What evidence exists for the high potential preventability of cardiovascular diseases?
Several recent studies demonstrate that individuals who maintain a profile of ideal cardiovascular risk factor levels from young adulthood into middle age essentially escape their remaining lifetime risk for major CVD events. Indeed, both CVD and non-CVD mortality rates are reduced, thereby resulting in an additional 10 years’ longevity (Capewell, Simon and Lloyd-Jones, Donald M. Optimal Cardiovascular Prevention Strategies for the 21st Century JAMA, November 10, 2010—Vol 304, No. 18.2057-8).
Capewell et al. recently demonstrated that if the majority of the US population reached middle age with this ideal phenotype, more than 90% of the coronary heart disease deaths otherwise expected in 2010 might be prevented.
However, barely 5% of the US population now maintains this ideal profile into middle age.
For the first time, The American Heart Association (AHA) has defined the “ideal cardiovascular risk factor profile”, identifying the following seven health factors and lifestyle behaviors that support heart health termed Life’s Simple 7:
- Total cholesterol <200 mg/dL (untreated)
- BP <120/<80 mm Hg (untreated)
- Fasting blood glucose <100 mg/dL (untreated)
- Body mass index < 25 kg/m2
- Abstinence from smoking
- Physical activity at goal for adults > 20 y of age: 150 min/wk moderate intensity or 75 min/wk vigorous intensity, or combination
- Four to five of the key components of a healthy diet consistent with current American Heart Association guideline recommendations. For example, a Healthy (DASH-like) diet
DASH diet or Dietary Approaches to Stop Hypertension is a diet based on an eating plan rich in fruits and vegetables, and low-fat or non-fat dairy, with whole grains. It is a low salt, high fiber, low to moderate fat diet, and is rich in potassium, calcium, and magnesium. Many other diets have the same basic principles as this diet including the Mediterranean, South Beach and Zone diets.
The AHA created the definition as part of its effort to achieve its new national goal : By 2020, improve the cardiovascular health of all Americans by 20 percent while reducing deaths from cardiovascular diseases and stroke by 20 percent. The novel focus of the new goal will be preventing heart disease and stroke, most notably by helping people identify and adopt healthier lifestyle choices. This will be the first time the AHA has adopted better health as a principal goal.
In a recent survey of adult Americans, the AHA found that 39 percent said they thought they had ideal heart health; however, 54 percent of those (and 70 percent of all respondents) said a health professional had told them they had a risk factor for heart disease and/or needed to make a lifestyle change to improve their heart health. These findings indicate most people don't associate important risk factors, such as poor diet and physical inactivity, with cardiovascular disease. The Heart Strategies Concentrating on Risk Evaluation (Heart SCORE) Study found that less than 10% of participants met greater than or equal to five components of ideal cardiovascular death in all subgroups (by age, race, sex and income level) (Bambs, Claudia et al. Low Prevalence of "Ideal Cardiovascular Health" in a Community-Based Population. Circulation. 2011;123:850-857).
To help people improve their heart health, the AHA developed a new online resource – My Life Check. The short assessment easily identifies the seven goals for ideal health and notes where a person is on the spectrum, while additional tools and information offer specific action steps to improve the measurements and track personal progress toward better health.
Take home message: Begin talking to your doctor about achieving your ideal cardiovascular profile as soon as possible. This involves assessing your current risk factors for cardiovascular disease and putting in place a prevention plan that addresses the major modfiable lifestyle factors (smoking, diet, exercise and alcohol consumption among others). This plan should be constantly monitored and updated. Due to their specialty training, preventive medicine specialists take into account the environmental and biological factors that provide context to health behaviors so that prevention plans are holisitic in nature.
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