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Improving Your Heart Health With Life's Essential Eight

Baptist Health Miami Cardiac & Vascular Institute

If you’re at a point in life where your cardiovascular health has become a concern, if not an outright problem, there are steps you can take starting today to prevent and even reverse cardiovascular disease, according to an expert with Baptist Health Miami Cardiac & Vascular Institute.


It all starts with “Life’s Essential Eight,” recently updated recommendations from the American Heart Association (AHA) comprising five lifestyle factors and three health dashboard indicators most vital to achieving optimum cardiovascular health and dramatically decreasing your risk of heart attack, stroke or type 2 diabetes.


“‘Life’s Essential Eight’ grew out of the Million Heart Program launched in 2010 by the AHA and the American College of Cardiology,” says Theodore Feldman, M.D., a cardiologist with more than 35 years of experience. As medical director of Prevention and Community Health at Miami Cardiac & Vascular Institute, and co-medical director of its Lipid Management Program, Dr. Feldman specializes in the prevention, diagnosis and treatment of complex cardiovascular disease and its risk factors.


“The thinking was that, by focusing on these simple steps, we should be able to prevent one million heart attacks and strokes here in the United States between 2010 and 2020,” Dr. Feldman explains. By helping patients and doctors understand their metrics and the importance of improving on them, the AHA hoped to reduce heart attack and stroke in the U.S. by 20 percent by 2020 and 25 percent by 2025, he says.


What are “Life’s Essential Eight?”

According to Dr. Feldman, “Life’s Essential Eight” encompasses lifestyle factors such as eating a healthy diet, exercising regularly, managing your weight and not smoking or vaping or being exposed to secondhand smoke.


Theodore Feldman MD

Theodore Feldman, M.D.medical director of Prevention and Community Health at Miami Cardiac & Vascular Institute, and co-medical director of its Lipid Management Program



“Are you eating five servings of fruits and vegetables every day? Are you getting at least 150 minutes of cardio exercise a week? Are you more than 50 pounds overweight? Do you smoke or have you ever smoked? These are all things that we know can positively or negatively impact your cardiovascular health,” Dr. Feldman notes.


Sleep duration is another area that has proven to be vital to one’s cardiovascular health, so much so that last year the AHA updated its guidelines after a review of clinical studies highlighted its importance. Noting that humans spend a third of their lives sleeping, Dr. Feldman warns that inadequate sleep is behind a host of serious health conditions.


“Clinically, we know that poor sleep health leads to obesity, sleep apnea, heart disease and more,” says Dr. Feldman. “We also know that if we don’t get enough sleep, the benefits of all those other factors during your waking hours is dramatically reduced.”.” The AHA says that seven to nine hours of sleep daily is ideal for adults but children need even more. Ideal daily sleep ranges for children are 10-16 hours for ages 5 and younger; 9-12 hours for ages 6-12 years; and 8-10 hours for ages 13-18 years.


Aside from the five lifestyle factors, there are three medical dashboard indicators – your LDL (Low-Density Lipoprotein) cholesterol level, your blood sugar and your blood pressure – that Dr. Feldman says are red flags for cardiovascular disease. “For an average patient in good health, we want to see normal blood sugar, LDL under 100 and blood pressure under 120 over 80,” he says.


Metabolic syndrome a growing problem

The problem isn’t just when any one of these indicators is elevated, Dr. Feldman says. Patients with several of these conditions simultaneously have what is known as metabolic syndrome, a more serious condition that needs to be treated aggressively and followed closely.


“Metabolic syndrome refers to a group of five conditions that can include high blood pressure, high blood sugar, excess abdominal fat, high triglyceride levels and low HDL (high-density lipoprotein) cholesterol levels,” explains Dr. Feldman. “If you have any three of these together, you have an exponentially increased risk of developing heart disease, stroke and type 2 diabetes.”


The number of Americans with metabolic syndrome continues to grow according to the U.S. Centers for Disease Control & Prevention (CDC). Among U.S. adults aged 18 years or older, the prevalence of metabolic syndrome rose by more than 35 percent from 1988 to 2012, increasing from 25.3 percent to 34.2 percent.


Lifestyle changes aren’t always easy

Given this trend, it’s unsurprising perhaps that the number of Americans who would score well in all aspects of “Life’s Essential Eight” is extremely low, says Dr. Feldman. Just one percent of U.S. adults scored perfect in all metrics, he says of the initial study’s findings.


“There’s a difference between knowing what you need to do and being successful at doing it,” Dr. Feldman acknowledges, adding that starting a healthy habit can be just as challenging as ditching an unhealthy one. “Lifestyle changes aren’t always easy. Getting someone to stop smoking or to eat less or to exercise more can be a challenge. As an example, if you take 100 patients with an obese BMI (body mass index) of 30+, only one of them will be able to get it down below 25.”


An epidemic of obesity and AFib

Dr. Feldman says that obesity is itself a significant contributor to heart disease, and that Americans are growing heavier decade after decade. “In 1981, just 11 percent of U.S. adults were clinically obese, meaning they had a BMI of 30 or higher. In 2020, that number had quadrupled to 40 percent,” he notes.


Obesity is responsible for 60 different diseases, according to Dr. Feldman – many of them within the realm of cardiovascular disease, such as obstructive sleep apnea and atrial fibrillation, or AFib. “AFib, which develops because the heart thickens as the body becomes increasingly obese, is at epidemic levels here in the U.S.” he says. “There has also been a dramatic increase in diabetes, or ‘diabesity,’ as I call it.”


Moving your metrics reduces your risk

For people who want to improve their overall heart health, however, losing weight alone won’t do it, warns Dr. Feldman. “Other lifestyle factors are important, too. From what we learned with the Million Heart Program, those who moved their metrics and scored perfect on at least five factors were able to reduce their risk of cardiovascular disease over a 10-year period by 88 percent,” he says. “That’s an amazing number.”


The study also found that following the heart-healthy guidelines from the Million Heart Program offered benefits that extend well beyond one’s cardiovascular system. “It also helped reduce chronic diseases by 50 to 80 percent – including cancer, diabetes, osteoarthritis and lung disease,” says Dr. Feldman. “Being overweight and sedentary are big risk factors for these and other diseases.”


Embracing “Life’s Essential Eight” – or at the very least trying to improve your essential eight – will pay healthy dividends well into your future, assures Dr. Feldman. “If people paid attention to their own indicators and lifestyles, there would be a lot less heart disease. Work with your primary care physician and stay on top of your dashboards,” he advises.


A heart-healthy lifestyle can prevent or reduce the need for additional therapy, Dr. Feldman adds. “Lifestyle can make a huge difference. Although it works better in combination with medication therapies, it can delay and even eliminate the need for being on cholesterol-lowering statins, blood pressure pills and other medications for the rest of your life.”



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With internationally renowned centers of excellence, 12 hospitals, more than 27,000 employees, 4,000 physicians and 200 outpatient centers, urgent care facilities and physician practices spanning across Miami-Dade, Monroe, Broward and Palm Beach counties, Baptist Health is an anchor institution of the South Florida communities we serve.

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