Life’s Essential 8 (LE8) is a comprehensive framework developed by the American Heart Association (AHA) to define, measure, and promote optimal cardiovascular health across a person’s lifespan. This metric evolved from the previous “Life’s Simple 7” to reflect contemporary scientific understanding of heart and brain health. The LE8 framework expands the focus beyond traditional disease risk factors to include specific behavioral and biological components. It serves as a standardized checklist to help individuals and healthcare providers assess health status and target areas for improvement.
The Eight Pillars of Cardiovascular Wellness
The eight factors comprising Life’s Essential 8 are divided into two groups: four Health Behaviors and four Health Factors. These pillars work together, as improvements in behaviors often lead to positive changes in the measurable health factors. The goal is to move each component toward its ideal range, significantly reducing the lifetime risk of cardiovascular disease.
Health Behaviors
Diet
The diet metric focuses on an overall healthy eating pattern rather than a single nutrient or food group. This approach emphasizes consuming whole foods, including fruits, vegetables, lean proteins, nuts, and seeds. A high score is achieved by limiting the intake of added sugars, sodium, processed meats, and tropical oils.
Physical Activity
Physical activity is measured by the total weekly duration and intensity of movement. Adults should aim for at least 150 minutes of moderate-intensity activity, such as brisk walking, or 75 minutes of vigorous-intensity aerobic exercise each week. Regular physical activity strengthens the heart muscle, improves blood flow, and helps manage body weight and blood pressure.
Nicotine Exposure
This pillar addresses the avoidance of all inhaled nicotine products, including traditional cigarettes, e-cigarettes, and vaping devices. Nicotine is a potent vasoconstrictor that damages the lining of blood vessels, increasing the risk of atherosclerosis and clot formation. The metric also considers exposure to secondhand smoke, recognizing its adverse effects on cardiovascular health.
Sleep Health
The newest component recognizes the link between sleep and cardiovascular function. Adults who consistently achieve seven to nine hours of quality sleep per night score optimally in this category. Insufficient or irregular sleep patterns can disrupt the body’s natural regulation of blood pressure and stress hormones, increasing inflammation and disease risk.
Health Factors
Body Mass Index (BMI)
BMI is a calculation of body weight relative to height; maintaining a score under 25 kg/m\(^2\) is the ideal range for adults. Excess body weight increases the workload on the heart and is associated with higher blood pressure, elevated blood glucose levels, and unfavorable lipid profiles. This factor measures healthy weight management.
Blood Lipids
This factor measures the levels of fats in the blood, primarily focusing on non-High-Density Lipoprotein (non-HDL) cholesterol. High levels of Low-Density Lipoprotein (LDL), often called “bad cholesterol,” contribute to atherosclerosis, the buildup of fatty plaque within artery walls. This plaque narrows vessels, restricting blood flow and raising the risk of heart attack or stroke.
Blood Glucose
The blood glucose metric assesses how efficiently the body manages sugar, measured using fasting glucose or the long-term marker hemoglobin A1c (HbA1c). Chronically high blood sugar (hyperglycemia) damages the inner lining of blood vessels through glycosylation. This damage impairs the vessels’ ability to relax, leading to stiffening and reduced blood flow.
Blood Pressure
Blood pressure is the force of blood pushing against the artery walls; the optimal measurement is less than 120/80 mm Hg. Sustained high blood pressure (hypertension) forces the heart to work harder to circulate blood, causing the muscle to thicken and weaken over time. This constant strain increases the risk of heart failure, stroke, and kidney damage.
How Your Heart Health Score Is Calculated
The Life’s Essential 8 framework utilizes a quantitative scoring system to provide a precise assessment of cardiovascular status. Each of the eight components is assigned a score based on a continuum ranging from 0 to 100 points. This granular scale allows for a more nuanced evaluation than the previous three-tiered system.
The 100-point scale for each factor rewards incremental improvements, with 100 representing the ideal health status and 0 representing the lowest. For instance, a physical activity score increases as a person moves toward the recommended 150 minutes per week. A person managing blood pressure with medication can still achieve a higher score than someone with uncontrolled hypertension.
An individual’s overall cardiovascular health score is determined by calculating the unweighted average of the scores from all eight components. This composite score also ranges from 0 to 100 and provides a single figure for overall health. The AHA classifies this final score into one of three categories to summarize a person’s cardiovascular health status.
A total score between 80 and 100 points indicates High cardiovascular health, suggesting excellent adherence to the guidelines and a significantly lower risk of heart disease. A score between 50 and 79 points is classified as Moderate cardiovascular health, signifying room for improvement and partial adoption of recommended behaviors. Scores below 50 points are considered Low cardiovascular health, identifying individuals who should focus on making substantial lifestyle changes to reduce health risks.
Strategies for Improving Your Essential 8 Score
Improving the Life’s Essential 8 score requires an intentional approach to daily habits and medical monitoring. Focusing on small, consistent behavioral adjustments creates a ripple effect that positively influences multiple health factors simultaneously. For instance, prioritizing a whole-food diet low in sodium and added sugars directly aids in managing weight, blood pressure, and blood glucose levels.
Integrate physical activity into the daily routine by breaking up long periods of sitting with short, brisk walking intervals. This contributes to the weekly activity goal and helps regulate blood sugar spikes after meals. To score higher in sleep health, practice good sleep hygiene by establishing a consistent bedtime and minimizing exposure to bright screens in the hour before sleep.
Active management of the four health factors involves consistent self-monitoring and engagement with a healthcare team. Regularly check blood pressure at home and discuss strategies like following the DASH diet, which emphasizes potassium and limits sodium, with a provider. For blood lipids and glucose, work with a physician to understand personalized targets and determine if lifestyle changes alone are sufficient or if medication is necessary.
Adherence to all eight pillars is supported by eliminating nicotine exposure completely, as this action rapidly improves the health of the blood vessel lining. Viewing the LE8 as an interconnected system emphasizes that positive changes in one area, such as consistent exercise, can make it easier to achieve better sleep and maintain a healthy weight.