Is 7 your heart-healthy number?

We often talk about cardiovascular events and disease, but this perspective is, at least in some ways, biased. A complementary perspective is to focus on cardiovascular health, but such approach requires first to agree on a sound yet sanctionable definition.(1) Furthermore, is pursuing an ideal cardiovascular health associated with meaningfully clinical benefits, at the population level as well as at the individual one?

The American Heart Association (AHA) has provided a poignantly succinct definition of optimal cardiovascular health, based on 7 different dimensions, all rooted to sound scientific and clinical evidence (Figure 1), labelling them Life Simple’s 7 (LS7).(2) Namely, you are pursuing ideal cardiovascular health if:

1. your diet is well balanced and full of servings based on fruits, vegetables, fish, and whole grains;
2. you are physically active;
3. you have a reasonably normal body weight;
4. you do not smoke or have discontinued doing so at least one year before;
5. you have no hyperglycemia;
6. your systolic and diastolic blood pressures are not increased;
7. you do not have dyslipidemia.

Of course, achieving these goals is per se satisfactory and worth the effort. But does a consistent pattern of optimal cardiovascular health translate into clinical benefits on hard and patient-relevant endpoints?

A recent issue of the European Journal of Preventive Cardiology provides a poignant synthesis of the current evidence base on this topic.(3) Indeed, te Hoonte and colleagues collected data from as many as 59 studies on LS7, including almost 2 million participants. The rosy expectations of the reviewers for the benefits of LS7 were confirmed by finding that ideal cardiovascular health was associated with significant reductions in the long-term risk of many adverse events and cardiovascular conditions, including atrial fibrillation, heart failure, myocardial infarction, peripheral artery disease and stroke. This held true also for composite cardiovascular endpoints, as well as cardiovascular mortality. While we may consider the possibility of a synergy between these 7 dimensions of cardiovascular health, even meeting some but not all of such 7 goals was associated with clinically meaningful and statistically significant reductions in adverse outcomes. Notably, results were largely consistent in subgroup and sensitivity analyses.

Is there any caveat? Any drawback in pursuing ideal cardiovascular health as per LS7 criteria? In all truth, we cannot find any, especially as long as these targets are met with non-pharmacologic means), and indeed we believe that everyone should be taught to pursue these goals, and appropriate incentives (eg food coupons) should be considered to foster their adoption at the community as well as individual level.(4) Notably, recent developments have lead the AHA to revise its own criteria for optimal cardiovascular health, recommending the expansion of such definition to encompass also sleep quality and quantity, yielding the novel Life Simple’s 8 (LS8) criteria.(5)

We do not want to appear too optimistic or partisan, but evidently the plausible benefits of adopting a LS7-abiding lifestyle go well beyond cardiovascular prevention. Indeed, it is reasonable that anyone who has a healthy diet, is physical active, has a normal body weight, does not smoke, has normal blood pressure, and normal levels of blood glucose and lipids will also have a better quality of life, while preventing chronic obstructive pulmonary disease, cancer, and several inflammatory conditions.

In conclusion, the AHA’s LS7 has been proven as a scientifically sound and clinically meaningful approach to prevent cardiovascular and improve cardiovascular prognosis. The outstanding question is no longer whether pursuing ideal cardiovascular health is worth our while, but rather how to best implement it globally in a timely fashion.(6-8)

Figure 1. American Heart Association Life Simple’s 7 (2): 7 criteria to define ideal cardiovascular health.

Source: Figure created by Giuseppe Biondi-Zoccai 

Note: The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.