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 through 2018
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Background: The American Heart Association recently published an updated algorithm for quantifying cardiovascular health (CVH)—the Life’s Essential 8 score. We quantified US levels of CVH using the new score. Methods: We included individuals ages 2 through 79 years (not pregnant or institutionalized) who were free of cardiovascular disease from the National Health and Nutrition Examination Surveys in 2013 through 2018. For all participants, we calculated the overall CVH score (range, 0 [lowest] to 100 [highest]), as well as the score for each component of diet, physical activity, nicotine exposure, sleep duration, body mass index, blood lipids, blood glucose, and blood pressure, using published American Heart Association definitions. Sample weights and design were incorporated in calculating prevalence estimates and standard errors using standard survey procedures. CVH scores were assessed across strata of age, sex, race and ethnicity, family income, and depression. Results: There were 23 409 participants, representing 201 728 000 adults and 74 435 000 children. The overall mean CVH score was 64.7 (95% CI, 63.9–65.6) among adults using all 8 metrics and 65.5 (95% CI, 64.4–66.6) for the 3 metrics available (diet, physical activity, and body mass index) among children and adolescents ages 2 through 19 years. For adults, there were significant differences in mean overall CVH scores by sex (women, 67.0; men, 62.5), age (range of mean values, 62.2–68.7), and racial and ethnic group (range, 59.7–68.5). Mean scores were lowest for diet, physical activity, and body mass index metrics. There were large differences in mean scores across demographic groups for diet (range, 23.8–47.7), nicotine exposure (range, 63.1–85.0), blood glucose (range, 65.7–88.1), and blood pressure (range, 49.5–84.0). In children, diet scores were low (mean 40.6) and were progressively lower in higher age groups (from 61.1 at ages 2 through 5 to 28.5 at ages 12 through 19); large differences were also noted in mean physical activity (range, 63.1–88.3) and body mass index (range, 74.4–89.4) scores by sociodemographic group. Conclusions: The new Life’s Essential 8 score helps identify large group and individual differences in CVH. Overall CVH in the US population remains well below optimal levels and there are both broad and targeted opportunities to monitor, preserve, and improve CVH across the life course in individuals and the population.
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Preventing the development of hypertension reduces risk more than treating existing hypertension.
“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 [37]
The Implications for Public and Individual Health section says that improving cardiovascular health earlier has a larger effect on outcomes, and it recommends better blood-pressure control. It does not compare the risk reduction from preventing hypertension with that from treating existing hypertension; the claim applies its broader point to a specific comparison the paper does not make. No page number was provided for the passage. (LLM, conf=0.72)
Experimental — accuracy not yet measuredPhysical activity alone is unlikely to result in clinically significant weight loss, but combining dietary modification with exercise results in greater long-term weight loss than dietary modification alone.
“While physical activity alone is unlikely to result in clinically significant weight loss, combining dietary modification with exercise results in greater long-term weight loss than dietary modification alone.37,38”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [37]
The ‘Implications for Public and Individual Health’ section discusses diet, physical activity, and maintaining lean body weight as aspects of cardiovascular health, but does not compare their effects on weight loss. Searches for clinically significant weight loss and for exercise plus diet versus diet alone found no passage addressing either part of the claim. Page numbers were not available in our copy. (LLM, conf=0.75)
Experimental — accuracy not yet measuredMost individuals with T2D have multiple additional metabolic risk factors for CVD, including excess abdominal adiposity, hypertension and dyslipidemia, with the majority meeting criteria for metabolic syndrome.
“Most individuals with T2D have multiple additional metabolic risk factors for CVD, including excess abdominal adiposity, hypertension and dyslipidemia, with the majority meeting criteria for metabolic syndrome.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 [37]
The Status of CVH in Adults section reports BMI, blood-lipid, glucose, and blood-pressure scores for the adult sample, but not the prevalence of those risk factors among people with T2D. Searches for type 2 diabetes, abdominal adiposity, and metabolic syndrome found no passage establishing that most people with T2D have multiple additional risk factors or meet metabolic-syndrome criteria. (LLM, conf=0.75)
Experimental — accuracy not yet measuredSGLT2i appear to primarily reduce incident and worsening HF.
