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U.S. Department of Health and Human Services Office of Disease Prevention and Health Promotion

Improve cardiovascular health in adults — HDS‑01 Data Methodology and Measurement

On this page:  About the National Data  |  Methodology  |  History

About the National Data

Data

Data Source:  National Health and Nutrition Examination Survey (NHANES), CDC/NCHS

Baseline: 65.6 was the mean cardiovascular health score (maximum score of 100.0) among adults aged 20 years and over in 2013-16

Target: 72.2 mean cardiovascular health score

Numerator
Sum of cardiovascular health scores among non-pregnant adults aged 20 years and over.
Denominator
Number of non-pregnant adults 20 years and over with available data on cardiovascular health scores.
Target-setting method
Percent improvement
Target-setting method details
10 percent improvement from the baseline.
Target-setting method justification
Trend data were not available for this objective. A 10 percent improvement from the baseline was used to calculate a target. This method was used because the target was a statistically significant improvement from the baseline. The target represents a notable improvement in the mean score and appreciates recent trends in the individual metrics within the composite score.

Methodology

Questions used to obtain the national baseline data

(For additional information, please visit the data source page linked above.)

From 2013-2014 and 2015-2016 National Health and Nutrition Examination Survey:

Numerator:
{Have you/Has SP} ever been told by a doctor or other health professional that {you/s/he} had hypertension, also called high blood pressure?
  1. Yes
  2. No
  3. Refused
  4. Don't know
Because of {your/SP's} high blood pressure/hypertension, {have you/has s/he} ever been told by a doctor or other health professional to take prescribed medication?
  1. Yes
  2. No
  3. Refused
  4. Don't know
{Are you/Is SP} now taking prescribed medication?
  1. Yes
  2. No
  3. Refused
  4. Don't know
The next questions are about specific medical conditions. {Other than during pregnancy, {have you/has SP}/{Have you/Has SP}} ever been told by a doctor or health professional that {you have/{he/she/SP} has} diabetes or sugar diabetes?
  1. Yes
  2. No
  3. Borderline
  4. Refused
  5. Don’t know
[To lower (your/his/her) blood cholesterol, (have/has) (you/SP) ever been told by a doctor or other health professional]… to take prescribed medicine?
  1. Yes
  2. No
  3. Refused
  4. Don't know
(Are you/Is SP) now following this advice to take prescribed medicine?
  1. Yes
  2. No
  3. Refused
  4. Don't know
These next questions are about cigarette smoking and other tobacco use. {Have you/Has SP} smoked at least 100 cigarettes in {your/his/her} entire life?
  1. Yes
  2. No
  3. Refused
  4. Don't Know
{Do you/Does SP} now smoke cigarettes?
  1. Every day
  2. some days
  3. not at all
  4. Refused
  5. Don't know
How long has it been since {you/SP} quit smoking cigarettes?

______ ENTER NUMBER (OF DAYS, WEEKS, MONTHS OR YEARS)
Now I would like to ask you a few questions about smoking in this home. How many people who live here smoke cigarettes, cigars, little cigars, pipes, water pipes, hookah, or any other tobacco product?
  1. No one in household is a smoker
  2. 1 household member is a smoker
  3. 2 household members are smokers
  4. 3 household members are smokers
  5. Refused
  6. Don’t know
Not counting decks, porches, or detached garages, how many people who live here smoke cigarettes, cigars, little cigars, pipes, water pipes, hookah, or any other tobacco product inside this home?
  1. No one in household is a smoker
  2. 1 household member is a smoker
  3. 2 household members are smokers
  4. 3 household members are smokers
  5. Refused
  6. Don’t know
During the last 7 days, {were you/was SP} working at a job or business outside of the home?
  1. Yes
  2. No
  3. Refused
  4. Don't know
While {you were/SP was} working at a job or business outside of the home, did someone else smoke cigarettes or other tobacco products indoors?
  1. Yes
  2. No
  3. Refused
  4. Don't know
During the last 7 days, did {you/SP} spend time in a restaurant?
  1. Yes
  2. No
  3. Refused
  4. Don't know
While {you were/SP was} in a restaurant, did someone else smoke cigarettes or other tobacco products indoors?
  1. Yes
  2. No
  3. Refused
  4. Don't know
During the last 7 days, {did you/SP} spend time in a bar?
  1. Yes
  2. No
  3. Refused
  4. Don't know
While {you were/SP was} in a bar, did someone else smoke cigarettes or other tobacco products indoors?
  1. Yes
  2. No
  3. Refused
  4. Don't know
During the last 7 days, did {you/SP} ride in a car or motor vehicle?
  1. Yes
  2. No
  3. Refused
  4. Don't know
While {you were/SP was} riding in a car or motor vehicle, did someone else smoke cigarettes or other tobacco products?
  1. Yes
  2. No
  3. Refused
  4. Don't know
During the last 7 days, did {you/SP} spend time in a home other than {your/his/her} own?
  1. Yes
  2. No
  3. Refused
  4. Don't know
While {you were/SP was} in a home other than {your/his/her} own, did someone else smoke cigarettes or other tobacco products indoors?
  1. Yes
  2. No
  3. Refused
  4. Don't know
During the last 7 days,{were you/was SP} in any other indoor area?
  1. Yes
  2. No
  3. Refused
  4. Don't know
While {you were/SP was} in the other indoor area, did someone else smoke cigarettes or other tobacco products?
  1. Yes
  2. No
  3. Refused
  4. Don't know
In a typical week {do you/does SP} do any moderate-intensity sports, fitness, or recreational activities that cause a small increase in breathing or heart rate such as brisk walking, bicycling, swimming, or golf for at least 10 minutes continuously?
  1. Yes
  2. No
  3. Refused
  4. Don't Know
In a typical week, on how many days {do you/does SP} do moderate-intensity sports, fitness or recreational activities?

_______ Days
How much time {do you/does SP} spend doing moderate-intensity sports, fitness or recreational activities on a typical day?

_______ ENTER NUMBER (OF MINUTES OR HOURS)
In a typical week, {do you/does SP} do any vigorous-intensity sports, fitness, or recreational activities that cause large increases in breathing or heart rate like running or basketball for at least 10 minutes continuously?
  1. Yes
  2. No
  3. Refused
  4. Don't Know
In a typical week, on how many days {do you/does SP} do vigorous-intensity sports, fitness or recreational activities?

_______ Days
How much time {do you/does SP} spend doing vigorous-intensity sports, fitness or recreational activities on a typical day?

______ ENTER NUMBER (OF MINUTES OR HOURS)

Methodology notes

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 &lt1 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.
https://wwwn.cdc.gov/Nchs/Nhanes/2015-2016/TCHOL_I.htm

Age-adjustment notes

This Indicator uses Age-Adjustment Groups:

  • Total: 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
  • Sex: 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
  • Race/Ethnicity: 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
  • Educational Attainment: 25-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
  • Family Income (percent poverty guidelines): 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
  • Health Insurance Status: 20-29, 30-39, 40-49, 50-59, 60-64
  • Marital Status: 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
  • Country of Birth: 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
  • Veteran Status: 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
  • Activity Limitations: 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+

History

Comparable HP2020 objective
Related, which includes objectives that have the same or a similar intent to either a measurable or developmental/archived objective in Healthy People 2020.
Revision 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.