For years, the community of researchers studying sleep has tried to raise awareness about the growing link between poor sleep and heart disease. Now, after putting in a lot of effort, they can mark progress towards recognizing this very important connection.
For the first time, the American Heart Association has added sleep to the main components it advises Americans to use to measure cardiovascular health. The new menu is now called Life Basics 8replaces a shorter list of metrics called Life’s Simple 7, which was created in 2010.
Adequate sleep now joins the familiar list of goals to track while building a healthy heart: a healthy diet, ample physical activity, smoking cessation, a healthy weight, healthy levels of blood fats, blood sugar, and blood pressure.
It’s a change influenced by the extensive evidence that NHLBI-funded scientists have provided about the relationship between sleep and cardiovascular health over the years.
“We are pleased to see the American Heart Association include evidence, mostly from NHLBI-backed research, that shows healthy sleep is fundamental to human health, including heart health,” said David Goff, PhD, director. NHLBI Division of Cardiovascular Diseases. Referring to the NHLBI’s partnership with the AHA to advance heart health and lifestyle research, Goff added, “The evolution of Life’s Simple 7 program from AHA to Essential 8 holds great promise to advance our shared mission to transform discovery into better cardiovascular health for all.”
Marishka Brown, Ph.D., Director of the NHLBI’s National Sleep Disorders Research Center, Approves. She called the new sleep scale “a testament to the strength of NHLBI-funded research.”
“This action by the American Heart Association clearly shows that sleep is just as important to cardiovascular health and general health as other factors such as exercise and nutrition,” Brown said. She said the launch of Basic Version 8 will lead to greater awareness of the relationship between poor sleep and health, more informed research on the topic and, ultimately, new sleep-based interventions that can reduce the risk of heart disease.
Brown added that changing the AHA will encourage researchers to investigate the aspects of sleep that contribute to cardiovascular health and how untreated sleep disturbances contribute to cardiovascular disease.
The spotlight on sleep comes at a pivotal time: Millions of Americans aren’t getting enough of it, and many don’t realize how it might affect cardiovascular health. For example, studies link poor sleep to a greater risk of obesity, diabetes and high blood pressure — all risk factors for heart disease, which is the leading cause of death in the United States and worldwide. Although the exact mechanisms linking poor sleep to heart disease continue to be investigated, improving sleep may improve heart health and ultimately save lives, researchers say.
Life’s Essential 8 is the result of two decades of work and more than 2,400 scientific papers related to cardiovascular health.
said Susan Redline, MD, MPH, professor of sleep medicine at Harvard Medical School and director of the epidemiology program at Brigham and Women’s Hospital. An NHLBI grantee, her research has demonstrated the link between poor sleep and cardiovascular risk factors as well as clinical heart disease across multiple populations, and has been pushing for its broader inclusion as a health measure for improving population health. “As minorities are at increased risk for sleep problems and cardiovascular disease, new recommendations may help reduce health disparities,” Redline said.
So why has the AHA updated the scale now?
“It takes time to build the evidence base,” explained Marie-Pierre Saint-Ong, PhD, a sleep researcher at Columbia University Irving Medical Center in New York who studies the relationship between sleep and heart health. “And you can’t really make recommendations if you don’t have solid evidence.”
Motivated by research, the evidence linking sleep problems to heart disease has been gradually growing for years. But over the past decade, she has represented large and diverse groups of the NHLBI mesaAnd the CardiaAnd the show youAnd the CHS and the Jackson Heart Study They began to include sleep measures in their health assessments. St-Onge said sleep research and its relationship to cardiovascular disease has now exploded.
Redline and St-Onge suggested that a recent file study They helped co-authors provide the AHA with one critical piece of evidence it needed to include sleep in Baseline 8. Presented as an abstract in 2020 in Circulation, one of the AHA’s flagship journals, the study focused on the NHLBI’s MESA cohort of 1920 ethnically diverse adults. Middle-aged and older adults, a population group considered to be at high risk for heart disease. The study showed that participants who got enough sleep (seven to nine hours of sleep each night) in addition to meeting Life’s Simple 7 guidelines, had up to a 61% lower odds of developing heart disease. It concluded that adding sleep duration to Life’s Simple 7 scale would create a more powerful tool for predicting heart disease risk.
Now that the AHA has made that change, Redline and St-Onge said there’s more work to be done. In particular, they advocate recognition of other aspects of sleep more broadly beyond its duration. These include measures such as sleep consistency and quality, which also affect cardiovascular health.
“In the next few years, I think we’ll be able to make the case for including a more precise set of sleep goals that individuals can pursue,” Redline said. “Not only do you need adequate sleep duration, but you need sufficient, consistent, quality sleep.”
In the coming years, scientists will continue to explore the biological underpinnings, including genes and blood markers, behind poor sleep and heart disease. They have already linked, for example, lack of sleep to atherosclerosis, or plaque buildup in the arteries of the heart, through various inflammatory mechanisms. Sleep problems have been linked to poor blood pressure control, which has detrimental effects on blood vessels. The researchers say that a better understanding of these mechanisms could lead to useful interventions, such as wearables or specialized mobile applications designed to reduce irregular sleep, as well as new drugs.
As research continues, experts are encouraging people to pay more attention to their sleep health and to consult health care providers if they are having trouble sleeping, and are encouraging doctors to ask their patients about sleep.
“Thanks to the AHA’s 8 Essentials, sleep has been elevated in the broader conversation about cardiovascular health,” notes NCSDR’s Brown, “which is fantastic. It will benefit our overall health in the long run.”
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