“SGLT2i appear to primarily reduce incident and worsening HF.17,37–44”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [37]
The paper’s Implications for Public and Individual Health section discusses improving cardiovascular health through diet and other population-level measures. Searches for SGLT2 inhibitors and reductions in incident or worsening heart failure found no passage addressing that claim. The retrieved passages have no page numbers. (LLM, conf=0.77)
Experimental — accuracy not yet measuredAmong individuals with MASLD, those with advanced liver fibrosis are at the highest risk.
“Among individuals with MASLD, those with advanced liver fibrosis are at the highest risk.37,38”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [37]
The paper’s Status of CVH in Adults and Implications for Public and Individual Health sections discuss cardiovascular-health scores and outcomes, not risk differences by liver-fibrosis stage among people with MASLD. Searches for MASLD, advanced liver fibrosis, and nonalcoholic fatty liver disease found no passage addressing the claim (page numbers unavailable in our copy). (LLM, conf=0.76)
Experimental — accuracy not yet measured
In stage G3 CKD, subgroup analyses suggest DOACs are noninferior to VKA for recurrent VTE or major bleeding.
“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 [37]
The Principal Findings section reports cardiovascular-health estimates using Life’s Essential 8, not anticoagulant outcomes. Searches for DOACs versus VKA and stage G3 CKD found no passage addressing recurrent VTE, major bleeding, or noninferiority; the available passages have no page numbers. (LLM, conf=0.76)
Experimental — accuracy not yet measuredMultiple 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.
“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 [37]
The paper’s Status of CVH in Adults section reports NHANES cardiovascular-health scores, while the retrieved References passages do not address the claim. Searches for albuminuria, CKM therapies, trial eligibility, and absolute risk reductions found no passage supporting the attributed RCT findings; page numbers were unavailable in our copy. (LLM, conf=0.76)
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Shu, W., Li, M., Xiao, H., Amaerjiang, N., Khattab, N. M., Zunong, J., Guan, M., Vermund, S. H., & Hu, Y. (2023) · Journal of the American Heart Association · doi:10.1161/jaha.122.029077 · Cited by 14 · see citing works
Food Insecurity and Ideal Cardiovascular Health Risk Factors Among US Adolescents
Hammad, N. M., Wolfson, J. A., de Ferranti, S. D., Willett, W. C., & Leung, C. W. (2024) · Journal of the American Heart Association · doi:10.1161/jaha.123.033323 · Cited by 14 · see citing works
- Authors
- Lloyd-Jones, D. M., Ning, H., Labarthe, D., Brewer, L., Sharma, G., Rosamond, W., Foraker, R. E., Black, T., Grandner, M. A., Allen, N. B., Anderson, C., Lavretsky, H., & Perak, A. M.
- Affiliations
- Northwestern University Feinberg School of Medicine, Chicago, IL (D.M.L.-J., H.N., D.L., N.B.A., A.M.P.).
- Northwestern University (US)
- Mayo Clinic (US)
- Johns Hopkins University (US)
- University of North Carolina at Chapel Hill (US)
- Washington University in St. Louis (US)
- University of Massachusetts Amherst (US)
- University of Arizona (US)
- University of California San Diego (US)
- University of California, Los Angeles (US)
- ORCID
- Venue
- Circulation
- Published
- 2022-09-13
- Volume
- 146
- Issue
- 11
- Pages
- 822-835
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W4283698126
- Semantic Scholar
- 0d5a3148e3654d20c8ac3ee2acc193b0f52d32b2
- Cited by
- 480
- References
- 48
- Citations by year
- 2026: 81 · 2025: 141 · 2024: 167 · 2023: 83 · 2022: 8
- FWCI
- 69.59
- Type
- journal article
- Language
- en
- Update notices
- correction (2022-11-14)
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
- UNC Libraries
- Funders
- National Heart, Lung, and Blood Institute (K23HL145101)
- National Center for Complementary and Integrative Health (K24AT009198)
- 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 › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- cardiovascular health, Life's Essential 8, cardiovascular health score, cardiovascular disease prevention, diet quality, physical activity, body mass index, nicotine exposure, sleep duration, serum lipids, blood glucose, blood pressure, children and adolescents, adults, sex differences, racial and ethnic disparities, socioeconomic status, depression, NHANES, prevalence estimates, United States population, health disparities
- MeSH terms
- Adolescent, Adult, American Heart Association, Blood Glucose, Blood Pressure, Cardiovascular Diseases, Child, Child, Preschool, Female, Humans, Male, Nicotine, Nutrition Surveys, Pregnancy, Risk Factors, United States, Prevalence
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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