Eduardo Sanchez

Value of primordial and primary prevention for cardiovascular disease: a policy statement from the American Heart Association.

The process of atherosclerosis may begin in youth and continue for decades, leading to both nonfatal and fatal cardiovascular events, including myocardial infarction, stroke, and sudden death. With primordial and primary prevention, cardiovascular disease is largely preventable. Clinical trial evidence has shown convincingly that pharmacological treatment of risk factors can prevent events. The data are less definitive but also highly suggestive that appropriate public policy and lifestyle interventions aimed at eliminating tobacco use, limiting salt consumption, encouraging physical exercise, and improving diet can prevent events. There has been concern about whether efforts aimed at primordial and primary prevention provide value (ie, whether such interventions are worth what we pay for them). Although questions about the value of therapeutics for acute disease may be addressed by cost-effectiveness analysis, the long time frames involved in evaluating preventive interventions make cost-effectiveness analysis difficult and necessarily flawed. Nonetheless, cost-effectiveness analyses reviewed in this policy statement largely suggest that public policy, community efforts, and pharmacological intervention are all likely to be cost-effective and often cost saving compared with common benchmarks. The high direct medical care and indirect costs of cardiovascular disease-approaching

An Effective Approach to High Blood Pressure Control: A Science Advisory From the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention

450 billion a year in 2010 and projected to rise to over

An effective approach to high blood pressure control: a science advisory from the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention.

1 trillion a year by 2030-make this a critical medical and societal issue. Prevention of cardiovascular disease will also provide great value in developing a healthier, more productive society.

Discovering the full spectrum of cardiovascular disease: Minority Health Summit 2003: report of the Obesity, Metabolic Syndrome, and Hypertension Writing Group.

Cardiovascular diseases, including heart disease, hypertension, and heart failure, along with stroke, continue to be leading causes of death in the United States.1,2 Hypertension currently affects nearly 78 million* adults in the United States and is also a major modifiable risk factor for other cardiovascular diseases and stroke.1 According to data from the National Health and Nutrition Evaluation Survey (NHANES) in 2007 to 2010, 81.5% of those with hypertension are aware they have it, and 74.9% are being treated, but only 52.5% are under control, with significant variation across different patient subgroups.1,4–7 Of those with uncontrolled hypertension, 89.4% reported having a usual source of health care, and 85.2% reported having health insurance.3 This is the current status, despite the fact that therapies to lower blood pressure and associated risks of cardiovascular events and death have been available for decades, and various education and quality improvement efforts have been targeted at patients and healthcare providers. The direct and indirect costs of hypertension are enormous, considering the number of patients and their families impacted, and the healthcare dollars spent on treatment and blood pressure–related complications.8 Currently, hypertension affects 46% of patients with known cardiovascular disease and 72% of those who have had a stroke, and it is listed as a primary or contributing cause in ≈15% of the 2.4 million deaths in 2009.1 In 2008, the total estimated direct and indirect cost of hypertension was estimated at

Scientific Statement: Socioecological Determinants of Prediabetes and Type 2 Diabetes

69.9 billion.8 Thus, it is imperative to identify, disseminate, and implement more effective approaches to achieve optimal control of this condition. High-quality blood pressure management is multifactorial and requires the engagement of patients, families, providers, and healthcare delivery systems and communities. This includes expanding patient and healthcare provider awareness, appropriate lifestyle …

An Integrated Framework For The Prevention And Treatment Of Obesity And Its Related Chronic Diseases

Cardiovascular diseases, including heart disease, hypertension, and heart failure, along with stroke, continue to be leading causes of death in the United States [(1,2)][1]. Hypertension currently affects nearly 78 million[∗][2] adults in the United States and is also a major modifiable risk

Workplace Wellness Recognition for Optimizing Workplace Health A Presidential Advisory From the American Heart Association

This article provides an overview of our current understanding of the epidemiology of obesity, the metabolic syndrome, and hypertension among racial/ethnic groups. Three presentations made at the conference by the present writing group are summarized and updated with other information on ethnic groups, and recommendations developed by the writing group for programs, public policy, and research are put forward.

