A new na­tional goal: sav­ing a mil­lion hearts

The Sun News (Sunday) - - Coasting - BY JANE E. BRODY

At­ten­tion all Amer­i­cans: Too many are at risk of suc­cumb­ing be­fore your time to the na­tion’s lead­ing killer, car­dio­vas­cu­lar dis­ease. Trans­la­tion: heart at­tacks and strokes.

Af­ter a decades-long drop, the car­dio­vas­cu­lar death rate has all but stalled and, fright­en­ingly, has even re­versed in a young group of peo­ple – adults ages 35 to 64, among whom deaths from heart dis­ease are now ris­ing.

Ac­cord­ingly, the Cen­ters for Dis­ease Con­trol and Pre­ven­tion has started an am­bi­tious na­tional ef­fort – Mil­lion Hearts 2022 – to re­vive what had long been a steady down­turn in the car­dio­vas­cu­lar death rate fos­tered largely by a de­cline in smok­ing and bet­ter de­tec­tion and treat­ment of el­e­vated blood pres­sure and choles­terol.

With your co­op­er­a­tion and the sup­port of the med­i­cal pro­fes­sion, in­sur­ance com­pa­nies, gov­ern­ment agen­cies and com­mu­ni­ties through­out the coun­try, the agency hopes to prevent 1 mil­lion heart at­tacks and strokes by the year 2022.

Achiev­ing this goal does not re­quire any new drugs, surg­eries or dis­cov­er­ies. It is not rocket science. There is al­ready a well-es­tab­lished path to coun­ter­ing car­dio­vas­cu­lar dis­ease. All it re­ally re­quires is the will of in­di­vid­u­als and so­ci­ety to fol­low it.

While this ef­fort may ini­tially in­volve some ad­di­tional dol­lars to bring car­dio­vas­cu­lar risk fac­tors un­der con­trol in more peo­ple, in the end the sav­ings could be as­tro­nom­i­cal.

As the cen­ters’ ex­perts es­ti­mated last year, if 2016 trends re­main con­stant through 2021, an es­ti­mated 16.3 mil­lion po­ten­tially pre­ventable life-threat­en­ing or fa­tal events, or 3.3 mil­lion a year, are pro­jected to oc­cur, in­clud­ing 2.2 mil­lion emer­gency depart­ment vis­its, 2.2 mil­lion deaths and 11.8 mil­lion hos­pi­tal­iza­tions, at a pro­jected cost of $170 bil­lion. A third of these pre­ventable events are likely to af­flict peo­ple ages 35 to 64, these ex­perts, Dr. Janet S. Wright, Hi­lary K. Wall and Matthew D. Ritchey, cal­cu­lated.

“A lot of the plateau stems from the epi­demics of obe­sity and di­a­betes that have come home to roost,” said Ritchey, a se­nior sci­en­tist in the cen­ters’ divi­sion of heart dis­ease and stroke pre­ven­tion. “This is es­pe­cially so among adults aged 35 to 64, for whom heart dis­ease and stroke mor­tal­ity is ris­ing. It’s very con­cern­ing. Many are peo­ple with young chil­dren and ag­ing par­ents to care for.”

The ex­perts are not call­ing for a rev­o­lu­tion. “Small, sus­tained changes over time can have a big im­pact on in­di­vid­u­als and on the coun­try,” Ritchey said.

He and his col­leagues cited 213 mil­lion op­por­tu­ni­ties to im­prove car­dio­vas­cu­lar risk among Amer­i­cans by ad­dress­ing be­hav­iors that are cur­rently stand­ing in the way of progress:

● 71 mil­lion peo­ple are phys­i­cally in­ac­tive, par­tic­i­pat­ing in no leisure-time ex­er­cise.

● 54 mil­lion peo­ple are still smok­ing com­bustible to­bacco prod­ucts.

● 40 mil­lion adults have un­con­trolled high blood pres­sure.

● 39 mil­lion with high choles­terol are not us­ing med­i­ca­tion to lower it.

● 9 mil­lion peo­ple for whom a daily baby as­pirin is ap­pro­pri­ate are not tak­ing it.

In other words, “mil­lions of Amer­i­cans have car­dio­vas­cu­lar risk fac­tors that place them at in­creased risk of hav­ing a car­dio­vas­cu­lar event, de­spite the ex­is­tence of proven strate­gies for pre­vent­ing or manag­ing”

those risks, Wall and co-au­thors wrote.

