Heart disease prevention: A good investment for individuals, communities

From the 25 July 2011 Science Daily article

ScienceDaily (July 25, 2011) — Preventing heart disease before it starts is a good long-term investment in the nation’s health, according to a new policy statement from the American Heart Association.
The policy statement, published in Circulation: Journal of the American Heart Association, summarizes years of research on the value of investing in prevention, particularly through community-based changes to make it easier to live a healthy lifestyle:

• Every dollar spent on building trails for walking or biking saves $3 in medical costs.
• Companies that invest in workers’ health with comprehensive worksite wellness programs and health work environments have less absenteeism, greater productivity and lower healthcare costs.
• Initiating a nationwide plan to drastically cut the amount of salt in the food supply to support an average intake of 1500 mg per day may reduce high blood pressure in the country by 25 percent, saving $26 billion in healthcare costs annually.

As a call to action, the statement puts an equal amount of responsibility on individuals and on society — specifically federal, state and local policy-makers.
“People often don’t realize the power to stay healthy is in their own hands,” said William S. Weintraub, M.D., lead author of the statement and the John H. Ammon chair of cardiology and cardiology section chief at Christiana Care Health System in Newark, Del. “But it’s not something many individuals or families can do alone. It takes fundamental changes from society as a whole.”
It’s more difficult to make healthy choices in some neighborhoods because it’s hard to find a safe place to bike or a nearby store with fresh vegetables at an affordable price, he said.

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World’s Leading Scientists Join Forces To Set Priority Interventions To Save 36 Million Lives From Non-Communicable Diseases

http://www.who.int/nmh/events/un_ncd_summit2011/en/index.html

World’s Leading Scientists Join Forces To Set Priority Interventions To Save 36 Million Lives From Non-Communicable Diseases***

From the April 5 2011 article

NCDs (non-communicable diseases), mainly heart disease, stroke, diabetes,cancers, and chronic respiratory disease, are responsible for two out of every three deaths worldwide and the toll is rising.***A landmark global alliance between leading scientists and four of the world’s largest NGOs brings together evidence from a 5-year collaboration with almost 100 of the world’s best NCD experts and proposes a short-list of five priority interventions to tackle this increasing global crisis. Reducing tobacco and salt use, improving diets and physical activity, reducing hazardous alcohol intake, and achieving universal access to essential drugs and technologies have been chosen for their health effects, cost-effectiveness, low costs of implementation, and political and financial feasibility….

….The top priority must be to reduce tobacco use followed by lowering salt intake, say the authors. Key to the success of this intervention will be the accelerated implementation of the Framework Convention on Tobacco Control (FCTC) to achieve the proposed goal, “a world essentially free from tobacco by 2040”, where less than 5% of the population uses tobacco; achieving this goal would prevent at least 5.5 million premature deaths over 10 years.

By 2025, they would like to see salt intake reduced to less than 5 g per person. They point out that reducing global salt consumption by just 15% through mass-media campaigns and reformulation of processed foods and salt substitution could prevent an estimated 8.5 million deaths in just 10 years.

Importantly, the costs of these interventions will be small, say the authors. The yearly cost to implement tobacco control and salt reduction will be less than US 50 cents per person per year in countries like India and China. The total package of priority interventions will require a new global commitment of about $9 billion per year.

*** The free full text of this Lancet article may be found here, however registration is required.

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• Patients must set the agenda on non-communicable diseases (International Alliance of Patient Organizations, 17 May 2011)

“Geneva, Switzerland, 17 May 2011 – Patient advocates have called for a stronger role in setting the agenda in the design and delivery of strategies to prevent and manage non-communicable diseases (NCDs), and chronic diseases more broadly. This call was made at a Side Meeting to the World Health Organization (WHO) World Health Assembly in Geneva, Switzerland. The meeting was hosted by the International Alliance of Patients’ Organizations (IAPO) and two of its member patient groups; Alzheimer’s Disease International (ADI) and the Multiple Sclerosis International Federation (MSIF) and attended by over 50 participants including member state representatives, health professionals and WHO representatives…

…Speakers from Africa, Latin America and Europe highlighted, with practical examples, how patient advocates are contributing knowledge, experience and resources to support efforts to tackle chronic disease. Across the world in high, middle and low income countries, patient groups routinely provide health information and training to patients and health professionals. These have been shown to support prevention strategies and effective disease management to ensure that patients’ needs are met. ….

HHS Launches New Consumer-Focused Immunization Website

From the US National Library of Medicine (NLM) Public Health Partners listerv

HHS Launches New Consumer-Focused Immunization Website
http://www.hhs.gov/news/press/2011pres/03/20110330a.html

The U.S. Department of Health and Human Services (HHS) has unveiled a new
website, Vaccines.gov, to help parents and other consumers learn about the
most effective way to protect themselves and their children from
infectious diseases and learn about immunization.

“Vaccines.gov puts the power of prevention at the fingertips of all Americans,” said Dr. Howard K. Koh, HHS Assistant Secretary for Health. “We urge everyone to visit this site and learn more about how vaccines can protect the health of each family member as well as the entire Nation.”

