A 41-year-old who follows most of the guidelines for a healthy heart may have an actual biological age of 36. Then there’s the 53-year-old who doesn’t get enough sleep, doesn’t exercise regularly and has high levels of bad cholesterol who may actually have a biological age closer to 57, according to a new analysis presented at the annual meeting of the American Heart Association on Monday.

Biological aging may be slowed significantly when people adopt the eight behaviors recommended by the heart association, dubbed “Life’s Essential 8,” the report from Columbia University researchers found.

Data from more than 6,500 adults showed there could be up to five years’ difference between people’s chronological age and their biological age, also known as phenotypical age, if they incorporate all eight recommendations into their daily lives.

Phenotypical age is calculated by combining a person’s actual age with the levels of nine markers in the blood collected as part of a typical annual physical. Previous research has shown that phenotypical age correlates well with a person’s risk for premature death.

Among the blood levels that play a role in determining a person’s biological age are those that indicate liver, kidney and immune system health, risk for diabetes, and level of inflammation.

How to slow aging

The “Essential 8,” based on guidance from the heart association:

• Eat better. Consume a diet with a variety of fruits and vegetables, whole grains, healthy protein sources (mostly plants and seafood), non-tropical plant oils and minimally processed foods. Cut back on salt and alcohol and avoid added sugars.
• Be more active. Aim for at least 150 minutes of moderate to vigorous physical activity a week and two days a week of moderate to high-intensity muscle strengthening activities, such as weight lifting or resistance training.
• Quit tobacco. Smoking is the most preventable cause of premature death in the U.S.
• Get a healthy amount of sleep. Try to get an average of seven to nine hours of sleep each night.
• Manage your weight. Strive for normal weight, which is defined as a body mass index between 18.5 and 25. A BMI lower than that is considered underweight, a BMI between 25 and 29.9 is considered overweight, and a BMI of 30 or more is considered obese. For those with BMIs higher than what is considered healthy, set a short-term goal of losing (and keeping off) 3% to 5% of body weight.
• Control cholesterol levels. For most adults, an LDL (“bad” cholesterol) level of less than 100 is recommended. For people at high risk — such as those who have already had a heart attack or stroke, or who have genetic forms of high cholesterol — an LDL level of less than 70 is recommended.
• Manage blood sugar. The healthy range for fasting blood sugar is lower than 100 mg/dL, while 100 to 125 mg/dL indicates an increased risk for developing Type 2 diabetes.
• Manage blood pressure. A systolic blood pressure of less than 120 mm Hg and a diastolic reading of less than 80 mm Hg is healthiest.

“By improving heart health we can slow down our bodies’ aging process,” said study author Nour Makarem, assistant professor of epidemiology at Columbia University’s Mailman School of Public Health in New York City. “Another important message is that what we observed was dose dependent, which means that as heart health goes up, biological aging goes down.”

The research shows that even gradual changes can improve heart health and slow down aging, Makarem said.

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“The cool thing is there are eight health factors and behaviors that are modifiable,” she said. “This is a very hopeful message.”

What’s nice about this study is that it shows that by doing things for your heart, you also see improvements in other organs, like the liver and the kidneys, said cardiologist Dr. Howard Weintraub, clinical director of the Center for the Prevention of Cardiovascular Disease at NYU Langone Health.

Knowing that following the eight recommendations can make a person age more slowly may inspire some to try to improve their lifestyles, said Weintraub.

“When I tell a 30-year-old patient that their carotid artery looks like that of a 55-year-old, it gets their attention,” he added.

The size of the benefit in terms of biological age was surprising to Dr. Annapoorna Kini, director of the cardiac catheterization lab at Mount Sinai Fuster Heart Hospital in New York City.

“We used to think that heart health was 50% inherited and 50% lifestyle,” she said, adding that the study suggests that lifestyle may be even more important than genetic inheritance.

Still, Kini said, more research is needed to verify the results. If a larger study that follows people over time validates the findings, “it may be a game changer,” she said.