The ABCS of Preventing Heart Attacks and Strokes

Each year, more than 2 million Americans have a heart attack or stroke, of whom more than 800,000 of them die; cardiovascular disease is the leading cause of death in the United States and the largest cause of lower life expectancy among blacks. Related medical costs and productivity losses approach $450 billion annually, and inflation-adjusted direct medical costs are projected to triple over the next two decades if present trends continue.

The Department of Health and Human Services (DHHS), with other public and private partners are launching a “Million Hearts” initiative to prevent 1 million heart attacks and strokes over the next 5 years by implementing proven, effective, inexpensive interventions.

Million Hearts will improve management of the “ABCS” with efforts to reduce smoking, improve nutrition, and reduce blood pressure:

• Aspirin for high-risk patients,
• Blood-pressure control,
• Cholesterol management,
• Smoking cessation.

Currently, less than half of people with ischemic heart disease take daily aspirin or other antiplatelet agents; less than half with hypertension have it adequately controlled; only a third with hyperlipidemia have adequate treatment; and less than a quarter of smokers who try to quit get counseling or medications.

As a result, more than 100 million people — half of American adults — smoke or have uncontrolled high blood pressure or cholesterol; many have more than one of these cardiovascular risk factors. Increasing utilization of these simple interventions could save more than 100,000 lives a year.

Improving care is particularly critical in light of increases in the prevalence of obesity and diabetes. Obesity and physical activity are currently being addressed by complementary efforts designed to improve understanding, implement pilot or community-based programs, and evaluate outcomes. The First Lady's “Let's Move” campaign is a comprehensive initiative with the goal of ending childhood obesity — a precursor to cardiovascular disease — within a generation by fostering environments that support increased physical activity and improved nutrition for children and families. And public and private partners are working to expand the Diabetes Prevention Program, which promotes weight loss, improved nutrition, and increased physical activity among people at highest risk.

(From: The “Million Hearts” Initiative — Preventing Heart Attacks and Strokes, T.R. Frieden and D.M. Berwick, 10.1056/NEJMp1110421)