Eduardo Sanchez, M.D., M.P.H., Chief Medical Officer for Prevention and Chief of the Centers for Health Metrics and Evaluation, American Heart Association
Lots of folks need an Rx for the heart.
A study in today’s Journal of the American Heart Association examined long-term heart health in nearly 3,500 middle-age to older adults in the Framingham Offspring Study, part of a long-running project to monitor heart disease risk factors. Heart health was based on the AHA’s Life’s Simple 7 (LS7) metrics – smoking status, eating pattern, physical activity levels, body mass index, blood pressure, cholesterol level, and glucose level.
The study provides two important insights:
- People who maintained high cardiovascular health (CVH) during the study period (1991-2008) experienced less cardiovascular disease and death due to any cause compared to those who started with high and moved to low CVH, started at low and moved to high CVH, or started at low and stayed at low CVH.
Notably, people with low CVH at the beginning with improvement to high CVD at the end had almost twice the odds of having underlying disease, compared to those who maintained high scores throughout. This suggests that it’s important to achieve ideal or at least high CVH as early as possible and to maintain it throughout adulthood. Still, whatever your stage in life, it’s possible to make changes that can have a positive effect.
- The number of people with ideal CVH – defined as not having heart disease and maintaining optimal levels of the LS7 metrics (achieved without drug treatment) – declined over time. This was mostly due to a shrinking percentage of people with a healthy weight and healthy levels of blood pressure, blood sugar and cholesterol.
This is not surprising. Data from the National Health and Nutrition Examination Survey indicate virtually a zero prevalence of ideal CVH and low numbers of people with 6 or more optimal levels of LS7 metrics (declining from 10.3 percent among adolescents ages 12-19 to 0.5 percent among adults ages 60 and older).
Promoting healthy lifestyles through public health practices and policies
The study authors point out that although achieving and preserving good cardiovascular health requires individual effort, we must consider the effect of public health policies. Put another way, taking responsibility for one’s own health is critical. So is learning that complex, interrelated aspects of our physical, social and policy environments can influence health.
Public health practices and policies that change systems and environments support individual efforts to make healthy lifestyle choices. Community-based efforts can help transform the environments where behavior occurs to make healthier choices easier – more accessible, affordable, and attractive – for everyone. For example, well-maintained sidewalks, bike lanes and parks support physically active lifestyles, while healthier food options in corner stores, vending machines and other public places promote better eating habits.
Improving the cardiovascular health of all Americans by 20 percent by 2020 is an integral part of the AHA’s 2020 impact goal. While Life’s Simple 7 helps individuals identify where they stand personally, the association has also advocated for and pursued population-based policy, systems and environmental change to foster and facilitate a culture of cardiovascular health. Examples include our efforts to reduce smoking and exposure to second hand smoke; work in school settings to assure healthier food and more physical activity; creation of a tool to assess workplace cardiovascular health and wellness policies, programs and practices; and refinement of a policy approach, through the Voices for Healthy Kids initiative, to achieve a culture of health for all children.
Despite these efforts and many other advances in prevention and treatment that have resulted in declines in CVD deaths over the past several decades, heart disease is still the leading and stroke the fifth leading cause of death in the U.S.
For all Americans
The AHA’s 2020 impact goal intentionally states that it is for “all Americans,” alluding to the importance of health equity – where everyone deserves to live the healthiest life possible. Addressing the clinical factors (the right doctor, the right diagnosis, and the right medicine) and the behavioral factors (smoking status, eating habits, and physical activity levels) that contribute to living the healthiest possible life is vital, but not sufficient. This is because some of the influences that help or hinder one’s ability to live the healthiest life possible are socioeconomic factors.
Also known as social determinants of health, these factors include educational attainment, income, race/ethnicity, and the availability and affordability of safe housing and food. For example, CVH correlates positively with higher educational attainment and income, and food insecurity and housing insecurity correlate with poor health. Health status, educational attainment and income all vary by race and ethnicity. The association has invested time and resources to become a stronger change agent to eliminate disparities in educational attainment and in access to health insurance and medical care.
The new JAHA study makes the case that early and sustained high CVH is most cardio-protective, and alludes to the importance of complementing individual efforts to attain high CVH with supportive policies in school, workplace and community environments. It will take multi-level, multi-sector and multi-disciplinary approaches to achieve and maintain high CVH and for all to live a long, healthy life. After all, Life is Why.