The as-yet un­stop­pable epi­demic of obe­sity is most likely the lead­ing cause of pre­ventable car­dio­vas­cu­lar dis­ease and deaths. Ex­cess weight can re­sult in high blood pres­sure, high choles­terol lev­els, Type 2 di­a­betes and a re­luc­tance to be phys­i­cally ac­tive, all of which con­tribute to car­dio­vas­cu­lar risk.

So if you do noth­ing else, make a con­certed ef­fort to shed ex­cess pounds and keep them off. Los­ing just 10 per­cent of body weight can have a ma­jor im­pact on your health.

If your choles­terol level is too high and di­etary changes like eat­ing less red meat and more seafood, fruits and vegeta­bles and choos­ing hearthealthy fats are not enough to bring it down, talk to your doc­tor about choles­terol-low­er­ing med­i­ca­tion like a statin. If pre­scribed, take it and con­tinue to take it in­def­i­nitely. Cur­rently, two pa­tients in five dis­con­tinue the drug within three months, and within six months only slightly more than half still take it.

De­spite decades of na­tion­wide ef­forts to get high blood pres­sure prop­erly di­ag­nosed and treated, Ritchey said this all­too-com­mon con­trib­u­tor to car­dio­vas­cu­lar dis­ease of­ten es­capes med­i­cal surveil­lance.

“Pa­tients come for a reg­u­lar doc­tor visit, but their el­e­vated blood pres­sure is not for­mally di­ag­nosed and there­fore not treated. It’s a pre­ventable risk fac­tor hid­ing in plain sight,” he said.

One of the sim­plest steps peo­ple could take on their own to prevent and treat high blood pres­sure is to lower their sodium in­take. Salt is the lead­ing di­etary source of sodium, which can raise blood pres­sure to dan­ger­ous lev­els in mil­lions of peo­ple.

In the most re­cent na­tional sur­vey of Amer­i­can di­ets, the aver­age daily sodium in­take for young adults was 3,809 mil­ligrams a day. Yet only 2,500 mil­ligrams is con­sid­ered suit­able for a healthy per­son, and a max­i­mum of 1,500 mil­ligrams is rec­om­mended for those who al­ready have high blood pres­sure.

Avoid foods that are al­ways high in salt, like smoked fish, pro­cessed meats, cured olives and salted snacks. Learn to read la­bels on pack­aged foods – they must list sodium lev­els per serv­ing – and ask to have salt with­held when order­ing food to take out or eat in.

More can be done through en­vi­ron­men­tal and work­place curbs to fur­ther re­duce smok­ing. Doc­tors are of­ten re­luc­tant to ask pa­tients about smok­ing, and pa­tients may not ad­mit that they smoke or how much they smoke, so mea­sures to foster ces­sa­tion are never pre­scribed.

En­cour­ag­ing phys­i­cal ac­tiv­ity can pro­vide myr­iad health ben­e­fits by help­ing peo­ple con­trol their weight, blood pres­sure and choles­terol and even smok­ing. The ur­ban ex­o­dus of the last half­cen­tury has fos­tered de­pen­dence on mo­tor­ized ve­hi­cles and a com­men­su­rate de­cline in daily ex­er­cise.

Amer­i­cans are not likely to start walk­ing miles to go gro­cery shop­ping, but many more could pur­posely build ac­tiv­ity into their daily lives. Just 10-minute bouts of ac­tiv­ity three times a day can im­prove car­dio­vas­cu­lar health. Com­mu­ni­ties can cre­ate safe ar­eas in which to walk and cy­cle and host events to en­cour­age such ac­tiv­i­ties.

Fi­nally, if you are a can­di­date for a daily baby as­pirin (healthy peo­ple over 75 are not con­sid­ered can­di­dates), take it. This very cheap over-the­counter med­i­ca­tion, which can also re­duce the risk of can­cer of the colon and rec­tum, is rec­om­mended for adults ages 50 to 59 who have a 10 per­cent or greater 10year risk of car­dio­vas­cu­lar dis­ease, a life ex­pectancy of at least 10 years and no in­creased risk of bleed­ing, as well as those who al­ready had a heart at­tack or stroke.

GRA­CIA LAM New York Times

There is al­ready a path to coun­ter­ing car­dio­vas­cu­lar dis­ease. All it re­ally re­quires is the will of in­di­vid­u­als and so­ci­ety to fol­low it.

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