Despite the progress in cardiology over the past several decades, cardiovascular disease (CVD) still remains the number one cause of death worldwide. Population aging and cardiovascular risk factors are the major drivers in the incidence of CVD. It is estimated that approximately 80% of cardiovascular deaths reported worldwide are attributed to risk factors responsible for CVD. The American Heart Association (AHA) Life’s Essential 8 have been introduced to prevent CVD. Life’s Essential 8 includes: healthy diet, adequate and good quality sleep, abstain from tobacco use, regular exercise, maintain ideal body weight, manage blood glucose, control cholesterol, and manage blood pressure. In addition to preventing CVD, Life’s essential 8 has shown to slow the aging process and to prevent cancer. With the implementation of healthy habits, and with the new developments in molecular mechanisms related to aging, it is quite possible that healthy aging can be achieved. Further, the application of artificial intelligence in clinical practice will shift the approach from management to prevention and to individualized care. With prevention and individualize care, the cost of health care will decrease, human suffering will diminish, and mortality will decline.

• Longevity; Healthy Aging; Life’s Essential 8; Multimorbidity; Prevention.

Boudoulas KD, Boudoulas HK, Boudoulas H (2026) Habits for Healthy Aging and a Long Life: An Intergenerational Approach. J Family Med Community Health 13(1): 1218.

AHA: American Heart Association; BMI: Body Mass Index; CVD: Cardiovascular Disease; DASH: Dietary Approaches To Stop Hypertension; HA1C: Glycosylated Hemoglobin; LDL: Low Density Lipoprotein

Despite the great achievements in cardiology over the past several decades, Cardiovascular Disease (CVD) remains the leading cause of death worldwide. According to an article published in the Journal of the American College of Cardiology in September 2025 [1], there were 19.2 million deaths from CVD (one third of all deaths) in 2023, as compared with 12.1 million in 1990. The prevalence of CVD worldwide increased from 311 million in 1990 to 626 million in 2023. Population growth (from approximately 5 billion in 1990 to 8 billion in 2023), population aging (with individuals aged ≥ 65 years increasing from 12.5% in 1990 to 17.7% in 2023), and cardiovascular risk factors are the major drivers in the increase burden of CVD since 1990 [1,2].

Over the last several decades, a global increase in the average life expectancy has been observed mostly due to elimination of the majority of infectious diseases and a decrease in infant mortality [3]. This has resulted in an aging population worldwide. Aging is characterized by a progressive loss of physiologic function of the organs and biological systems of the human body. This deterioration of organ function is the primary risk factor for many human diseases, such as, diabetes mellitus, CVD, cancer, and neurodegenerative disease, among others [2-4]. Multimorbidity in the aging population, defined as coexistence of two or more chronic diseases in the same person, is not uncommon. Multimorbidity can be found in 30% of individuals between the ages of 45 to 64 years, 65% of individuals between the ages of 65 to 84 years, and 82% of individuals older than 85 years, and contributes to disability and death [2-5].

Despite the fact that aging is the greatest risk factor for multimorbidity in developed countries, most biomedical research, at least until recently, has focused on an individual disease without much consideration of the interrelationship between aging and multimorbidity. Thus, despite the significant advances in treating an individual disease, largely we have been unsuccessful at postponing aging and multimorbidity related to aging [6]. The American Heart Association (AHA) introduced Life’s Simple 7 in 2010 [7] to promote cardiovascular health, which was then updated in 2022 in Life’s Essential 8 [8]. The AHA Life’s Essential 8 includes the following: healthy diet, adequate and good quality sleep, abstain from tobacco use, regular exercise, maintain ideal body weight, manage blood glucose, control cholesterol, and manage blood pressure, and are briefly outlined [8].

Healthy Diet: Emphasis should be placed on the Mediterranean diet [9], which is the diet used by people in countries bordering the Mediterranean Sea such as Greece, Italy, and Spain, among others. In addition, the DASH [10] (Dietary Approaches to Stop Hypertension) diet should also be utilized. These diets include vegetables, fruits, plant based proteins (legumes, nuts, grains), and lean animal proteins (skinless poultry, fish, low fat dairy products). Olive oil, canola oil, or avocado oil should be used when preparing meals, and proper hydration maintained by drinking sufficient amounts of water. Alcohol, fried foods, processed meat, salt, and sugar should be avoided. Evidence from cohort, case control, and Mendelian randomization studies have shown that any level of alcohol consumption increases the incidence of blood pressure, dementia, and cancer [11,12].

