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Kenneth H. Cooper MD, MPH


The 7 Recommendations for a Healthy Heart: How Are American Adults Doing?

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Eat better

Thursday, Dec 24, 2015

It’s no secret that cardiovascular disease (CVD) is the leading cause of death in the United States for both men and women. In fact, this has been the case nearly every year for over a century. The American Heart Association has 7 recommendations that aim to improve cardiovascular health and decrease unnecessary and premature cardiovascular morbidity (illness) and mortality (death).1  These recommendations are listed below.

  • Don’t smoke  (never smoked or quit more than 1 year ago)
  • Be physically active (150 minutes or more of moderate intensity activity or 75 minutes or more of vigorous intensity activity per week)
  • Have normal blood pressure (less than 120/80 mm Hg)
  • Have normal fasting blood glucose levels (less than 100 mg/dL)
  • Have normal blood cholesterol levels (less than 200 mg/dL)
  • Have a normal body weight (body mass index less than 25 kg/m2)
  • Eat a healthy diet (meet 4-5 components of the healthy diet score*)

In an effort to determine the trends for what proportion of the population meets each of these guidelines, Yang et al.2 reviewed data from nationally representative samples of U.S. adults between 1988-2010. Data was collected from 1988-1994 (n=16,215), 1999-2004 (n=13,097), and 2005-2010 (n=15,647). More importantly, the impact of meeting some or all of these guidelines on cardiovascular mortality was examined. All data was collected as part of the National Health and Nutrition Examination Survey (NHANES), which is overseen by the Centers for Disease Control and Prevention.

Not surprisingly, very few participants (2%) met all 7 recommendations during the period 1988-1994; this number was even lower by 2005-2010 (1.2%). The trends among the percentage of the samples reaching each recommendation during these two time periods varied. For example, the percentage reporting that they never smoked or quit more than one year ago increased significantly from 1988-1994 to 2005-2010. The percentage with normal blood pressure and normal blood cholesterol remained essentially unchanged during these same time periods. However, the percentage consuming a healthy diet, having a BMI less than 25 kg/m2 and having a fasting glucose level of less than 100 mg/dL declined significantly from 1988-1994 to 2005-2010. While not shown in Table 1, the percentage of those reporting no physical activity increased sharply from 1988-1994 to 2005-2010 (15.6% and 31.9%, respectively). These data are summarized in Table 1 below.

Table 1. Percentage of U.S. Adults Meeting Each of the Seven Recommendations from the American Heart Association (1988-1994 and 2005-2010 data).

The entire sample was followed for an average of 14.5 years. The age-adjusted cardiovascular disease death rate versus the number of heart-healthy recommendations met is shown in Figure 1. You may be wondering what a ‘person-year’ is: if one person is followed for one year, it’s considered as 1 person-year of data. If 10 people are followed for 10 years, then it’s 100 person-years of data. Death rates are commonly expressed as the number of deaths per 1000 person-years. As shown in Figure 1, those meeting 0-1 of the 7 recommendations were about 6 times more likely to die from cardiovascular disease during the follow-up period when compared with individuals who met 6-7 of the recommendations.


In their conclusion, the authors strongly emphasized the need for better public health intervention programs which specifically target healthy eating and physical activity. Unfortunately, there are many American adults who have not undergone blood cholesterol or blood glucose testing, and data shows that 18% of the estimated 78 million Americans with hypertension are unaware of its presence. Thus, a greater emphasis needs to be placed on the need for regular physical exams and screenings in the adult population. With estimated annual direct costs of CVD totaling $273 billion, not to mention the emotional toll caused by CVD, the public would be wise to heed the American Heart Association recommendations.

To learn more about healthy lifestyle, consider The Cooper Institute’s Nutrition for Health and Fitness, Weight Loss Strategies, or Personal Training Education  workshops. You don’t need to be a fitness professional to take a course, the general public is welcome.


*The healthy diet score ranges from 0 to 5 and is calculated by summing the following components, each of which is worth 1 point:  1) 4.5 cups or more of fruits and vegetables per day   2) two or more 3.5-oz servings of fish per week   3) three servings per day of whole grains   4) less than 1500 mg of sodium per day   5) 36 ounces or less of sugar-sweetened  beverages per week.



Lloyd-Jones, D.M., Hong, Y., Labarthe, D., et al.  (2010). Defining and setting national goals for cardiovascular health promotion and disease reduction. Circulation. 121(4):586-613.

Yang, Q., Cogswell, M.E., Flanders, D., et al. (2012). Trends in Cardiovascular Health Metrics and Associations with All-Cause and CVD Mortality among U.S. Adults. JAMA. 307(12):1273-1283.