Dorothea K. Vafiadis

The Importance of Population-Wide Sodium Reduction as a Means to Prevent Cardiovascular Disease and Stroke A Call to Action From the American Heart Association

Blood pressure (BP)-related diseases, specifically, stroke, coronary heart disease, heart failure, and kidney disease, are leading causes of morbidity and mortality in the United States and throughout the world. In the United States, coronary heart disease and stroke are the leading causes of mortality, whereas heart failure is the leading cause of hospitalizations.1 Concurrently, the prevalence of chronic kidney disease remains high and is escalating.2,3 The direct and indirect costs of these conditions are staggering, over

Sodium, Blood Pressure, and Cardiovascular Disease Further Evidence Supporting the American Heart Association Sodium Reduction Recommendations

400 billion just for cardiovascular disease (CVD) in 2009.1,4 The human consequences are likewise enormous. The relation between BP and adverse health outcomes is direct and progressive with no evidence of a threshold, that is, the risk of CVD, stroke, and end-stage kidney disease increases progressively throughout the range of usual BP starting at a level of ≈115/75 mm Hg.5,–,7 Overall, elevated BP is the second leading modifiable cause of death, accounting for an estimated 395 000 preventable deaths in the United States in 2005.8 Worldwide, elevated BP accounts for 54% of stroke and 47% of coronary heart disease events; importantly, about half of these events occur in persons without hypertension.9 The 2020 goal of the American Heart Association (AHA) is to improve the cardiovascular heath of all Americans by 20% while continuing to reduce deaths from CVD and stroke by 20%.4 Two of the key metrics for ideal cardiovascular health are a BP of <120/80 mm Hg and sodium consumption of <1500 mg/d. The purpose of this advisory is 2-fold: first is to highlight the impressive body of evidence that links sodium intake with elevated BP and other adverse outcomes, and second, to serve as a call to action on behalf of the AHA for individuals, healthcare providers, …

Update on prevention of cardiovascular disease in adults with type 2 diabetes mellitus in light of recent evidence: A scientific statement from the American Heart Association and the American Diabetes Association

Recent reports of selected observational studies and a meta-analysis have stirred controversy and have become the impetus for calls to abandon recommendations for reduced sodium intake by the US general population. A detailed review of these studies documents substantial methodological concerns that limit the usefulness of these studies in setting, much less reversing, dietary recommendations. Indeed, the evidence base supporting recommendations for reduced sodium intake in the general population remains robust and persuasive. The American Heart Association is committed to improving the health of all Americans through implementation of national goals for health promotion and disease prevention, including its recommendation to reduce dietary sodium intake to <1500 mg/d.

Update on Prevention of Cardiovascular Disease in Adults With Type 2 Diabetes Mellitus in Light of Recent Evidence: A Scientific Statement From the American Heart Association and the American Diabetes Association

Cardiovascular disease risk factor control as primary prevention in patients with type 2 diabetes mellitus has changed substantially in the past few years. The purpose of this scientific statement is to review the current literature and key clinical trials pertaining to blood pressure and blood glucose control, cholesterol management, aspirin therapy, and lifestyle modification. We present a synthesis of the recent literature, new guidelines, and clinical targets, including screening for kidney and subclinical cardiovascular disease for the contemporary management of patients with type 2 diabetes mellitus.

The Power of Play: Innovations in Getting Active Summit 2011 A Science Panel Proceedings Report From the American Heart Association

Cardiovascular disease risk factor control as primary prevention in patients with type 2 diabetes mellitus has changed substantially in the past few years. The purpose of this scientific statement is to review the current literature and key clinical trials pertaining to blood pressure and blood glucose control, cholesterol management, aspirin therapy, and lifestyle modification. We present a synthesis of the recent literature, new guidelines, and clinical targets, including screening for kidney and subclinical cardiovascular disease for the contemporary management of patients with type 2 diabetes mellitus.

