Neha Pathak, MD, FACP, DipABLM: Welcome to the WebMD Health Discovered Podcast. I'm Dr Neha Pathak, WebMD's Chief Physician Editor for Health and Lifestyle Medicine. For so many of us, especially those in the sandwich generation, preventive health can feel like one more thing on an already impossible list. We're raising kids, caring for aging parents, managing work, financial stress, and it can feel really hard to prioritize something that might not show up as a problem until decades from now. But the truth is that prevention isn't just about avoiding a future event. It's about protecting your energy, your brain, and your ability to show up for the people who need you today. That's why this conversation matters. In today's episode, we're talking about a practical framework for health and how sleep, stress management, mental well-being, and social connection fit into heart health, stroke prevention, and even cognitive health. If you've ever left a doctor's visit feeling like there wasn't time to talk about the bigger picture, this episode is for you because it brings the focus back to what you can control starting today. First, let me introduce my guest, Dr Eduardo Sanchez. Dr Sanchez serves as Chief Medical Officer for Prevention for the American Heart Association. He's the association's clinical lead on Target: BP, a joint blood pressure control initiative with the American Medical Association, and the association's clinical lead on the Cardiovascular Kidney Metabolic Health Initiative. Welcome to the WebMD Health Discovered Podcast, Dr Sanchez.

Eduardo Sanchez, MD, MPH, FAHA: Thank you so much for having me.

Pathak: I wanna start by thanking you so much for being with us today and to highlight and underline why I think your work and the work of the American Heart Association is so important, because we know that heart disease is still the number one killer in the U.S. and globally. And so many of us who need to hear that message or kind of know it in the back of our minds are sandwiched between so many competing priorities. And I like to think of it as we're all playing whack-a-mole all day long, raising children, taking care of older parents, and it feels almost impossible to think about preventing something that may be a problem decades into the future. So all that to say, people are stretched thin, and preventive health often slips to the bottom. So before we get into all the tools and the initiatives that you are working on, can you just start us off with why it's so important for us to prioritize our own health?

Sanchez: First and foremost, it's really a privilege and an honor, and I love talking about this topic. I'm gonna start here and just say prevention is one thing. It's keeping bad things from happening, and I like to think of things a little bit differently, frame it as health promotion. And I would say to you that health promotion and disease prevention, if you will, are so important because in order for you to be there for others, whether it's your spouse, your children, your parents, your parents-in-law, your other friends and family, or your workplace and your colleagues, et cetera and so on, you have to be taking care of yourself. So that, to me, has been the principle of how I've thought of how I show up every day. I've gotta show up being able to do the things that people expect me to be able to do. And I would say that those who maybe haven't prioritized that might find that when they do, they're actually showing up even better.

Pathak: So I've heard you speak before, and I've heard you say that we really need to think about putting our own oxygen mask on first. So translate that for us in terms of what does putting on the oxygen mask first for ourselves look like in real-life health choices?

Sanchez: Sure. I think I would even shorten it and say, take care of you. It's not take care of you selfishly; it's take care of you so that then you can take care of others. And I think there's kind of three places to focus in terms of taking care of you: your body, your mind, and your relationships. And that would be the starting point for me. You know that taking care of your body actually contributes to some of what you should be doing to take care of your mind. And there are some other things that taking care of your mind might be slightly different. And when you take care of your mind, that actually blends into taking care of and nurturing those relationships that bring you joy, those relationships that help you grow, and sometimes those relationships where you can help somebody who's in need of help.

Pathak: So talk to me a little bit about the American Heart Association's mission and the initiatives that you are doing to really work within communities so that we can start thinking about what we need to do in our day-to-day lives.

