Cardiovascular disease (CVD), which includes heart disease and stroke, is the No. 1 killer in the United States.
The American Heart Association Guide for Improving Cardiovascular Health at the Community Level (Community Guide) provides a framework for anyone interested in reducing the burden of heart disease and stroke in the nation's communities. Previous recommendations focused on what to do if someone has risk factors or symptoms of CVD. "These new recommendations provide population-wide prevention measures to lower everyone's risk of cardiovascular disease, not just those with risk factors or symptoms," says Thomas A. Pearson, M.D., Ph.D., who chaired the expert panel that wrote the scientific statement.
While complementary to other recommendations, the Community Guide is truly a one-of-a-kind guide to heart-healthy lifestyles, he says. The statement emphasizes the social and environmental origins of the CVD epidemic and notes that scientific research, secular studies and community interventions provide a "compelling rationale for attacking the cardiovascular epidemic at the community level."
"The recommendations couldn't be more timely," adds American Heart Association President Robert O. Bonow, M.D. Two community-based studies suggest that the rates of new cases of heart disease have not fallen since 1990; for women, they may actually have risen. The rate of stroke has not declined since 1990, reversing a century-long trend. Obesity and diabetes, two of the strongest risk factors for cardiovascular disease, have reached epidemic proportions in the Western world.
The gap between goals outlined by the Community Guide and reality is large, presenting a challenge to communities, the panel reports. They say many Americans don't have access to cholesterol screening; many schools' physical activity programs have been reduced or eliminated, and schools often don't offer heart-healthy breakfasts or lunches. In addition, many people are still exposed to environmental tobacco smoke at work and home, and tobacco is still readily accessible to the nation's youth.
The Community Guide offers an easy-to-follow roadmap with specific recommendations to promote cardiovascular health. It includes strategies for assessment, education, community organization and partnering, ensuring personal health services, environmental change and policy change. The report also emphasizes identifying high-risk groups and modifying efforts to accommodate limited literacy, gender differences, and cultural, socioeconomic and language diversity.
Healthcare providers, employers, teachers and community leaders need to work together on efforts to prevent heart disease and stroke, and to make sure the "places where we live and work have the best environments to promote cardiovascular health," says Pearson, who is chairman of the department of community and preventive medicine at the University of Rochester Medical School in Rochester, N.Y.
"We also need to continue to be politically active," Pearson adds. "Cardiovascular disease is our leading health threat. We must continue to be advocates to our local, state and national representatives to ensure all Americans are aware of heart disease and stroke, can live and work in healthy settings, have access to appropriate healthcare, and can be reimbursed for that care.
"Americans have come to believe that heart disease and stroke prevention starts after they have already suffered a heart attack or stroke or after their doctor has identified risk factors such as high cholesterol or high blood pressure," Pearson says. "However, prevention starts in our families, religious organizations, schools and worksites on an everyday basis in all people."
Bonow says community-based programs have long been a cornerstone of the heart association's efforts. "These recommendations underscore how the challenge can continue to be met in community partnerships," he says. "The severity of the problem calls for it."
Other members of the writing group are Terry Bazzarre, Ph.D.; Stephen R. Daniels, M.D., Ph.D.; Joan M. Fair, R.N., Ph.D.; Stephen P. Fortmann, M.D.; Barry A. Franklin, Ph.D.; Larry B. Goldstein, M.D.; Yuling Hong, M.D., Ph.D.; George A. Mensah, M.D.; James F. Sallis, Jr., Ph.D.; Sidney Smith, Jr., M.D.; Neil J. Stone, M.D.; and Kathryn A. Taubert, Ph.D.
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