Special Issue of JACC Broadly Examines the Global Promotion of CV Health
A special issue of the Journal of the American College of Cardiology (JACC), published Aug. 15, focuses on the promotion of cardiovascular health, including topics that broadly impact public health – such as smoking cessation, dietary habits and medication adherence – and the prevention of cardiovascular disease and other related conditions.
Valentin Fuster, MD, PhD, MACC, editor in chief of JACC, uses his Editor’s Page to explore how the food industry could prove to be an unlikely ally in the fight against obesity. He states that “in contrast to a confrontation with the tobacco industry … the food industry can be characterized on a far more progressive basis,” with recognized efforts to improve product compositions in terms of sugar, saturated fat and calorie content. Fuster emphasizes the need for cardiovascular professionals to redirect their efforts toward cardiovascular health promotion, adding that “this change in approach may cause us to collaborate with unlikely allies, but as Picasso said, ‘Action is the foundational key to success.’”
Highlights of this special Cardiovascular Health Promotion issue of JACC include:
Incentive Payments in Smoking Cessation: Paying smokers to quit with payments that increased with the length of abstinence (as much as $1,500) led one third of participants in a study to stop smoking for six months, according to Jean-François Etter, PhD, et al. At three months, 44.4 percent of the smokers in the incentive group reported they had been abstinent continuously compared to 6.4 percent of the control group. At six months, 35.9 percent of the incentive group and 5.7 percent of the control group reported continuous abstinence. At 18 months, which was one year after incentive payments ended, 9.5 percent of the incentive group and 3.7 percent of the control were confirmed abstinent. With a difference of 5.76 percentage points between the control and the incentives group after 18 months, 17 people would need to go through an incentive program similar to the one in the study to get one person to quit. In an accompanying editorial, Joseph A. Ladapo, MD, PhD, and Judith J. Prochaska, PhD, MPH, note that this would cost $28,050 to yield one additional long-term quitter.
Medication Adherence: Patients who fully adhered to guideline-recommended therapies had lower instances of major adverse cardiovascular events, according to a study led by Sameer Bansilal, MD, MS, et al. Researchers assessed the medication adherence levels of 4,015 post-myocardial infarction (MI) patients and 12,976 patients with atherosclerotic disease. The study showed that only 43 percent of post-MI patients were fully adherent to guideline-indicated therapy, yet the risk of a major adverse cardiovascular event was reduced by 25 percent in full adherence and 20 percent in partial adherence. Further, the research indicated that “better medication adherence led to important cost savings.” In an accompanying editorial comment, Paul W. Armstrong, MD, FACC, discusses promising approaches for improving patient adherence, stating that “an often-neglected factor … is the frequency of physician follow-up and provider continuity.” He adds that “as a bare minimum, our first step as clinicians must be to routinely ask about adherence with all of our patients at every visit and to encourage them to take their medications as instructed.”
Dietary Habits and Atherosclerosis: A social-business eating pattern – a diet with high consumption of red meat, pre-made foods, snacks, alcohol and sugar-sweetened beverages – is associated with an increased risk of presenting subclinical atherosclerosis, according to the results of the Progression of Early Subclinical Atherosclerosis study. José L. Peñalvo, PhD, et al., evaluated 4,082 asymptomatic participants for the presence and extent of subclinical atherosclerosis based on their dietary habits (Mediterranean, Western or social-business eating). The results of the study showed that participants with a social-business eating patterned consumed approximately 475 more kcal per day than those following a Mediterranean diet. The authors state that “participants in this social-business eating group presented increased values of cardiovascular disease risk markers and increased presence and extent of subclinical atherosclerosis, including plaques in the carotid and the iliofemoral territories and calcification in the coronaries, independently of other risk factors.” In an accompanying editorial comment, Frank B. Hu, MD, PhD, explains that cardiologists should resist the urge to “prescribe overly simplified dietary advice” to patients. He emphasizes that “analyzing and promoting dietary patterns offers a promising approach for informing dietary guidance for individual patients as well as for providing national dietary guidance for chronic disease prevention.”
High BP Leads to CVD in China: Researchers in China have found that high blood pressure (BP) is the leading cause of cardiovascular disease in the country, according to Frank B. Hu, MD, PhD, et al. Researchers used data from a cohort of the China Health and Nutrition Survey to estimate time trends in cardiovascular risk factors from 1991 through 2011. High BP, high low-density lipoprotein cholesterol, and high blood glucose were associated with 3.1, 1.4, and 0.9 million cardiovascular events in China, respectively. Increase in body mass index (BMI) was associated with an increase in attributable cardiovascular disease events, from 0.5 million to 1.1 million between 1991 and 2011, while decreased physical activity was associated with a 0.7-million increase in attributable cardiovascular disease events. “Strategies to improve life-style factors are critically needed to improve the health of the Chinese population and counter the urbanization effect,” states Gerald S. Bloomfield, MD, MPH, FACC, in an accompanying editorial comment. “Some of the most effective strategies appear to be economic incentives such as subsidy strategies to decrease the price of healthful foods and beverages, as well as multicomponent interventions in the school setting that aim to encourage healthier lifestyle habits.”
AED Accessibility: There’s only a 20 percent chance that a potentially life-saving automated external defibrillator (AED) will be nearby when someone experiences cardiac arrest and a 20 to 30 percent chance that the nearby device will be inaccessible because it is inside a building that’s closed, according to a study led by Timothy C.Y. Chan, PhD. The study concludes that a model that accounts for both location and availability when determining AED placement has the potential to significantly increase the likelihood of accessing an AED when needed. Also, government legislation mandating all AEDs must be registered with emergency medical services dispatch centers and accessible to the public 24/7 would improve access to AEDs. In an accompanying editorial comment, Robert J. Myerburg, MD, FACC, says the study is important and should be included in planning strategies for AED locations, but society would benefit more by both achieving better outcomes after out-of-hospital cardiac arrest and reducing the number that occur in the first place.
Offspring of Long-Lived Parents: In middle-aged populations, the risks of cardiovascular conditions are progressively lower the longer a person’s parents lived past 69 years old, according to a research letter led by David Melzer, MBBCh, PhD, et al. “It’s been unclear why some older people develop heart conditions in their sixties while others only develop these conditions in their nineties or even older. Avoiding the well-known risk factors such as smoking is very important, but our research shows there are also factors inherited from parents that influence heart health. As we understand these parental factors better, we should be able to help more people to age well.”
Read the full issue of the JACC Cardiovascular Health Promotion issue and listen to the audio commentary by Fuster.
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