Adequate and Good Quality Sleep: Maintaining sufficient nighty and adequate sleep is essential for normal brain function. Further, during sleep the heart rate, blood pressure, cardiac output, adrenaline levels, and cortisone levels decrease, among others, contributing to metabolic homeostasis (including glucose and lipids) and a decrease in chronic inflammation. These factors contribute to a healthier immune system resulting in the prevention of infectious diseases, as well as chronic degenerative diseases [2-8]. Seven to nine hours of sleep nightly is suggested for adults, while eight to ten hours for ages between 13 to 18 years. Avoiding caffeine and alcohol in the late afternoon, consuming a small portion of food for dinner, and exercise will help to achieve good quality sleep. Stressful conditions also should be avoided [2-8].

Abstain from Tobacco Use: In addition to traditional cigarette smoking, electronic cigarettes and second hand smoking (passive smoking) are almost equally risky. It should be emphasized that approximately one third of all preventable deaths in the United States of America are related to the use of tobacco products [1-8].

Regular Exercise: It is a well-known that exercise results in a reduction of all-cause mortality and specific chronic diseases such as obesity, diabetes mellitus, CVD, and cancer, among others. For adults, it is recommended exercising for at least two and a half hours of moderate exercise or seventy-five minutes of vigorous exercise per week. Children should have at least sixty minutes of physical activity per day [5-8].

Maintain Ideal Body Weight: Having a healthy diet and participating in regular exercise will help to achieve this goal. An optimal Body Mass Index (BMI) for an adult should be between 18.5 to less than 25.

Manage Blood Glucose: Fasting plasma glucose should be between 79 to 99 mg/dl and glycosylated Hemoglobin (HA1C) less than 5.7%. Having a healthy diet by avoiding sugar, in combination with physical activity, will prevent the onset of diabetes mellitus. In certain instances, however, pharmacologic agents should be used to achieve this goal [8].

Cholesterol Control: Total cholesterol optimally should be less than 200 mg/dL and low density Lipoprotein Cholesterol (LDL) less than 100 mg/dL. Having a healthy diet by avoiding animal fat, in combination with physical activity, will assist to keep cholesterol low. In certain instances, however, pharmacologic agents should be used to achieve this goal [8-13].

Manage Blood Pressure: The ideal blood pressure should by less than 120 mmHg systolic and less than 80 mmHg diastolic [8-12]. Diet, exercise, and maintaining an ideal BMI can help lower blood pressure. In certain instances, however, pharmacologic agents should be used to achieve this goal [8].

Following Life’s Essential 8 can significantly reduce the risk of CVD [1-13], as the prevalence of CVD is largely associated with individual habits and the failure to adopt a healthy lifestyle. It is estimated that 80% of cardiovascular deaths reported worldwide in 2023 were attributed to risk factors responsible for this disease [1]. From 1990 to 2023, the frequency of obesity, diabetes mellitus, and physical inactivity have increased, while the frequency of smoking has declined worldwide. The benefit expected from the lower incidence of smoking has been offset by the concomitant increase of other risk factors [1].

Although Life’s Essential 8 was introduce to prevent CVD, more recent studies have shown that their application has been associated with slowing biological aging (i.e., the effect of chronological age on the human body) and the diseases associated with aging including CVD and cancer [14-17]. Though CVD and cancer are considered separate entities, evidence suggest that a complex and bidirectional relationship exist between these two diseases. Common risk factors for both diseases include aging, smoking, obesity, lack of exercise, diabetes mellitus, arterial hypertension, and a systemic inflammatory process, among others [18,19].

A healthy lifestyle helps maintain health at any age; however, the earlier it is implemented, the greater benefit it has long-term. Therefore, healthy habits should begin early in life at home [14]. These values should be transmitted from generation to generation early in life by parents, not only through words, but also through example. The authors of this article represent three generations, two of them physicians (KDB, HB), which attempt to inspire the youngest one to acquire these values by active participation in the writing of this article.

In addition to a healthy lifestyle, studies over the past several years have identified key molecular mechanisms related to aging. Targeting interventions that modulate these mechanisms have shown to extend longevity in experimental animal models maintaining health [6]. Hopefully, these interventions will be able to be applied successfully to humans in the years to come. It is also expected that in the near future, artificial intelligence will shift the approach from management to prevention and to individualized care. With prevention and individualize care, the cost of health care will decrease, human suffering will diminish, and overall mortality will decline [20].

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