People who strongly adhere to a set of eight lifestyle behaviors and heart-health metrics may have a lower risk for coronary heart disease and stroke than those who don't, new research shows – especially women, younger adults and people with a lower genetic predisposition to heart disease.
The study also found that adhering to Life's Essential 8 – key measures identified by the American Heart Association to improve and maintain good cardiovascular health – was better at predicting cardiovascular risks than Life's Simple 7, an earlier set of heart-health metrics that did not include sleep.
"Sleep health may hold great potential for improving cardiovascular health among the general population," said lead study author Dr. Xiang Li, a postdoctoral fellow in the department of epidemiology at Tulane University School of Public Health and Tropical Medicine in New Orleans.
The findings, presented Thursday at the AHA's Epidemiology and Prevention, Lifestyle and Cardiometabolic Health conference in Boston, are considered preliminary until full results are published in a peer-reviewed journal.
The AHA created Life's Simple 7 in 2010 as a way to encourage what research showed had the greatest positive impact on cardiovascular health. These included not smoking, being physically active, eating a healthy diet, maintaining a healthy weight and managing blood glucose, cholesterol and blood pressure levels.
The metrics were updated last year to clarify several components and add one more. Cigarette smoking was replaced with nicotine exposure, to also include e-cigarettes and exposure to secondhand smoke. A guide to assess diet quality was added, outlining the elements of two eating patterns (the DASH and Mediterranean diets) shown to promote good cardiovascular health. And the cholesterol component was updated to focus on non-HDL cholesterol rather than total cholesterol.
But the biggest change was the addition of sleep duration, after a growing body of research found adults who get seven to nine hours of sleep each night were better able to manage cardiovascular factors such as weight, blood pressure and risk for Type 2 diabetes.
In the new analysis, researchers used data from the UK Biobank to score 137,794 adults who were free of cardiovascular disease on how well they adhered to Life's Essential 8. Using a 100-point scale, scores were grouped into low, moderate or high adherence. Genetic risk scores for coronary heart disease and stroke also were calculated. Participants were almost evenly split between men and women and were an average 55 years old.
After a median 10 years of follow-up, those with high adherence scores had a 66% lower risk for coronary heart disease, 55% lower risk for stroke and 64% lower risk for cardiovascular disease than those with low adherence. Using the Life's Essential 8 model, compared to the previous checklist, better predicted who would develop cardiovascular conditions.
The analysis also showed women received a greater benefit from following the eight metrics than men. As adherence scores rose, the risk for coronary heart disease and cardiovascular disease fell more for women than it did for men. Likewise, the protective association between adherence scores and cardiovascular risks was stronger for people 55 and younger than it was for older adults.
"This is an optimistic message for women and young adults, that if they follow these behaviors, they can substantially decrease their future risk of heart disease," said Dr. Jamal Rana, chief of cardiology at Kaiser Permanente Oakland Medical Center in California.
"But that doesn't mean men or older adults shouldn't follow the metrics as well," said Rana, who was not involved in the new research. "No matter who you are, it decreases your future risk of cardiovascular disease."
The relationship between adherence and coronary heart disease risk was stronger among people with a low genetic disposition for the condition. Those with low genetic risk and high adherence to the metrics were 78% less likely to develop coronary heart disease over a decade of follow-up compared to people with high genetic risk and low adherence.
Likewise, those with a low genetic risk for stroke and high adherence to metrics were 64% less likely to have a stroke than those with a high genetic risk and low adherence scores.
"In this analysis, we found the genetic risk of stroke and LE8 (Life's Essential 8) jointly contribute to the risk of stroke, but the genetic risk is not modified by LE8," Li said. "On the other hand, the genetic risk of coronary heart disease and LE8 jointly contribute to the risk of coronary heart disease, and the genetic risk could be modified by LE8."
Rana said he'd like to see more data on how people with a high genetic predisposition for cardiovascular disease would be affected by greater adherence to Life's Essential 8.
"How much of their future risk could be modified by following a healthy lifestyle? This is the next question to explore," he said. "Because genes are not destiny."
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