A National Goal: Prevent a Million Heart Attacks and Strokes by 2022


Attention all Americans: Too many are at risk of succumbing before your time to the nation’s leading killer, cardiovascular disease. Translation: heart attacks and strokes.

After a decades-long drop, the cardiovascular death rate has all but stalled and, frighteningly, has even reversed in a young group of people — adults aged 35 to 64, among whom deaths from heart disease are now rising.

Accordingly, the Centers for Disease Control and Prevention has started an ambitious national effort — Million Hearts 2022 — to revive what had long been a steady downturn in the cardiovascular death rate fostered largely by a decline in smoking and better detection and treatment of elevated blood pressure and cholesterol.

With your cooperation and the support of the medical profession, insurance companies, government agencies and communities throughout the country, the agency hopes to prevent a million heart attacks and strokes by the year 2022.

Achieving this goal does not require any new drugs, surgeries or discoveries. It is not rocket science. There is already a well-established path to countering cardiovascular disease. All it really requires is the will of individuals and society to follow it.

While this effort may initially involve some additional dollars to bring cardiovascular risk factors under control in more people, in the end the savings could be astronomical.

As the centers’ experts estimated last year, if 2016 trends remain constant through 2021, an estimated 16.3 million potentially preventable life-threatening or fatal events, or 3.3 million a year, are projected to occur, including 2.2 million emergency department visits, 2.2 million deaths and 11.8 million hospitalizations, at a projected cost of $170 billion. A third of these preventable events are likely to afflict people aged 35 to 64, these experts, Dr. Janet S. Wright, Hilary K. Wall and Matthew D. Ritchey, calculated.

“A lot of the plateau stems from the epidemics of obesity and diabetes that have come home to roost,” said Dr. Ritchey, a senior scientist in the centers’ division of heart disease and stroke prevention. “This is especially so among adults aged 35 to 64, for whom heart disease and stroke mortality is rising. It’s very concerning. Many are people with young children and aging parents to care for.”

The experts are not calling for a revolution. “Small, sustained changes over time can have a big impact on individuals and on the country,” Dr. Ritchey said.

He and his colleagues cited 213 million opportunities to improve cardiovascular risk among Americans by addressing behaviors that are currently standing in the way of progress:

In other words, “millions of Americans have cardiovascular risk factors that place them at increased risk of having a cardiovascular event, despite the existence of proven strategies for preventing or managing” those risks, Ms. Wall and co-authors wrote.

The as-yet unstoppable epidemic of obesity is most likely the leading cause of preventable cardiovascular disease and deaths. Excess weight can result in high blood pressure, high cholesterol levels, Type 2 diabetes and a reluctance to be physically active, all of which contribute to cardiovascular risk.

So if you do nothing else, make a concerted effort to shed excess pounds and keep them off. Losing just 10 percent of body weight can have a major impact on your health.

If your cholesterol level is too high and dietary changes like eating less red meat and more seafood, fruits and vegetables and choosing heart-healthy fats are not enough to bring it down, talk to your doctor about cholesterol-lowering medication like a statin. If prescribed, take it and continue to take it indefinitely. Currently, two patients in five discontinue the drug within three months, and within six months only slightly more than half still take it.

Despite decades of nationwide efforts to get high blood pressure properly diagnosed and treated, Dr. Ritchey said this all-too-common contributor to cardiovascular disease often escapes medical surveillance.

“Patients come for a regular doctor visit, but their elevated blood pressure is not formally diagnosed and therefore not treated. It’s a preventable risk factor hiding in plain sight,” he said.

One of the simplest steps people could take on their own to prevent and treat high blood pressure is to lower their sodium intake. Salt is the leading dietary source of sodium, which can raise blood pressure to dangerous levels in millions of people.

In the most recent national survey of American diets, the average daily sodium intake for young adults was 3,809 milligrams a day. Yet only 2,500 milligrams is considered suitable for a healthy person, and a maximum of 1,500 milligrams is recommended for those who already have high blood pressure.

Avoid foods that are always high in salt, like smoked fish, processed meats, cured olives and salted snacks. Learn to read labels on packaged foods — they must list sodium levels per serving — and ask to have salt withheld when ordering food to take out or eat in.

More can be done through environmental and workplace curbs to further reduce smoking. Doctors are often reluctant to ask patients about smoking, and patients may not admit that they smoke or how much they smoke, so measures to foster cessation are never prescribed.

Encouraging physical activity can provide myriad health benefits by helping people control their weight, blood pressure and cholesterol and even smoking. The urban exodus of the last half-century has fostered dependence on motorized vehicles and a commensurate decline in daily exercise.

Americans are not likely to start walking miles to go grocery shopping, but many more could purposely build activity into their daily lives. Just 10-minute bouts of activity three times a day can improve cardiovascular health. Communities can create safe areas in which to walk and cycle and host events to encourage such activities.

Finally, if you are a candidate for a daily baby aspirin (healthy people over 75 are not considered candidates), take it. This very cheap over-the-counter medication, which can also reduce the risk of cancer of the colon and rectum, is recommended for adults aged 50 to 59 who have a 10 percent or greater 10-year risk of cardiovascular disease, a life expectancy of at least 10 years and no increased risk of bleeding, as well as those who already had a heart attack or stroke.



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