Message of prevention key in heart disease fight

Work to get basic information out to the public

Choosing February as American Heart Month is not coincidental. With Valentine's Day in February, it is a month in which people are heart-centric, in the spirit of honoring the emotional needs of the heart. So it is appropriate to extend that thought process from the emotional fulfillment to what is required physically to keep the heart healthy, says Clyde W. Yancy, MD, FACC, FAHA, FACP, medical director at Baylor Heart and Vascular Institute in Dallas and chief, cardiothoracic transplantation at Baylor University Medical Center.

While more and more medical interventions save people with heart disease, it is far better to avoid the disease than to treat it and education is key to prevention, he states. "The best way to treat heart disease is to never get it. I don't think that message gets out there. What gets out is the breakthrough discovery, the new technique and new strategy. It all sounds like we can fix anything," says Yancy.

In reality, heart disease shortens longevity, decreases economic productivity, and decreases quality of life. All these factors in turn disrupt families, society, and the economy, says Yancy.

Educating the patient

To prevent heart disease, people need to know that there are lifestyle choices they can make to lower their risk. However, certain factors that put a person at higher risk cannot be altered, says Yancy. For example, people cannot pick new parents, change their gender, change their race, or change their age.

They can choose not to smoke, to lead an active vs. a sedentary life, what kind of diet to follow, and try to lose pounds if overweight. People with high blood pressure should be seen by a physician on a regular basis to get the problem under control and those with diabetes also need regular treatment.

"These are all things that are important in the consideration of heart disease, particularly diet, obesity, smoking, and hypertension — all of which can be modified by each individual's own activity, and that comes back to education," says Yancy.

People need to know that even modest changes in lifestyle can make a big impact on their risk for heart disease, and that how they currently live impacts their future. The message concerning future health can be difficult to convey. "In our culture we are often reactionary. What we are trying to do is get people to be proactive and take a preventive position," says Yancy.

For example, high blood pressure is a huge issue as people age. That is because about 90% of people over the age of 60 become hypertensive as a result of blood vessels getting stiffer and dietary intake patterns that take their toll. If people in their middle years can be encouraged to keep their weight down, exercise regularly, and refrain from smoking, the likelihood of delaying high blood pressure is much better, says Yancy.

Most health care professionals, however, realize it usually takes more than the message to create lifestyle changes. Knowing the steps for delaying high blood pressure with the onset of age and actually following them are two different things.

Creating a sense of community is a great way to tackle lifestyle changes, says Maxine Barish-Wreden, MD, an internist with Sutter Medical Group and the medical director for Women's Heart Disease Prevention at Sutter Heart Institute in Sacramento, CA.

The American Heart Association created an employer-based program called "Start" to encourage employees to begin an exercise and fitness program at work, such as walking, and not wait until the evenings and weekends when they often are too tired.

"The Start program is a way to make people feel that they aren't alone. It's a way to have people spend time every day during work getting exercise, and a more powerful way to stay engaged than trying to do it yourself," explains Barish-Wreden.

Lifestyle changes can be a community affair as well, she adds. A woman in Nevada City, CA, a small town in the foothills north of Sacramento, wanted to lose 40 pounds by her 60th birthday. A newspaper reporter showed up at the gym to chronicle her efforts, adding to her feeling she had to remain committed.

To stay on track, she partnered with the owner of the gym and they decided to invite everyone in Nevada County to get fit. They called the program the Nevada County Meltdown and fitness clubs offered free time for people wanting to start an exercise program. About 2,000 people got involved, so they formed teams that competed against one another. The group lost 8,000 pounds.

"Again, it was the power of getting a whole community involved and doing it together that made the difference," says Barish-Wreden.

Group approach effective one

The same group approach is helpful in addressing children who are obese and inactive, she adds.

A healthy lifestyle needs to be a family affair; it doesn't do much good to teach children about good nutrition if their parents pick up fast food for dinner each night. "We can't expect children to shift their behavior. It has to be adults modeling good behavior, or there is no change," says Barish-Wreden.

Another way to motivate change is to provide a reward, she says. For example, the local newspaper company in Sacramento has a 24-hour fitness center onsite and offers financial incentives to employees who use the gym and take care of themselves, says Barish-Wreden.

It takes more than motivation

But she says it takes more than motivation to get people to put what they learn into practice. It also is important to address barriers to change, says Yancy. Some cannot see a physician on a regular basis or there is no money in their budget to add more heart-healthy foods to their diet.

Informing people of the dangers provides the foundation for change. Yancy encourages health care facilities to offer community awareness programs, such as blood pressure and weight screenings. "The kinds of things that are low tech and high touch make a big difference and make a big impact," says Yancy.

Sometimes the way to deliver the message must be considered as well. Yancy says that although many teens are at risk for developing heart disease at an early age due to poor dietary habits and lack of exercise, they function in an information overload.

"Public health messages are imbedded amidst so many other messages. It's not that they don't listen; I think we have to find a way to make the message important," says Yancy.

The American Heart Association develops campaigns to reach various at risk populations and encourage lifestyle changes.

For example, to raise awareness that heart disease is the No. 1 killer of women, they developed the "Go Red" campaign. According to AHA statistics, one in 2.6 women die of cardiovascular disease while one in 30 women die of breast cancer.

Yancy says it is informative programs that made women more aware of their risk for breast cancer and the importance of early detection through screenings, and the same proactive attitude needs to be developed for heart disease as well.

"If we could simply get more people to embrace the prevention message and really understand the best way to treat heart disease is to never get it in the first place, we would be that much ahead of the game," says Yancy.