Interassociation Consensus Statement on Cardiovascular Care of College Student-Athletes

In this article, we examine the socioecological determinants—the biological, geographic, and built environment factors—that influence risk for prediabetes and type 2 diabetes. A socioecological perspective looks beyond the individual to evaluate a multitude of influences, from the surrounding home, work, school, and community environments to social determinants and the influence of public policy on individual behavior (1). Figure 1, adapted from the Institute of Medicine socioecological model of childhood obesity, provides a good framework for understanding potential socioecological determinants of risk for type 2 diabetes. Figure 1 Levels and sectors of influence on obesity and diabetes risk (progress in preventing childhood obesity) (© 2007 the National Academies Press). SES, socioeconomic status. In November 2012, the American Diabetes Association Prevention Committee convened a writing group to review the evidence on socioecological factors contributing to recent increases in prediabetes and type 2 diabetes. Drawing from the work of the committee, in this article we review the overarching evidence-based contributions of socioecological factors to risk for type 2 diabetes. Rather than incorporate the entire universe of relational observations, this scientific statement is intended to evaluate the extent to which data indicate a contributing role of social and environmental factors to the current epidemic of type 2 diabetes. The world is in the midst of parallel and rapidly advancing epidemics—obesity and type 2 diabetes—that began in the latter half of the 20th century and continue to grow, unchecked. Current prevalence rates are staggering and are expected to continue to climb over the ensuing decades. In the U.S., one-third of adults and 16–18% of youth are obese (2), up from 5 to 6% three decades ago (Fig. 2). Increases in rates of type 2 diabetes have closely followed the increases in obesity. In the U.S., diabetes affects 8.3% of the population, including 18.8 million with diagnosed …

The role of worksite health screening: A policy statement from the American heart association

Improved patient experience, population health, and reduced cost of care for patients with obesity and other chronic diseases will not be achieved by clinical interventions alone. We offer here a new iteration of the Chronic Care Model that integrates clinical and community systems to address chronic diseases. Obesity contributes substantially to cardiovascular disease, type 2 diabetes mellitus, and cancer. Dietary and physical activity interventions will prevent, mitigate, and treat obesity and its related diseases. Challenges with the implementation of this model include provider training, the need to provide incentives for health systems to move beyond clinical care to link with community systems, and addressing the multiple elements necessary for integration within clinical care and with social systems. The Affordable Care Act, with its emphasis on prevention and new systems for care delivery, provides support for innovative strategies such as those proposed here.

Reducing Childhood Obesity through U.S. Federal Policy

The workplace is an important setting for promoting cardiovascular health and cardiovascular disease and stroke prevention in the United States. Well-designed, comprehensive workplace wellness programs have the potential to improve cardiovascular health and to reduce mortality, morbidity, and disability resulting from cardiovascular disease and stroke. Nevertheless, widespread implementation of comprehensive workplace wellness programs is lacking, and program composition and quality vary. Several organizations provide worksite wellness recognition programs; however, there is variation in recognition criteria, and they do not specifically focus on cardiovascular disease and stroke prevention. Although there is limited evidence to suggest that company performance on employer health management scorecards is associated with favorable healthcare cost trends, these data are not currently robust, and further evaluation is needed. As a recognized national leader in evidence-based guidelines, care systems, and quality programs, the American Heart Association/American Stroke Association is uniquely positioned and committed to promoting the adoption of comprehensive workplace wellness programs, as well as improving program quality and workforce health outcomes. As part of its commitment to improve the cardiovascular health of all Americans, the American Heart Association/American Stroke Association will promote science-based best practices for comprehensive workplace wellness programs and establish benchmarks for a national workplace wellness recognition program to assist employers in applying the best systems and strategies for optimal programming. The recognition program will integrate identification of a workplace culture of health and achievement of rigorous standards for cardiovascular health based on Life’s Simple 7 metrics. In addition, the American Heart Association/American Stroke Association will develop resources that assist employers in meeting these rigorous standards, facilitating access to high-quality comprehensive workplace wellness programs for both employees and dependents, and fostering innovation and additional research.