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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.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]
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“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”
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“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]
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“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]
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“Among individuals with MASLD, those with advanced liver fibrosis are at the highest risk.37,38”
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“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”
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“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”
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Metadata
- 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
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