A groundbreaking study conducted at Columbia University’s Mailman School of Public Health has found that incorporating a ninth psychological health metric into the traditional American Heart Association’s Life’s Essential 8 can significantly enhance the prediction of all-cause and cardiovascular mortality. The study’s findings, published in the Journal of the American College of Cardiology: Advances, shed light on the importance of psychological health in maintaining cardiovascular well-being.
Lead researcher Nour Makarem, PhD, assistant professor of Epidemiology at Columbia Mailman School, explains, “Psychological health plays a crucial role in cardiovascular health preservation, encompassing positive mental states like optimism and a sense of purpose, as well as addressing conditions such as depression which are associated with increased cardiovascular disease risk. Despite its significance, psychological health is not currently included as a metric in the conventional Life’s Essential 8.”
The study builds upon previous research by Makarem that introduced an eighth sleep health metric to the original “Life’s Simple 7” construct, resulting in the updated “Life’s Essential 8” and garnering recognition in the AHA’s Presidential Advisory. Now, the addition of a ninth metric for psychological health seeks to further enhance the predictive power of the cardiovascular health score for mortality outcomes.
By analyzing data from over 20,000 U.S. adults with an average age of 48, the research team evaluated the impact of incorporating a psychological health measure alongside the traditional Life’s Essential 8 metrics (diet, sleep health, physical activity, nicotine use, BMI, blood glucose, blood lipids, and blood pressure). The results showed that individuals with high cardiovascular health scores, augmented by a psychological health metric, experienced up to 70% lower all-cause mortality and 77% lower cardiovascular mortality compared to their counterparts with low scores. These reductions in mortality risk were even greater than those observed with the original Life’s Essential 8.
Makarem emphasizes the significance of the findings, stating, “Improving cardiovascular health, including psychological well-being, could lead to substantial gains in longevity. The enhanced cardiovascular health score, incorporating a psychological health metric, demonstrated superior performance in predicting mortality outcomes compared to the conventional Life’s Essential 8 score.”
In particular, the study revealed that the association between the enhanced cardiovascular health score and mortality risk was stronger in Black and female populations, with Black adults experiencing the most significant benefits. The study underscores the potential for integrating psychological health screening, such as for depression symptoms, into clinical and public health settings to promote cardiovascular health equity and reduce mortality rates.
Looking ahead, Makarem suggests the possibility of updating guidelines from “Life’s Essential 8” to a more inclusive “Life’s Necessary 9” framework. She acknowledges the need for further research to explore the relationship between comprehensive psychological health constructs and chronic disease outcomes, advocating for a pragmatic approach that can be easily implemented during routine clinical visits.
Accompanied by a commentary from experts at Johns Hopkins University School of Medicine and Albert Einstein College of Medicine, the study’s findings have significant clinical implications. Co-authored by Vanessa T. Dinh, Rahul Hosalli, Brooke Aggarwal, Pricila H. Mullachery, and Charles A. German, the research was supported by grants from the National Heart, Lung, and Blood Institute, American Heart Association, and National Institute on Minority Health and Health Disparities.
