Prevention Matters

September 26, 2010 marked the 10th anniversary of World Heart Day. Organized by the World Heart Federation, including the American Heart Association and the American College of Cardiology, World Heart Day calls attention to the death and disability caused by heart disease and stroke. Most people now understand that cardiovascular disease is the world’s leading cause of death and most people can identify at least some of the contributing risk factors – high cholesterol, high blood pressure, tobacco use. While we can name the threats, we are slower to recognize and embrace the policies and actions to prevent heart disease and stroke. Controlling diabetes, stopping tobacco use, eating more nutritiously and being more physically active are all important ways to help your heart stay healthy.

This year’s World Heart Day focus was workplace wellness. Most working adults spend the majority of their day at work and what we do at work affects our heart health. One of Partnership’s signature programs, Leading by Example (LBE) promotes workplace health through CEO to CEO engagement. Our LBE publications highlight the efforts of leading companies to build and support a healthy workforce.

Make your heart a 365 day project. Incorporate healthier practices while at work and home. Those working virtually or at home aren’t off the hook. Take a walk, put down the candy bar or cigarette and think about other ways to protect your heart during your work day.

For more information on Leading by Example click here, and for worksite health click here.


Diane Canova
VP, Policy and Programs
Partnership for Prevention

The positive impact improved treatment and more effective preventive measures are having on the death rate from coronary heart disease was named the “Best Prevention Idea of the Week,” while prescription labels inaccurately translated into Spanish was named the “Worst Prevention Idea of the Week."

The “Best/Worst” awards are announced each week in “Prevention Matters,” the blog of Partnership for Prevention. Nominees are submitted by Partnership staff as well as the general public, and are voted on by the staff. Partnership for Prevention is a nonpartisan organization of business, nonprofit and government leaders who are working to make evidence-based disease prevention and health promotion a national priority. More information is available at http://www.prevent.org/.

BEST

Prevention Gets Credit for Fewer Heart Deaths

Improved treatment, coupled with more effective preventive measures, may be having a positive impact on the death rate from coronary heart disease. Death rate data from the United States and Canada both indicate a drop in cardiovascular deaths. According to the American Heart Association, the annual death rate from coronary heart disease from 1996 to 2006 declined 36.4 percent and the actual death rate dropped 21.9 percent.

In Canada, according to a study in the May 12 issue of the Journal of the American Medical Association, the death rate from coronary heart disease in the province of Ontario fell by 35 percent from 1994 to 2005.

"The overall good news is that coronary heart mortality continued to go down despite people growing older," said study author Dr. Harindra C. Wijeysundera, a cardiologist at the Sunnybrook Health Sciences Centre Schulich Heart Centre in Toronto.

WORST

Translated prescriptions often wrong


Pharmacies that print prescription labels translated into Spanish often issue inaccurate or confusing instructions that could be potentially hazardous to a patient's health, according to a report in the May issue of Pediatrics journal. Researchers looked at 76 medicine labels generated by 13 different computer programs that many pharmacies use to make translations and found an overall error rate of 50 percent.

"It's not surprising, and it's something I experience in practice every day," said Dr. Alejandro Clavier, who works at Esperanza Health Center in Chicago's Little Village neighborhood on the Southwest Side.

Earlier this week, the research article, “Aspirin for Prevention of Cardiovascular Events in a General Population Screened for a Low Ankle Brachial Index (ABI)”, was published in JAMA. The goal of the study was to determine if daily aspirin reduced the risk of heart attack and stroke in patients with a low ABI, a quick and inexpensive way to establish risk for these events, and no other risk factors. Researchers hoped to show that the ABI could identify asymptomatic higher risk individuals that could benefit from preventive treatments, such as aspirin use.

The researchers found that aspirin was not effective in preventing first heart attack, stroke, or other cardiovascular events for individuals with low ABI and an absence of other risk factors. However, due to the fact that ABI was the only indicator used when determining risk, the study population was ultimately found to be at very low risk for heart attack and stroke. According to current guidelines, this low risk group would not be encouraged to use aspirin. So the study may actually say more about ABI or the range of ABI as a screening tool for cardiovascular risk than aspirin for primary prevention of cardiovascular events.

Other issues with the study include adherence to the therapy and disproportionate number of females in the study. Interestingly, the study showed no statistically significant difference between the aspirin and control groups for bleeding. Recently, aspirin use for primary prevention has been questioned due to a potential increased risk for gastrointestinal and intracranial bleeding; this study shows that bleeding events were similar between aspirin and non-aspirin users.

Ultimately, this study shows that ABI or the ABI threshold measurement used (0.95) is not enough to predict higher risk of heart attack and stroke on a population level. Future studies with more participants, improved compliance rates, a more equitable distribution of males and females, and a lower level of ABI for study inclusion are necessary to shed more light on this issue. An editorial, also published in JAMA, further explains the potential limitations of the study. Although at first glance this article appears to be another critique on aspirin for primary prevention-as many media outlets suggested- the current American Heart Association and United States Preventive Services Task Force guidelines for aspirin use to prevent first heart attacks and strokes should still be followed. And, as they recommend, those considering aspirin should talk to their health care provider to determine if aspirin is right for them.

Posted by:
Rebecca Doigan
Program Associate, Partnership for Prevention

Thirteen key aspects of cardiovascular disease prevention are identified as performance measures in a new, comprehensive set of detailed steps to help healthcare providers reduce patients’ risk for heart problems. The performance measures, developed by a joint task force of the American College of Cardiology and the American Heart Association, are simultaneously published in Circulation: Journal of the American Heart Association and the Journal of the American College of Cardiology.
The 13 measures are:

• lifestyle/risk factor screening
• dietary intake counseling
• physical activity counseling
• smoking/tobacco use assessment
• smoking/tobacco cessation
• weight and body fat assessment
• weight management
• blood pressure measurement
• blood pressure control
• blood lipid measurement
• blood lipid therapy and control
• estimation of a patient’s global risk for developing heart disease
• aspirin use in at-risk patients

Heart attack rates fall 17% within a year after smoking bans take effect, according to two recent analyses of laws in the USA, Canada and Europe. One analysis, which included 13 studies, appears in Circulation: Journal of the American Heart Association. A second analysis, which considered 11 studies, appears in the Journal of the American College of Cardiology.

The percentage of Americans without major heart disease risk factors rose during the 1980s and 1990s, but our health is declining again, a new study shows. The number of people with obesity, diabetes, and high blood pressure is increasing, even though the percentage of smokers is still heading south, according to the study published in Circulation: Journal of the American Heart Association.