ORLANDO - The problems associated with
cardiovascular disease can only be solved by
partnership—with patients, federal, state and local governments, and
other health care organizations, according to the American Heart
Association's leadership meeting here at the organization's 70th
scientific session.
"Advances in the understanding of genetics, physiology,
pathophysiology, and disease have created new opportunities for
clinical research," said Martha Hill, RN, PhD, president of the
American Heart Association. But this new knowledge will only have an
effect if scientists and physicians can integrate behavioral and social
sciences with the biomedical sciences. "This research transitions
from the laboratory to new applications for diagnosis, therapy, and
prevention in humans," she said in her presentation
during the opening session.
She called on the 37,000 meeting participants to lead the way in
solving the problems of cardiovascular disease by:
* Embracing the scientific findings that are relevant to the
AHA mission of reducing the burden of cardiovascular
disease.
* Translating research not only from the bench to the bedside but
also into the clinics, homes, and communities.
* Improving health behavior with the same zeal given to support
for biomedical research.
* Protecting basic research funding and encouraging further work
in the areas of behavioral science,
epidemiology, and prevention.
* Communicating the possibilities for preventing and treating
heart disease and stroke to members of Congress, state legislatures,
and local governmental officials.
In aid of this, she said, the AHA is working to insure that the
7.1% increase for stroke and heart disease research currently in the
federal budget stays there, and the organization is joining with others
in pushing for a doubling of the budget of the National Institutes of
Health by the year 2002.
She asked the AHA conference attendees to write the President and
support local grassroots efforts to increase federal funding in the
area of heart disease and stroke overall.
Research has also generated a new understanding in the behavioral
sciences that could lead to better efforts at prevention and treatment
of cardiovascular disease. "But putting the two kinds
of findings together in a coherent program is difficult," said Dr.
Hill. "Individual lifestyle habits significantly impact healthy with
unhealthy habits accounting for about 54% of known contributions to
heart disease. We know that behavioral and biologic interventions can
reduce morbidity, disability, and death due to heart disease and
stroke." However, what works in studies may or may not be effective
in a physician's office, clinic, or community, she said.
The "gap between potential and reality, intention and action,
information and behavior" must be spanned by better integrating the
information gleaned at the laboratory bench and the patient bedside
with that gathered from sources in the community.
Dr. Hill asked three questions: "Why does the gap exist? Why must it
be closed? What are we, as scientists and the AHA, doing to close
it?" Her questions were echoed by David Satcher, MD, MPH, nominee for
U.S. Surgeon General and currently director for the federal Centers for
Disease Control and Prevention in Atlanta, Ga. "I think the real
challenge now is how do we get people out there in the communities to
change their behavior," said Dr. Satcher. "That's what the CDC and
the American Heart Association can do together."
Dr. Hill lamented the fact that although studies have shown there are
ways to change and treat risk factors for stroke and
cardiovascular disease, implementation of these
strategies has been halting. "Despite programs that show how to lower
cholesterol, increase awareness of blood pressure and the
use of automated external defibrillators, the results have not been
generalized to the public as a whole," she said. "The failing
starts with the biomedical community that emphasizes basic and
translational research," she said. Studies that show how to use such
information have had to fight for funding and have often failed to get
the money needed. "For example, in a review of the literature on the
impact of medication non-adherence on coronary heart disease
outcomes, no clinical trials that specifically tested the impact of a
compliance-enhancing intervention were identified," she said.
As physicians are increasingly able to diagnose and intervene in
disease, the expectation is that all physicians will make use of such
tools. And as such tools are conveyed to the patients, one expects that
the problem will be solved. But, as Dr. Hill said, "Physician
behavior is influenced by many factors, an increasing number of which
they do not control. Patient behavior is also complex and influenced by
many factors." Physical and social environment has an impact as do
the kinds of health insurance a person has. And, she said, the way in
which academic health centers—where most research is conducted—are
organized makes it difficult to set up interdisciplinary approaches to
managing cardiovascular disease, even though these
methods have been proven most effective in the major treatment
trials.
Recognizing these barriers to effective practice will allow the AHA to
overcome them and make major in-roads against
cardiovascular disease—the disease that kills more
people than any other in the United States today.
"None of this can be attained by the AHA alone," said Dr. Hill.
Among the partners working toward these goals are Research!American, a
national research advocacy group; the American College of
Cardiology, the North American Vascular Biology
Organization, the CDC, the Health Care Finance Administration, the
Health Employers Data Information Set, the National Committee for
Quality Assurance, the National High Blood Pressure,
Cholesterol and Heart Attack Alert Education programs of
the National Heart, Lung and Blood Institute, as well as corporate
partners in the pharmaceutical and medical device industry.
"Partnering will be important," said Dr. Satcher, who delivered the
Lewis A. Conner Memorial Lecture as part of the scientific session's
opening. The CDC has recently become more aware of the need for
prevention in the area of chronic diseases, he said "It is the
leading cause of death in this country, responsible for about 40% of
all deaths," he said. "We spend $250-$260 billion per year treating
cardiovascular diseases in this country. What is the
cause of this problem?"
"Let me say that cardiovascular disease
prevention is at a crossroads," said Satcher. "I think we need to
take a new road. We are investing $1 trillion per year in our health
care system in this country...Public health must work with
practitioners to insure the prevention of
cardiovascular diseases, and we must begin that
partnership now. The nation spends $425 billion medical care dollars to
treat chronic disease (each year). But the per capita expenditure for
chronic disease prevention is only $1.21." That means that far less
than 1% of medical expenditures goes to prevention of chronic
diseases. "There is obviously room for improvement," he said.
"CDC hopes to improve by providing cardiovascular
disease prevention projects in every area of the country—just as
it has done with immunizations, programs to detect breast and cervical
cancer, and diabetes education projects," Dr. Satcher said.
"But to do that effectively, the agency will need to partner with the
American Heart Association," he said.
A 1993 CDC study showed that of 2.1 million deaths annually, nine
behaviors accounted for more than half. Tobacco accounted for 400 000,
poor diet and lack of physical activity accounted for 300 000, alcohol
use for 100 000. "It was clear from this study that if we were going
to make progress, we were going to have to change behaviors," he
said. "Of those deaths related to tobacco, 43% were deaths from
cardiovascular diseases," he said. "Smoking is a
major issue here; it doubles the risk of heart disease." Surveys
indicate that Americans—particularly the young—are unlikely to eat
healthy diets or exercise regularly. "An armed forces report recently
stated that the youth of the 1990s are less physically fit than their
fathers—the first time that has happened in recent history," said
Dr. Satcher.
As a result, the declines in stroke and heart disease rates that were
the cause of celebration in the 1960s and 1970s are beginning to
stagnate. Dr. Satcher said that turning the situation around will take
the partnership of public health and medical practitioners
as well as organizations. "The future of public health in the United
States will be difficult as cities become more crowded and young people
continue to make deadly choices about sex, violence, tobacco, and
diet," said Dr. Satcher. But he is not without hope. "I believe the
pressures to reduce health care costs will lead to more prevention and
applied research."
© 1998 American Heart Association, Inc.
Cardiovascular News
Overview of the American Heart Association National Meeting in Orlando
This article has been cited by other articles:
 |
|
 |
|
  U. Ramakrishnan, E. Kuklina, and A. D Stein Iron stores and cardiovascular disease risk factors in women of reproductive age in the United States Am. J. Clinical Nutrition, December 1, 2002; 76(6): 1256 - 1260. [Abstract] [Full Text] [PDF]
|
|
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||