The Wall Street Journal last Friday amplified the warning sounded by the National Forum in its 2017 and 2018 signature reports, Wrong Direction and Losing Ground. In her lengthy WSJ piece, Betsy McKay alerted readers that after decades of public health success that slashed death rates from heart disease and stroke, America is backsliding. Her article backs up the National Forum’s call to action to prevent, measure and control cardiovascular disease (CVD) risk factors earlier in people’s lives.
McKay quotes the lead author of the National Forum reports, Stephen Sidney of Kaiser Permanente Northern California. He observes that the rise in obesity and Type 2 diabetes are major drivers of the uptick in CVD mortality rates.
In Wrong Direction, Sidney and the National Forum called attention to the mortality trend that has derailed America’s steady progress against CVD. Not long ago, the National Forum’s goal was, Heart disease and stroke will no longer be the leading cause of death by 2020. That goal was bold but realistic when we adopted it earlier this decade. Not anymore.
What’s alarming is that people are getting CVD, having heart attacks and strokes and dying from them at younger ages. As Sidney pointed out in Losing Ground, heart disease and stroke are affecting people in their 50s and 40s, and even younger.
How did we get here? Overweight and obesity are increasingly prevalent. The Centers for Disease Control and Prevention reported that during a recent 25-year period (1988-2013), the number of adults diagnosed with diabetes nearly tripled. According to the National Institute of Diabetes and Digestive and Kidney Diseases, adults with diabetes are nearly twice as likely to die from heart disease and stroke than people without diabetes. Diabetes increases one’s chances of having high blood pressure and high cholesterol, both major CVD risk factors. Overweight and obesity also increase one’s chances of having heart disease or stroke or high-risk factors for them. Sedentary lifestyles—too much sitting—contribute to and worsen all these conditions.
Can we go back to making progress against heart disease and stroke mortality? Fortunately, yes. Public health and health systems research has illuminated a path to better cardiovascular health.
How? First, the healthcare system—clinicians, providers and payers—can improve early identification and control of CVD risk factors. As Sidney points out, following guidelines for detection, evaluation and treatment of CVD risk factors can make a big impact. “Progress in the 40-59 age group is possible. Heart disease and stroke deaths declined twice as fast among Kaiser Permanente Northern California patients as they did in the U.S. as a whole between 2000 and 2015.”  The strategies KPNC used are available to the public on the Million Hearts® website.
Mountain People’s Health Councils, a federally-qualified health center in rural Tennessee, increased their hypertension control rate from 74% in 2015 to over 90% in 2018. Listen to former Surgeon General Regina Benjamin’s interview of Patricia Dyer of MPHC to learn more.
Second, at the community level, mayors are using the National Forum’s Move with the Mayor™ program to encourage people to be more active. In Green Bay, former Mayor Jim Schmitt encouraged city employees to walk more. In 2017, their average of 184 minutes of moderate-intensity physical activity per week exceeded the CDC’s recommendation of at least 150 minutes per week. Additionally, mayors can make it possible and easier for people to by more active by ensuring that new streets are complete, meaning they include safe spaces for bicyclists and pedestrians. Mayors can expand smoke-free spaces in their communities and prohibit tobacco and vaping sales to minors.
Third, Congress, the White House and state legislatures need to increase resources for chronic disease prevention. Much of the progress in past decades was made by the success of anti-smoking programs and educating the public about healthy eating. To an extent, we have lost ground as we’ve taken our foot off the gas. Such programs need to be maintained, along with increasing safe places for people to walk to school, work, shopping and entertainment, and exploring new uses of technology to encourage heart-healthy lifestyles.
 Sidney S, Quesenberry CP Jr, Jaffe MG, Sorel M, Nguyen-Huynh MN, Kushi LH, Go AS, Rana JS. Recent Trends in Cardiovascular Mortality in the United States and Public Health Goals. JAMA Cardiol. 2016 Aug 1;1(5):594-9. doi: 10.1001/jamacardio.2016.1326
 Diabetes, Heart Disease and Stroke. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/heart-disease-stroke. Accessed June 27, 2019
 Sidney S. Losing ground: Heart disease and stroke deaths hit hardest right in the middle. National Forum for Heart Disease & Stroke Prevention, October 2018
 Sidney S., Sorel ME, Quesenberry CP, Jaffe MG, Solomon MD, Nguyen-Huynh MN, Go AS, Rana JS. Comparative Trends in Heart Disease, Stroke and All-Cause Mortality in the United States and a Large Integrated healthcare Delivery System. Am J Med. 2018 Jul;131(7): 829-836.e1. doi: 10.1016/j. amjmed.2018.02.014. Epub 2018 Apr 2.
 Dyer P and Benjamin R. Regina M. Benjamin, 18th United States Surgeon General, Interviews the 2018 Million Hearts Hypertension Control Champion. https://www.nationalforum.org/wp-content/uploads/2019/05/Regina-Benjamin-Trish-Dyer-Interview-Mtn-Peoples-Health-Council-NF-HTN-Webinar19_FIN-Transcript.pdf. Accessed June 27, 2019.
 Healthy Green Bay. 2018. https://www.nationalforum.org/wp-content/uploads/2018/09/MWTM-GB-Infographic-Edited-v11.pdf. Accessed June 27, 2019