For more than a decade, the American Heart Association (AHA) has advocated for following "Life's Simple 7," a checklist for cardiovascular health that includes maintaining a nutritious diet, avoiding smoking, and getting adequate physical activity. The AHA recently expanded this program to "Life's Essential 8" to incorporate another crucial aspect of cardiovascular health: good sleep.
New research supports the elevated status of sleep. In a study published in the Journal of the American Heart Association, researchers monitored cardiovascular events, such as cardiac arrests and strokes, among 2,000 middle-aged and older individuals over an average of four years. The goal was to compare the predictive value of AHA's Simple 7 without considering sleep, versus when sleep was taken into account. The study found that without considering sleep, a low Simple 7 score was not significantly associated with cardiovascular disease, although previous research had linked it to cardiovascular risk. However, when sleep was included in the analysis, it significantly predicted future cardiovascular disease. Moreover, individuals with the highest scores on the Essential 8 scale had nearly half the risk of cardiovascular disease events compared to those with the lowest scores. Both the duration and quality of sleep were similarly influential for cardiovascular health.
The important role of sleep does not come as a surprise. Past research has established connections between poor sleep and less healthy habits, including unhealthy diets, lower physical activity levels, and greater psychological risk factors for heart disease, such as stress. Sleep is also linked to other cardiovascular health threats like diabetes, high blood pressure, and obesity. Furthermore, research suggests that sleep affects the underlying physiological mechanisms related to these conditions, such as hunger hormones, insulin response, and metabolic regulation.
Despite the growing recognition of sleep's significance, most adults do not get enough of it. In 2020, approximately 33% of U.S. adults reported sleeping less than seven hours per night, which is recommended by the U.S. Centers for Disease Control and Prevention for adults aged 18 to 60. Specifically, adults aged 25 to 44, as well as Native Hawaiian and Pacific Islanders and Black adults, were more likely to experience insufficient sleep. Inequality has been identified as a factor that can impede sleep for certain populations. For instance, studies have shown that Black Americans often experience less restful sleep, partly due to stress.
Another issue, according to lead author Nour Makarem, is that adequate sleep is not always prioritized. People tend to sacrifice sleep when they are busy socializing or working. Makarem emphasizes the importance of making time for sleep and building good sleep habits, such as adhering to a regular sleep schedule, engaging in pre-bedtime relaxation without screens, and maintaining a quiet and dark sleep environment.
Makarem acknowledges that further research is needed, including longer-term studies and clinical trials to investigate whether screening for sleep problems and improving sleep habits can enhance cardiovascular outcomes. Nevertheless, the weight of evidence suggests that sleep is crucial for heart health. Makarem emphasizes the significance of sleep by noting that we spend about a third of our lives sleeping and that it plays a vital role in preserving various aspects of our health and functioning.
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