Better Population Health Through Behavior Change in Adults A Call to Action

Background— To examine the influence active-play video gaming (also referred to as exergaming, exertainment, and active gaming) might have on improving health-related skills, enhancing self-esteem and self-efficacy, promoting social support, and ultimately motivating positive changes in health behaviors, the American Heart Association convened The Power of Play: Innovations in Getting Active Summit. The summit, as well as a follow-up science panel, was hosted by the American Heart Association and Nintendo of America. Methods and Results— The science panel discussed the current state of research on active-play video gaming and its potential to serve as a gateway experience that might motivate players to increase the amount and intensity of physical activity in their daily lives. The panel identified the need for continued research on the gateway concept and on other behavioral health outcomes that could result from active-play video games and considered how these games could potentially affect disparate populations. Conclusions— The summit represented an exciting first step in convening healthcare providers, behavioral researchers, and professionals from the active-play video game industry to discuss the potential health benefits of active-play video games. Research is needed to improve understanding of processes of behavior change with active games. Future games and technologies may be designed with the goal to optimize physical activity participation, increase energy expenditure, and effectively address the abilities and interests of diverse and targeted populations. The summit helped the participants gain an understanding of what is known, identified gaps in current research, and supported a dialogue for continued collaboration.

The National Physical Activity Plan: A Call to Action From the American Heart Association A Science Advisory From the American Heart Association

The American Heart Association (AHA) has adopted a bold new strategy in framing its 2020 goals: “By 2020, to improve the cardiovascular health of all Americans by 20% while reducing deaths from cardiovascular diseases and stroke by 20%.”1 By medically treating cardiovascular risk biomarkers and the disease itself, clinicians played a major role in achieving the AHA’s 2010 goal to reduce coronary heart disease, stroke, and risk by 25%.1 Now, however, with direct annual cardiovascular disease–related costs projected to triple, from

Stakeholder Discussion to Reduce Population-Wide Sodium Intake and Decrease Sodium in the Food Supply A Conference Report From the American Heart Association Sodium Conference 2013 Planning Group

272 billion in 2010 to

Translation and Implementation of Added Sugars Consumption Recommendations A Conference Report From the American Heart Association Added Sugars Conference 2010

818 billion in 2030,2 economic realities necessitate a new approach. To avoid bankrupting the healthcare system, we must improve the distribution of cardiovascular health levels across the population by preserving cardiovascular health from childhood and by treating health risk behaviors to help more individuals improve their cardiovascular health into older ages. This heightened emphasis on preventing disease by addressing health behaviors leads to 3 novel emphases in the 2020 goals: (1) Preserving positive “cardiovascular health” by promoting healthy lifestyle behaviors; (2) treating unhealthful behaviors (poor-quality diet, excess energy intake, physical inactivity, smoking), in addition to risk biomarkers (adverse blood lipids, high blood pressure, hyperglycemia, obesity); and (3) a combination of individual-level and population-based health promotion strategies that aim to shift the majority of the public toward the next level of improved cardiovascular health. The 7 metrics that define cardiovascular health (smoking, diet quality, physical activity level, body mass index, blood pressure, blood cholesterol, and fasting blood glucose) are each classified into 3 clinical strata (ideal, intermediate, and poor). Individuals with all 7 metrics at ideal levels are considered to have “ideal cardiovascular health.” However, the prevalence of ideal cardiovascular health is very low in the US population, and the prevalence of poor-quality diet, physical inactivity, and overweight/obesity is alarmingly high, presaging …

Food-intake patterns assessed by using front-of-pack labeling program criteria associated with better diet quality and lower cardiometabolic risk

The health benefits of regular physical activity and the relation between physical inactivity and chronic disease morbidity and mortality are well established. Also clear is the fact that efforts to increase physical activity at the population level will require collective action by government, nongovernment, for-profit, and nonprofit entities working together at the local, state, and national levels. The US National Physical Activity Plan (NPAP), developed by the National Physical Activity Plan Alliance, of which the American Heart Association (AHA) is a member, is designed to facilitate this collective action, to help organizations from all sectors of society work together to increase physical activity in all segments of the American population. The purposes of this advisory are to summarize the data that describe the health benefits of regular physical activity and the public health burden of low levels of physical activity, to describe the NPAP and the role it will play in increasing population levels of physical activity, and to encourage readers of Circulation to join the AHA’s efforts to promote its implementation. As summarized in Table 1, there is substantial evidence supporting the benefits of regular physical activity to prevent a wide variety of disease conditions and to enhance quality of life. Interestingly, there is less of an appreciation of noncardiovascular benefits of lifestyle physical activity and structured exercise, and this is an area of great opportunity for educating the public and healthcare practitioners. View this table: Table 1. The Health Benefits of Regular Physical Activity Physical inactivity is rapidly becoming a major global concern and is the fourth leading cause of death worldwide.2,3 As noted by Kohl and colleagues, “In view of the prevalence, global reach, and health effect of physical inactivity, the issue should be appropriately described as pandemic, with far-reaching health, economic, environmental, and social consequences.”4 According …