Shots - Health Blog
3:03 pm
Tue September 13, 2011

The 'Next Big Step': Preventing 1 Million Heart Attacks And Strokes

They're calling it Million Hearts – a newly launched campaign to put a half-dozen simple and proven public health strategies into wider practice. Federal health officials say it can prevent a million heart attacks and strokes between now and 2016.

Federal officials call it "the next big step" in cardiovascular prevention. There's lots of evidence it's an achievable goal.

First, deaths from cardiovascular disease have already been cut by 60 percent over the past generation. About half of that reduction is due to better diet, smoking cessation and other public health measures. The other half comes from from better medical treatment.

"But we still have a long way to go," Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, told Shots. "We still have 107 million adults — just about half of all adults — who either have blood pressure out of control, cholesterol out of control, or who smoke."

The campaign has two parts. One aims to change the behavior of doctors and patients. The other aims to change what all of us eat. Both are summed up by the acronym ABCS – which stands for aspirin, blood pressure control, cholesterol control and smoking.

In the realm of doctors and patients, Frieden and a phalanx of other federal officials want to expand by 10 million the number of Americans who have their high blood pressure under control and by 20 million those with controlled blood cholesterol levels.

To get there will require raising blood pressure control from less than half the people with hypertension now to 65 percent. Cholesterol control will have to triple.

The other medical-care strategy is to get people at high risk of heart attacks and strokes to take a baby aspirin every day. Fewer than half now do. The government wants to get that up to 65 percent.

Another goal is to get four million smokers to quit by 2016. That target is more modest – lowering smoking prevalence from 19 percent of adults today to 17 percent five years from now.

The smoking-cessation part of the campaign is part medical, part public health. "Less than a quarter of people who smoke get evidence-based help to quit," Frieden says.

Getting doctors to urge patients to quit "doubles the likelihood of a successful quit attempt," Frieden and Dr. Donald Berwick, the chief of Medicare and Medicaid, write in an article posted Tuesday by the New England Journal of Medicine. Prescribing one of the seven approved smoking-cessation drugs further increases quit rates.

The public health part of the stop-smoking initiative is familiar. A year from now it'll be stepped up by graphic new warnings on all cigarette packs – unless the industry gets courts to block them.

All these strategies "could save more than 100,000 lives a year," Frieden and Berwick claim. Over five years that adds up to half the Million Hearts goal.

The rest is supposed to come from two big changes in what Americans eat. Federal officials want to cut average daily salt intake by 20 percent.

But this doesn't mean throwing away the saltshaker, Frieden says. "Most Americans eat about twice as much sodium as we should get," he says. "About 80 percent of that comes in restaurant and packaged foods — it's not what you add at the table.

"What the studies show," he adds, "is that if you take half of the salt out of food and tell people 'put as much salt on as you want,' they only put back about 20 percent of what got taken out."

So the Food and Drug Administration plans to work with the food industry to cut back on the salt that's already in food when it gets on the plate. Other agencies will press for reduced salt in food the government pays for and will try to raise consumer awareness.

Similarly, the government wants to eliminate artificial trans fat in purchased foods — chemicals that raise levels of bad cholesterol and lower good cholesterol. Already, Americans' consumption of trans fat has been reduced by half; going the rest of the way could save 50,000 lives a year, according to Frieden and Berwick.

This is the public face of the campaign. Behind the scenes, one driving force of Million Hearts is the realization that with more doctors using electronic medical records and adopting new medical information technology systems, improving cardiovascular preventive care is "the best place to start," Frieden says.

"Most of us get reminders from our dentists or auto mechanics or our vet if our teeth or car or pet needs maintenance," Frieden says. "But we rarely get a reminder from our doctor."

If Million Hearts works as intended, that will change.

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