Supporting the Complex Health Needs of Americans With Multiple Chronic Conditions

Eduardo SanchezEduardo Sanchez, M.D., M.P.H., Chief Medical Officer for Prevention and Chief of the Centers for Health Metrics and Evaluation, American Heart Association

It is challenging enough to live with a chronic disease like hypertension, but having multiple chronic conditions is even more difficult. Yet this is a reality for the roughly 1 in 4 adults in the United States who have two or more concurrent chronic conditions. This comorbidity can greatly complicate efforts to provide and coordinate quality care and adds to the cost of care. Almost two-thirds of total health care spending is directed toward care for persons with multiple chronic conditions.

Based on National Health and Nutrition Examination Survey data and the recently revised definition of high blood pressure, nearly half of American adults have hypertension (46 percent), almost one-third have high cholesterol (29 percent), close to one-fifth have prediabetes (17 percent), and about 1 in 8 (12.8 percent) have diabetes.

When one considers combinations of hypertension, high cholesterol, and diabetes, about 20 percent of American adults have hypertension and high cholesterol, 10 percent have hypertension and diabetes, and 8 percent have diabetes and high cholesterol. More than 6 percent have all three conditions.

The American Heart Association was involved in the release of cholesterol management guidelines in 2013, and in the release of new high blood pressure management guidelines in November 2017. AHA is also focusing on diabetes.

Individuals who have diabetes are two to four times more likely to die from cardiovascular disease than those without diabetes. The two most common kinds of diabetes are referred to as Type 1 and Type 2. More than 90 percent of adults with diabetes have Type 2, a condition that can be prevented or delayed with a prescribed regimen of healthy eating, physical activity, and weight loss. Type 1 diabetes often occurs during childhood and is an autoimmune disease in which the pancreas produces little or no insulin. Though causes of Type 1 differ greatly from causes of Type 2, individuals with Type 1 diabetes are also at increased risk for cardiovascular disease compared to those without diabetes. In both Type 1 and Type 2 diabetes, proper management of blood glucose is critical to reducing cardiovascular disease risk.

The AHA’s commitment to improve the cardiovascular health of all Americans has always included attention to normal blood glucose or blood glucose control as well as addressing the cardiovascular health needs of people living with diabetes. Last week, the AHA and the American Stroke Association hosted their first Cardiometabolic Health and Diabetes Summit. Participants included a diverse set of key players from the healthcare industry. They were convened to map out strategies for addressing cardiometabolic health and diabetes with special attention to clinical care across the primary and specialty spectrum, the patient perspective, the community, and health technology.

The summit launched the AHA Cardiometabolic Health and Diabetes Initiative, which aims to improve cardiovascular health and lower cardiovascular risk by preventing diabetes (when possible) and by optimizing treatment and management of diabetes, hypertension, and high cholesterol (when necessary).

We’ll do this by connecting disciplines such as primary care, cardiology, endocrinology and other providers in the clinical care space. We will address sociodemographic factors that affect an individual’s health as well as community factors that are health-promoting. By tapping into the expertise of thought leaders and practitioners during our summit, we know how AHA should best approach cardiometabolic health and diabetes.

One thing is certain – the cardiovascular and cardiometabolic health of the US population can improve only if everyone has access to quality clinical and community care. This includes lifestyle management to improve health and prevent diseases, and evidence-based management and treatment of diseases if they develop. Our work will use an equity first approach that gives special attention to those who are disproportionately affected by cardiovascular disease risk factors or health-affecting social factors (i.e., income, education, occupation, race, ethnicity, social support, culture, access to medical care and residential environment) that can be as influential as traditional risk factors.

Only by acknowledging and addressing these critical factors and adding diabetes to the AHA list of priorities will we improve the nation’s heart health. The millions of Americans living with multiple chronic conditions are counting on us.

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