Sanchez: Absolutely. So the American Heart Association's mission, a mission statement that is among my favorites in life and one that I have been able to remember without having to read the words, whereas in other organizations I needed to read the words, is to be a relentless force for a world of longer, healthier lives. And I love that mission statement because it's more expansive than some of the things that I'm gonna talk about, but it has actually given the American Heart Association not only license, but we've taken the opportunity to sort of go beyond what people might think in their minds is what the American Heart Association is about. We are an organization that's a hundred years old. We've actually thought about, well, what do the next hundred years look like? And we've come up with a vision statement that we wanna advance health and hope for everyone, everywhere. I will say to you one other thing, which is that we're an organization that does things in three areas: science; the programs that the science might suggest we ought to be doing; and advocacy for those programs to be available based on the science that we help not only fund—we are a research funding organization—but also the research that we take and collect, synthesize, and turn into information for clinicians, people who are taking care of patients, to know what to do when someone has high blood pressure or has a heart attack or, oh, by the way, has a stroke. Because I think it's important to say we are the American Heart Association/American Stroke Association, and stroke, by the way, is the number four cause of death in people in the United States. And the things that prevent heart disease are largely the things that prevent stroke. I'll just go ahead and take the opportunity to say we've learned that things that help prevent heart attack and stroke also help prevent, delay, or halt what's called cognitive decline—in the vernacular, dementia—the things that we worry about, Alzheimer's disease. So that's really, really important, that the American Heart Association be about that. I would also say that in our quest around science, one of the things that I'm hoping we'll talk a little bit more about is that we have identified the essential elements for cardiovascular health: Life's Essential 8. I'll talk about those a little bit later. But as we have learned and understood Life's Essential 8, we've also begun to understand that it is more than just those things. Psychological health and well-being are critically important. Social well-being and relationships are critically important to get to a place where those eight essential factors can be optimized, can reach their best and highest levels. So we are an organization that is about science, and science is about a journey to identify truth. And when you're on that journey, you come to see that there are other things that maybe you didn't consider. An organization that has been about heart disease and the things that cause it and how to prevent it has come to realize that factors that maybe it hadn't thought about—mental health, social relationships—play a role as well. And here we are.

Pathak: I think this is so critical, and when I heard you speak, I think it was really empowering to someone like me in the sandwich generation. It's really empowering because by doing some of these things—and I do wanna dig into the Essential 8—we're not just thinking about blood pressure or cholesterol or diabetes or dementia or cognitive risks. Just in the initiative that you're working on, the Cardiovascular Kidney Metabolic Health Initiative, we're sort of seeing a bigger picture that so many of these conditions are interrelated. And so it's empowering to think that if we can focus on these Essential 8, plus that, we are really combating a lot of what may be future risks instead of just playing whack-a-mole with one particular health condition or another. So talk to us a little bit about what makes up Life's Essential 8.

Sanchez: So I'm gonna say 'em real quick, and then I wanna focus on four that I think are really, really important in this conversation we're having of take care of you. So Life's Essential 8: four behaviors and four conditions where, when those are at their best level, you are going to have a very high likelihood of living a long, healthy life, which will allow you to take care of you and allow you to take care of others. Those eight things: not smoking, eating healthy, engaging in regular physical activity, getting healthy amounts of sleep, and having your weight, blood pressure, cholesterol, and blood glucose—that is, blood sugar—at healthy levels. If they're there because you're doing the four things really well and all the other factors that might contribute are aligned, then you are at optimal cardiovascular health. If you're having to take medications to get there, you're close to optimal health, and you do what you can do. It's never too late. Life's Essential 8 is about three things: promoting health, preventing disease, and even after you have disease, promoting health while you have a disease and sometimes allowing you to maybe quit taking medications because other things you do are a little bit better than you did before. I hope that helps. And the four that I think are really important for taking care of yourself: not smoking, eating healthfully, getting recommended levels of physical activity, and getting healthy amounts of sleep—that's seven to nine hours. Just so I don't want anybody to wonder what we're talking about: seven to nine hours for most adults. And I promise you, you function better with seven to nine hours. And I wanna be clear: for many people, getting seven hours of sleep might be very, very difficult. And all I would say is acknowledge that, get as close as you can when you can do it, and find ways to accommodate your life—and help others accommodate your life—so that you can. Because if you are at your best, you can serve everyone else who needs you at your best.

Pathak: And I think that what's really interesting is that there's also a kids version, which helps think about the Essential Eight not only as an individual unit, so not just for you, but if this is something you wanna do within your family system. Can you talk a little bit about that version?

Sanchez: Oh, absolutely. So, yes, the Life's Essential Eight. They are to be thought of through the life course. One of the sandwich generation opportunities that I have is that my 91-year-old mother is alive, and she's as good as she can be on Life's Essential Eight. And I'd like to think now, and we didn't plan Life's Essential Eight, I would encourage y'all to examine your own life and look, and you might be doing pretty well on those, and there's room for doing even better as opposed to, oh my gosh. So "even better" has become my mantra for this year. We all are doing pretty good. How can we do even better?

