class of these cardioprotective glucose-lowering therapies between those who were and were not taking the other agent.17–19,21”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [21]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Incidentally identified moderate-to-severe coronary calcifications on a nongated chest computed tomography scan typically correlates with CAC ≥100, carries similar prognostic value, and can also identify patients with CKM syndrome most likely to benefit from preventive therapies.21–24”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [21]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“However, a more recent meta-analysis that included 10 GLP-1 RA trials estimated a 13% reduction in HF hospitalization (HR, 0.87 [95% CI, 0.80–0.94]).36”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [36]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“CVD risk reduction was observed with semaglutide prior to clinically significant weight loss, and similar CVD event reductions were observed regardless of the magnitude of weight achieved,21”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [21]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“indicating some cardiovascular benefits that are weight-independent”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [21]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“GLP-1–based therapy often causes significant weight loss and improvements in CKM risk profiles and MASLD, while SGLT2i has a marked impact on CKD.19–30”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [21]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Both SGLT2i and GLP-1–based therapy improve kidney outcomes,49–51 with GLP-1–based therapy additionally promoting significant weight reduction and glycemic control (especially semaglutide and tirzepatide)19–25 and reducing liver fibrosis in MASH”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [21]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“In patients with T2D and ASCVD, SGLT2i and GLP-1–based therapy significantly reduces the risk of MACE and cardiovascular mortality, promotes weight loss,34 and reduces progression of kidney disease”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [36]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Several trials corroborate the safety and efficacy of exercise training for HFpEF, but these did not exclusively recruit patients with obesity.21–23”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [21]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“While there is growing evidence for GLP-1 benefit in HFpEF, there is less clarity regarding efficacy and safety in HFrEF, based on somewhat increased risk for adverse outcomes among patients taking GLP-1 RA in small HFrEF trials.19–21”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [21]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Two high-quality simulation model–based cost-effectiveness analyses projected that adding SGLT2i therapy to prior GDMT in adults with symptomatic HFrEF was cost-effective from a US health care sector perspective and a lifetime analytic horizon,35,36 with an incremental cost-effectiveness ratio between $68 000 and $84 000 per QALY gained (assuming an annual drug cost of $4192 to $5684, which is con”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [36]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“In adults with CKM syndrome stage 4 syndrome with CKD and symptomatic HF with LVEF ≤40%, addition of an SGLT2i prior to GDMT at 2025 US prices is projected to be cost-effective compared with prior GDMT.”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [36]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“However, neither study specifically examined the subgroup of individuals with CKD.”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [36]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“In probabilistic sensitivity analyses, the incremental cost-effectiveness ratio was <$120 000 per QALY gained in >95% of the simulations in 1 analysis,35 and approximately 70% of the simulations in the other.36”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [36]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Among these 4 medication classes (6 classes if the patient also self-identifies as Black race), 2 are kidney-protective; namely, 1) RASi, with ARNI having superior HF benefits over ACEi/ARB; and 2) SGLT2i.13,21–25”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [21]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“RASi, with ARNI having superior HF benefits over ACEi/ARB; and 2) SGLT2i.13,21–25”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [21]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Assessment of fibrosis risk starts with the FIB-4 index, with further sequential assessments as needed to rule out (or rule in) clinically significant fibrosis (≥ stage 2).19–21”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [21]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Moreover, it is an independent risk factor for CVD morbidity and mortality.36”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [36]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“DOACs offer advantages over VKAs: rapid onset, predictable effect, wider therapeutic window, no routine monitoring, and fewer food/drug interactions.21”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [21]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“In stage G3 CKD (eGFR, 30–59 mL/min/1.73 m2), subgroup analyses suggest DOACs are noninferior to VKA for recurrent VTE or major bleeding.35–38”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [36]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“DOAC kidney clearance varies (dabigatran 80%, edoxaban 50%, rivaroxaban 35%, apixaban 27%).21”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [21]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“The CHAP (Chronic Hypertension and Pregnancy) trial demonstrated that optimizing BP control during pregnancy to target <140/90 mm Hg was associated with lower risk of adverse maternal and fetal outcomes.36”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [36]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Multiple RCTs of CKM therapies included albuminuria as an eligibility criterion, with absolute risk reductions for cardiovascular and kidney outcomes commonly greater for those with more baseline albuminuria.12,15,33–38”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [36]
Experimental — accuracy not yet measured
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Assessment of Atherosclerotic Cardiovascular Disease Risk in Primary Prevention
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Features of a Balanced Healthy Diet with Cardiovascular and Other Benefits
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Emerging therapies for MASLD and their impact on plasma lipids
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Cardiovascular Risk Factor Management After Hypertensive Disorders of Pregnancy
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Life's Essential 8 and midlife trajectories in cognition and brain health: The CARDIA study
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Non-Traditional Cardiovascular Risk Factors: Tailored Assessment and Clinical Implications
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10-Year and 30-Year Risks of Cardiovascular Disease in the U.S. Population
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Self-citationImpact of Healthy Lifestyle in Patients With Familial Hypercholesterolemia
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Sleep Capital: Linking Brain Health to Wellbeing and Economic Productivity Across the Lifespan
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Mapping the insomnia patient journey in Europe and Canada
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Self-citationCentral stress pathways in the development of cardiovascular disease
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Association between Life’s Essential 8 and cognitive function: insights from NHANES 2011–2014
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Cardiovascular Health, 2010 to 2020: A Systematic Review of a Decade of Research on Life's Simple 7
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Self-citationImplementing sustainable liver health in Europe: a second EASL–Lancet Commission
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Improving the cardiovascular health care of transgender and non-binary persons
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Metadata
- Authors
- Lloyd-Jones, D. M., Allen, N. B., Anderson, C. A. M., Black, T., Brewer, L. C., Foraker, R. E., Grandner, M. A., Lavretsky, H., Perak, A. M., Sharma, G., Rosamond, W., & on behalf of the American Heart Association
- ORCID
- Venue
- Circulation
- Published
- 2022-08-02
- Volume
- 146
- Issue
- 5
- Pages
- e18-e43
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- PMC
- PMC10503546
- OpenAlex
- W4283695295
- Semantic Scholar
- 066c19a643fada4d5e4a9c9a68ac02fb8ca11d10
- Cited by
- 2,785
- References
- 226
- Citations by year
- 2026: 650 · 2025: 916 · 2024: 731 · 2023: 432 · 2022: 54
- FWCI
- 108.46
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
- UNC Libraries
- Funders
- American Heart Association
- Centers for Disease Control and Prevention
- National Heart, Lung, and Blood Institute (K23HL145101)
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092950)
- National Institute for Occupational Safety and Health
- National Institute on Minority Health and Health Disparities (R21MD013490, L60 MD012087)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Keywords
- cardiovascular health, Life's Essential 8, Life's Simple 7, cardiovascular health score, cardiovascular health assessment, diet, physical activity, nicotine exposure, sleep health, body mass index, serum lipids, blood glucose, blood pressure, social determinants of health, mental health, life course, interindividual variability, long-term monitoring
- MeSH terms
- American Heart Association, Blood Pressure, Cardiovascular Diseases, Heart, Humans, Risk Factors, United States, Exercise
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