Vaccines.govis the first cross-government website devoted to providing consumer information about vaccines and immunization, combining content and expertise from agencies across the Department. It is the result of unprecedented collaboration among federal health and communications experts to offer online content about vaccine and immunization based on consumer needs.

The site includes content about vaccine recommendations, the diseases that vaccines prevent, important information for getting vaccinated, and tips on travel health. It also links consumers with resources in their states to learn about vaccine requirements for school or child care entry and local community information.

“This website will help ensure that Americans have accurate, Web-based information on immunizations,” said Dr. Bruce Gellin, director of the National Vaccine Program Office at HHS, which led the creation of Vaccines.gov. “It was developed with significant consumer input based on the public’s feedback and is remarkably easy to navigate. It is designed to answer consumers’ questions, educate them about diseases that vaccines prevent, and connect Americans with resources to keep themselves and their families healthy.”

In the coming year, Vaccines.gov will be expanded to include information from other government Departments, grow to include a Spanish version of the site, offer new content on vaccine recommendations and infectious disease outbreaks, and be continually tested to ensure Vaccines.gov addresses the needs and questions of consumers.

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Updated heart disease prevention guidelines for women focus more on ‘real-world’ recommendations

Updated heart disease prevention guidelines for women focus more on ‘real-world’ recommendations

From the February 15 2011 Eureka news alert

Updated cardiovascular prevention guidelines for women [link goes to free full text of the article] focus on what works best in the “real world” vs. clinical research settings and consider personal and socioeconomic factors that can keep women from following medical advice and treatment. The guidelines also incorporate illnesses that increase heart disease risk in women, such as lupus, rheumatoid arthritis and pregnancy complications Helping women — and their doctors — understand risks and take practical steps can be most effective in preventing heart disease and stroke.

 

The 2011 update identifies barriers that hinder both patients and doctors from following guidelines, while outlining key strategies for addressing those obstacles.

“Awareness continues to be a key driver to optimal care,” said Mosca, director of preventive cardiology at New York-Presbyterian Hospital and professor of Medicine at Columbia University Medical Center. “Cause initiatives such as Go Red for Women and provider compliance programs such as Get With The Guidelines® are strong components in our efforts to broaden awareness and improve adherence among patients and providers.”

She said getting a dialogue started between a woman and her doctor is a critical first step.

“If the doctor doesn’t ask the woman if she’s taking her medicine regularly, if she’s having any side effects or if she’s following recommended lifestyle behaviors, the problems may remain undetected,” she said. “Improving adherence to preventive medications and lifestyle behaviors is one of the best strategies we have to lower the burden of heart disease in women.”

To evaluate patient risk, the guidelines incorporate illnesses linked to higher risk of cardiovascular disease in women, including lupus and rheumatoid arthritis, and pregnancy complications such as preeclampsia, gestational diabetes or pregnancy-induced hypertension. Mosca said women with a history of preeclampsia face double the risk of stroke, heart disease and dangerous clotting in veins during the five to 15 years after pregnancy. Essentially, having pregnancy complications can now be considered equivalent to having failed a stress test.

“These have not traditionally been top of mind as risk factors for heart disease,” she said. “But if your doctor doesn’t bring it up, you should ask if you’re at risk for heart disease because of pregnancy complications or other medical conditions you’ve experienced.”

The updated guidelines also emphasize the importance of recognizing racial and ethnic diversity and its impact on cardiovascular disease. For example, hypertension is a particular problem among African-American women and diabetes among Hispanic women.

Although putting clinical research into practical, everyday adherence can be challenging, solid scientific evidence is still the basis for many of the guidelines, Mosca said. Some commonly considered therapies for women are specifically noted in the guidelines as lacking strong clinical evidence in their effectiveness for preventing cardiovascular disease and, in fact, may be harmful to some women. Those include the use of hormone replacement therapy, antioxidants and folic acid.

The update includes depression screening as part of an overall evaluation of women for cardiovascular risk, because while treating depression has not been shown to directly improve cardiovascular health, depression might affect whether women follow their doctor’s advice.

Despite a growing body of clinical evidence to fight heart disease and stroke in women, more is needed, Mosca said. Coronary heart disease death rates in women dropped by two-thirds from 1980 to 2007, due to both effective treatment and risk factor reduction, according to the American Heart Association, but cardiovascular disease still kills about one woman every minute in the United States.

In future studies, researchers should look at interventions during specific times throughout a woman’s lifespan ― including puberty, pregnancy and menopause ― to identify risks and determine effective prevention opportunities during those critical times, Mosca said. More cost-effective analyses and clinical trial research with male- and female-specific results are also needed, especially regarding risks posed by preventive therapies.

“Now that science has shown the benefits are often similar for men and women, there is a need to understand if the risks are also similar and acceptable,” she said.

“These guidelines are a critical weapon in the war against heart disease, the leading killer of women,” Mosca said. “They are an important evolution in our understanding of women and heart disease. And I cannot stress personal awareness and education enough. Initiatives such as Go Red For Women give women access to the latest information and real-life solutions to lower their risk of heart disease.”