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People who strongly adhere to a set of cardiovascular health metrics may live close to a decade longer than those who don't, new research suggests.

The study, published Monday in , found people with higher scores for cardiovascular health lived up to nine years longer on average than those with the lowest scores. The scores measure adherence to a set of lifestyle behaviors and health factors developed by the 91ÊÓƵ known as Life's Essential 8.

These measures encourage not using tobacco products, being physically active, eating a healthy diet, getting the right amount of sleep, managing weight and controlling blood pressure, blood glucose and cholesterol levels. A prior study found adults with greater adherence to these metrics lived longer without chronic disease than those with lower scores.

The new findings provide evidence "that you can modify your lifestyle to live longer," said lead study author Dr. Lu Qi, a professor of epidemiology and director of the Tulane University Obesity Research Center in New Orleans.

Qi and his colleagues analyzed data for 23,003 adults who participated in the 2005-2018 National Health and Nutrition Examination Survey, linking it to data from the National Death Index through Dec. 31, 2019. Participants were 20 to 79 years old and were followed for a median of 7.8 years.

Using a 100-point scale, the researchers determined whether participants had low (scoring under 50), moderate (50 to 79) or high (80 or higher) cardiovascular health scores for each of the eight components. They also calculated an overall cardiovascular health score.

People with the highest overall scores had an average 8.9 more years of life expectancy at age 50 than those with the lowest scores. Among the individual components, tobacco use, sleep, physical activity and blood glucose levels had the greatest impact on life expectancy.

Compared to people who smoked the most, those who did not smoke lived 7.4 years longer. Those who slept the recommended seven to nine hours per night lived five years longer than those who slept too much or not enough. People who were most physically active lived 4.6 years longer than those who were least active. And those who scored higher for maintaining control of blood glucose lived 4.9 years longer than those with poor blood glucose control.

"What this shows us is how important an overall assessment of one's cardiovascular health is, based on these eight factors," said Nathan Wong, a professor and director of the Heart Disease Prevention Program in the division of cardiology at the University of California, Irvine. "It's not just one or two things."

About 42% of the gain in life expectancy was attributable to fewer cardiovascular-related deaths.

But that means nearly 58% of life years gained from having a better cardiovascular health profile were not related to cardiovascular disease, said Wong, who was not involved in the research. "That indicates the impact of maintaining good cardiovascular health extends to other causes of death."

Wong said the findings should motivate people to better understand their own cardiovascular health risks through annual health exams and the use of online tools, such as the AHA's , which can provide a personalized cardiovascular health score based on Life's Essential 8. "The consumer can get a good idea of their cardiovascular health from such an assessment and what they can do to improve their cardiovascular health risk," he said.

While Life's Essential 8 includes many key metrics of cardiovascular health, Wong said, future research should look at the extent to which other factors might also play a part.

"Information on psychosocial factors such as stress and depression, as well as on social determinants of health such as access to health care, may also play an important role and modify the impact that the key cardiovascular health metrics have on cardiovascular and non-cardiovascular outcomes," he said. "As the study looked exclusively at mortality, effects on non-fatal cardiovascular outcomes should also be examined, given their substantial impact on health care utilization."