In 2010, the American Heart Association defined a novel construct of cardiovascular health to promote a paradigm shift from a focus solely on disease treatment to one inclusive of positive health promotion and preservation across the life course in populations and individuals. Extensive subsequent evidence has provided insights into strengths and limitations of the original approach to defining and quantifying cardiovascular health. In response, the American Heart Association convened a writing group to recommend enhancements and updates. The definition and quantification of each of the original metrics (Life's Simple 7) were evaluated for responsiveness to interindividual variation and intraindividual change. New metrics were considered, and the age spectrum was expanded to include the entire life course. The foundational contexts of social determinants of health and psychological health were addressed as crucial factors in optimizing and preserving cardiovascular health. This presidential advisory introduces an enhanced approach to assessing cardiovascular health: Life's Essential 8. The components of Life's Essential 8 include diet (updated), physical activity, nicotine exposure (updated), sleep health (new), body mass index, blood lipids (updated), blood glucose (updated), and blood pressure. Each metric has a new scoring algorithm ranging from 0 to 100 points, allowing generation of a new composite cardiovascular health score (the unweighted average of all components) that also varies from 0 to 100 points. Methods for implementing cardiovascular health assessment and longitudinal monitoring are discussed, as are potential data sources and tools to promote widespread adoption in policy, public health, clinical, institutional, and community settings.
Improving cardiovascular health in women is an urgent public health priority given the persistent and pervasive gaps in awareness, prevention, and management of cardiovascular disease in this population. Advances in scientific understanding have led to increased recognition of female-specific considerations in cardiovascular disease, which informed the development of the Female Life Stage construct by the American Heart Association in collaboration with the American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and Society for Maternal-Fetal Medicine. This construct integrates assessment of hormonal, psychosocial, and cardiovascular health across life stages. However, gaps remain in operationalizing this construct and optimizing the delivery of patient-centered, interdisciplinary care among women. Over the past several decades, women's cardiovascular centers have emerged as leaders, expanded rapidly, and elevated the recognition of cardiovascular diseases that exclusively, disproportionately, or differently affect women (eg, myocardial infarction with nonobstructive coronary arteries, spontaneous coronary artery dissection, Takotsubo syndrome). In this science advisory, we describe the current landscape of women's cardiovascular centers and propose a national infrastructure to support the expansion of dedicated Comprehensive Centers of Excellence for Women's Cardiovascular Care. These centers are conceptualized as interdisciplinary care models comprising 4 defining pillars: interdisciplinary clinical care, education and training, research, and community engagement. By establishing integrated pathways that span clinical disciplines, these centers can reduce fragmentation, enhance earlier risk identification, and expand opportunities to increase representation of women in clinical research. In doing so, they offer a bold opportunity for a scalable and equitable model to improve cardiovascular health for all women.