So for kids, it's the same eight. But I would say that the four healthy behaviors for children are even more important because that sets them up to maybe completely prevent the other four conditions: obesity, hypertension, hypercholesterolemia, and diabetes. Those are the diseases associated with the other four. And there is evidence that the sooner you are good on the first four, the more long-lasting the effect will be.

And I think what I hear, and I agree, is doing those things with your children—going for walks, emphasizing the healthier foods that are being eaten, emphasizing the not-so-healthy foods that are not being eaten, focusing on languaging around sleep and plenty of it, and then also hopefully no one smoking or vaping in the household. Those are also good ways to make habits—lifelong habits and customs and ways of behaving in the future as college students, as adults, and as families—that then can take, in a positively reinforcing way, those same Life's Essential Eight forward to others.

Pathak: As I hear you speak, I'm thinking about—I'm very involved with the American College of Lifestyle Medicine—and Lifestyle Medicine has its essential six pillars, which overlap significantly with the Life's Essential Eight that you've mentioned from the American Heart Association. So really focusing on healthful nutrition, physical activity, stress management, restorative sleep, avoiding risky or toxic substances like tobacco, smoking, vaping, and then really thinking about social connection. So how can we do all of these things in a way that's really affirming for the connections around us?

But I loved what you said earlier, which is that we have to think about all of these behaviors on a continuum. So the earlier we start, there's a higher chance of preventing things. Then there still may be a point where, even if you have optimized all of these things, you still may need the assistance of medications or other interventions to help with blood pressure, cholesterol, sugar. So this is also not a failure. And I see this often when I'm talking to friends, family, patients, where they say to me, well, I've been doing all of these things. I wanna hold off on trying to control my blood pressure with anything else but these interventions. How do you talk to people about—

Sanchez: That's a touchy subject for me. So here's the way I talk about blood pressure, and I am a primary care physician by training. I took care of patients for about a decade, and then I ended up having amazing opportunities come in front of me that precluded taking care of patients. But everything has been about public health, population health of the public around hypertension, high blood pressure.

Here's the way I talk about it, particularly and even more emphatically now with the release of a new guideline from the American Heart Association, American College of Cardiology, and a list of others. I emphasize the importance of getting blood pressure at a control level—the Life's Essential Eight level—as quickly as possible.

And here's the deal. If your blood pressure is high today, we can do lifestyle change, and we will do lifestyle change. If we only do lifestyle change and get to optimal levels of physical activity and healthy eating and not smoking and sleep and all the things, and no alcohol, it may take months to many months to get to a place where your blood pressure has come down to a level where your risk of a bad thing—a heart attack or stroke happening—is brought down as low as it possibly can be.

On the other hand, if I start you on a medication and bring your blood pressure down in seven days to that safe level, we can continue doing the lifestyle change. Somewhere down the line—months, probably months—we can have a conversation about removing that medication and no longer taking it. I had patients where we went down that road, and that is exactly what happened.

But the important thing is that you get out of the danger zone. And if I'm gonna be accountable to my responsibility to live the mission, to be a relentless force for a world of longer, healthier lives, that includes identifying those things that reduce risk as quickly as possible and then moving toward the thing that might result in taking medications off the list. Let me be clear. This is not done by me directing somebody. This is shared decision-making, where a patient might say, "Doc, I don't want to take any medication." And I would say, "Patient, I care about you. I wanna see you in a month, and I wanna see you in a month without the things that might cause you and your family grief and hardship."

And oh, by the way, when you have that kind of trusting, shared-respect relationship, that's the sort of negotiation that can happen. And I hope that's helpful. And again, this is all in the name of take care of you so that you can take care of others. And you're gonna best take care of you if the likelihood of a bad thing happening is reduced as much as possible, as quickly as possible.

Pathak: What's the next thing that someone who's listening should think about doing? We're talking about Life's Essential Eight. We're thinking about the context of stress and sleep and social connection. How do you approach thinking about that so that it doesn't feel overwhelming as you're trying to incorporate some of these shifts and changes into your life?

