On this page: About the National Data | Methodology | History
About the National Data
Data
Baseline: 65.6 was the mean cardiovascular health score (maximum score of 7.0) among adults aged 20 years and over in 2013-16
Target: 72.2 mean cardiovascular health score
Methodology
Cardiovascular health was assessed using the Life's Essential 8 (LE8), which includes physical activity, diet, nicotine exposure, sleep health, body mass index, blood pressure, blood lipids, and blood glucose. The overall LE8 scores are the mean of 8 metrics and range from 0 to 100. Higher scores indicate better cardiovascular health. The scoring methods for the LE8 are listed in Table 1. The USDA healthy eating index-2015 (HEI-2015) scores were used as the proxy for healthy diet scores, which were calculated using the first and second 24-hour dietary recalls in NHANES. HEI-2015 scores were based on a 13-component index: total fruit, whole fruit, total vegetables, grains and beans, whole grains, dairy, total protein foods, seafood proteins, fatty acid, refined grains, sodium, added sugar, and saturated fats, with total scores ranging from 0 to 100 and a higher score indicating a healthier diet. Fasting plasma glucose was available for subsample of participants because NHANES only collected fasting blood samples among half of the participants. Instead, hemoglobin A1c was measured among almost all participants. To maximize the sample size, hemoglobin A1c values <5.7%, 5.7%–6.4%, and ≥6.5% were used as a proxy for fasting plasma glucose levels <100 mg/dL, 100–<126 mg/dL, and ≥126 mg/dL, respectively, as recommended by the American Diabetes Association. Blood pressure is measured by averaging up to 3 blood pressure readings taken during the physical examination in the NHANES mobile examination center.
Table 1: Definition and scoring approach for quantifying the American Heart Association's Life's Essential 8 cardiovascular health score
| CVH Metric | Method of Measurement | Quantification of CVH Metric - Adults (≥20 Years) |
|---|---|---|
| Diet | Measurement: Self-reported daily intake of a DASH-style eating pattern
Example tools for measurement: Healthy eating index-2015 score |
Metric: Quantiles of Healthy eating index-2015 score
Scoring: Points Quantile 100: ≥95th percentile (top/ideal diet) 80: 75th–94th percentile 50: 50th–74th percentile 25: 25th–49th percentile 0: 1st–24th percentile (bottom/least ideal quartile) |
| Physical activity | Measurement: Self-reported minutes of moderate or vigorous physical activity per week
Example tools for measurement: NHANES PAQ questionnaire |
Metric: Minutes of moderate (or greater) intensity activity per week
Scoring: Points Minutes 100: ≥150 90: 120–149 80: 90–119 60: 60–89 40: 30–59 20: 1–29 0: 0 |
| Nicotine exposure | Measurement: Self-reported use of cigarettes or inhaled nicotine-delivery system
Example tools for measurement: NHANES SMQ |
Metric: Combustible tobacco use and/or inhaled nicotine-delivery system use; or secondhand smoke exposure
Scoring: Points Status 100: Never smoker 75: Former smoker, quit ≥5 yrs Former smoker, quit 1–<5 yrs 25: Former smoker, quit <1 year, or currently using inhaled nicotine-delivery system 0: Current smoker Subtract 20 points (unless score is 0) for living with active indoor smoker in home or exposed elsewhere to indoor smoke |
| Sleep health | Measurement: Self-reported average hours of sleep per night
Example tools for measurement: "On average, how many hours of sleep do you get per night?" Consider objective sleep/actigraphy data from wearable technology, if available |
Metric: Average hours of sleep per night
Scoring: Points Level 100: 7–<9 90: 9–<10 70: 6–<7 40: 5–<6 or ≥10 20: 4–<5 0: <4 |
| Body mass index | Measurement: Body weight (kg) divided by height squared (m2)
Example tools for measurement: Objective measurement of height and weight | Metric: Body mass index (kg/m2)
Scoring: Points Level 100: <25 70: 25.0–29.9 30: 30.0–34.9 15: 35.0–39.9 0: ≥40.0 |
| Blood lipids | Measurement: Plasma total and HDL-cholesterol with calculation of non-HDL-cholesterol
Example tools for measurement: Fasting or non-fasting blood sample | Metric: Non-HDL-cholesterol (mg/dL)
Scoring: Points Level 100: <130 60: 130–159 40: 160–189 20: 190–219 0: ≥220 If drug-treated level, subtract 20 points unless score is 0. |
| Blood glucose | Measurement: Casual hemoglobin A1c used as a proxy for fasting blood glucose
Example tools for measurement: Hemoglobin A1c blood sample | Metric: Hemoglobin A1c (%)
Scoring: Points Level 100: No history of diabetes and hemoglobin A1c <5.7 60: No diabetes and hemoglobin A1c 5.7–6.4 (Pre-diabetes) 40: Diabetes with hemoglobin A1c <7.0 30: Diabetes with hemoglobin A1c 7.0–7.9 20: Diabetes with hemoglobin A1c 8.0–8.9 10: Diabetes with hemoglobin A1c 9.0–9.9 0: Diabetes with hemoglobin A1c ≥10.0 |
| Blood pressure | Measurement: Appropriately measured systolic and diastolic blood pressure
Example tools for measurement: Appropriately sized blood pressure cuff | Metric: Systolic and diastolic blood pressure (mm Hg)
Scoring: Points Level 100: <120/<80 (Optimal) 75: 120–129/<80 (Elevated) 50: 130–139 or 80–89 (Stage I HTN) 25: 140–159 or 90–99 0: ≥160 or ≥100 Subtract 20 points if treated level unless score is 0. |
History
- Revised.
In 2023, the 2013-2016 baseline was revised from 3.2 mean cardiovascular health score (maximum score of 7.0) among adults aged 18 years and over to 65.4 mean cardiovascular health score (maximum score of 100.0) among adults aged 20 years and over. The original cardiovascular health metric, AHA's Life's Simple 7, included 7 metrics of cardiovascular health: physical activity, diet, smoking, cholesterol, body mass index, blood pressure, and diabetes. In June, 2022, the AHA updated the cardiovascular health metric to include sleep health, as part of the new Life Life's Essential 8. The scale used for assessment was modified from 0-7 to 0-100. Second hand smoking was also added to the smoking composite score in the updated metric. The change in age group from 18+ to 20+ was made for consistency across the data years because age in months is not available for adolescents younger than 20 years on NHANES pre-pandemic file (2017-March 2020), and LE8 scores for body mass index cannot be calculated for age groups 18 and 19. The target was revised from 3.5 mean cardiovascular health score (maximum score of 7.0) to 71.9 mean cardiovascular health score (maximum score of 100.0) using the original target setting method.
- Revised.
In 2024, the baseline was revised from 65.4 to 65.6 mean cardiovascular health score (maximum score of 100) due to a change in the definition of secondhand smoke exposure to include other indoor settings in addition to the participants' home, self reported diabetes (dropped diabetes medication), and blood glucose levels (based on HbA1c levels exclusively so that the sample would not need to be further restricted from the dietary recall to the fasting subsample as HbA1c is a good proxy and this is only one of the eight components). The target was revised from 71.9 to 72.2 mean cardiovascular health score using the original target setting method.