Sanchez: So let's go at it. So I will say one of the tremendous privileges that I had during the COVID pandemic was that, for the American Heart Association, I was a weekly, then monthly reporter, if you will, on what's going on internationally, domestically, and in the organization. And one of my colleagues came up with this construct. It may not have been original, but it sure was something that resonated, and that's control the controllables.

So one thing is there's so much going on. Take a moment at least to separate out that which you can do something about and that which is beyond your control. Example: I live in Dallas, Texas. We had a really, really, really nasty freeze over the weekend. Can't control that. What I could control was what I could do inside our house to make sure that it was warm. I could control making sure that we had enough food in the event that something went really, really south. And "control the controllables" became a way for me to think about communicating to folks.

So one is there may be controversy about whether you wear a mask or not. No controversy for me, but the truth is you can control what you do. You can wear a mask or not wear a mask. And so, control the controllables.

I'd say there are a few things that one can control that one might think about. And you said one—sorry, I'm gonna give you three, 'cause I'm gonna do one for your body. I'm finding more and more that getting enough sleep is a thing that is a challenge for many. So just kind of think about that and think about what you can do to get better sleep. That's one.

Two, your mind. Take a moment every day. Pick a time every day. Take a moment, if your life is really full of clutter—and I mean kind of the clutter of relationships and responsibilities—take a moment to breathe and think. It could be while you're having a meal. I am somebody who too often is eating while I'm on a call. But I have found that when I can stop and have that meal—healthy food—and be thoughtful, then that helps ground me a little bit.

And then the other is just about relationships. I'd say one thing is think about somebody who you love and you haven't talked to in a while. Reach out and talk to them. I just find that those are—it's sometimes hard to make it happen—but oh my gosh, they bring me such joy, and they bring the person you reached out to so much joy.

So one is think about sleep. Two, take a minute to just ground yourself. Take one or two or three deep breaths. It does make a difference. And then third, reach out to somebody who you haven't spoken to in a while and just let 'em know you're thinking about them, and let that conversation go where it's gonna go.

Pathak: I love everything you just said, and I love that you, as a representative of the American Heart Association, are saying this because I think often people really minimize the benefit of restorative sleep. They really minimize the benefit of connection. But to recognize how strong of a role there is for optimizing these things in heart health, in brain health, I think is really an empowering thing, and it gives people a lot more evidence and strength behind this being such a strong intervention that they should prioritize in their lives.

Sanchez: Couldn't agree with you more.

Pathak: I just wanna thank you so much for your time, Dr Sanchez, and this conversation. So critical, so important, and I think really empowering.

Sanchez: Well, thank you for the invitation. And here we are, to be a relentless force for a world of longer, healthier lives. We are here to serve, so anytime.

Pathak: I'd like to share three key takeaways from this discussion. First, taking care of yourself is not selfish. It's actually preventive medicine. A major theme of our conversation today was reframing prevention as health promotion, and that looks like caring for your body, mind, and relationships so you can show up better for your life and your loved ones today and protect the you 20 years from now.

Second, the American Heart Association's Life's Essential Eight gives a clear, evidence-based blueprint for cardiovascular and brain health. The framework includes four behaviors: not smoking, healthy eating, regular physical activity, and seven to nine hours of sleep, and four health metrics: healthy weight and well-controlled blood pressure, cholesterol, and blood sugar. Optimizing all of this lowers the risk for heart attack and stroke, and you can find a link to the American Heart Association's Life's Essential Eight in our show notes.

Finally, medication and lifestyle aren't rivals. They're a team, especially for blood pressure control, cholesterol control, and sugar control. One practical clinical point: if your blood pressure, cholesterol, or sugar are elevated, lifestyle changes are essential, but sometimes they can take time. Using medication can get you out of the danger zone quickly and can reduce near-term risks, while lifestyle changes should be the foundation today and long into the future. And just a reminder, for some people that support may be temporary. For others, you may need medications longer term on top of all of the lifestyle changes. Either way, it's not a failure; it's risk reduction and shared decision-making.

To find out more information about Dr Eduardo Sanchez and the American Heart Association, make sure to check out our show notes. Thank you so much for listening. Please take a moment to follow, rate, and review this podcast on your favorite listening platform. If you'd like to send me an email about topics you are interested in or questions for future guests, please send me a note at [email protected]. This is Dr Neha Pathak for the WebMD Health Discovered Podcast.