In heart health, we need more than just education…

Everyone knows that the heart health of Americans is dismal. Obesity, diabetes, and high blood pressure are all on the rise.

For now, technological advances in cardiac care continue to maintain, or in some cases, lower the death rate from heart disease. Squishing blockages, ablating abnormal heart tissue, and installing cardiac devices have successfully kept the abysmal lifestyle habits of so many at bay. Despite all the fury of modern technology–or maybe because of it–many continue to fail miserably on the front end, that is prevention.

This WSJ piece, from a noted Ivy league prevention expert, purports vascular age as another means to tell patients of their poor blood vessel health.  On a positive note, this piece educates us on the role of the blood vessel, particularly the seemingly inert, but highly susceptible to inflammation inner lining, known as the endothelium. Correctly proclaiming the endothelium as the crux of heart health is a good thing.

Also, telling an unhealthy 40 year old that he has the artery health of a 64 year old is certainly a novel idea that is more elegant and maybe a bit more eye-opening than just telling him he is fat, out of shape and now has diabetes. As far as educating goes, the vascular age thing is quite good, but it is still only education, not motivation.

In 2010, can anyone American not know about heart healthy behaviors?  Education on heart disease is ubiquitous;  even substituted for smart policy decisions, like Louisville’s chief doctor who opposed banning toxic trans-fats in favor of educating the public on their danger.

As is the case with most able-bodied, non-dabbling electrophysiologists, I can ablate SVT, Atrial Flutter, and implant pacemakers and ICDs with greater than 95% efficacy.  Even PAF can be successfully eliminated two-thirds of the time.  Yet, despite trying hard (really hard), I fail more than 90% of the time to get patients to change their heart healthy behaviors.  Nine in ten patients return just as fat and sedentary as they were at the time of my previous lecture on heart health.

In heart health, getting people to know is not the issue, rather the issue is in implementation of the plan. The treasure at the end of the rainbow, is a mechanism or strategy that affects people’s lifestyle choices.  Somehow, something. or someone needs to find a way to motivate people to change their lifestyle.  This is the holy grail of heart health.  The solution is before us in clear view.

Politicians, MPAs, MPHs and the like all talk about health care savings of this plan or that plan, but can you imagine the savings if there was a major change in population behavior. Imagine the savings if masses of people stopped smoking, started carving out time for 30 minutes of exercise, leaving the table still able to walk upright, and going to bed on time.  Imagine the health of our youth if we had mandatory gym class every day, healthy food in the cafeteria and healthy parent role models.

Imagine…

But how?

JMM

5 comments

  1. There seems to be a voodoo-like element to the "vascular age" idea. Cholesterol, blood pressure, triglycerides, age, smoking risk, weight etc can all me measured precisely. But vascular age? I just took the test in the WSJ article you linked to (see below) and my vascular age is 42. My actual age is 54. I get all the exercise anyone could possibly expect, never smoked, total chol = 130 with excellent HDL/LDL ratio, don't eat much meat, weigh 165 on a 6 foot frame. And have had two heart attacks (age 52 and 53) 15 months apart. Big ones. Total LAD blockage. I would think that my vascular age is a heck of a lot older than 42…..Given all the current emphasis on inflammation, it would seem like there should be some better way to evaluate it. Thoughts?

    VBM
    http://online.wsj.com/article/SB10001424052748703406604575278713597433300.html?mod=WSJ_hps_MIDDLESecondNews

  2. It's about statistics and inflammation.

    First statistics: Although it is clearly lower risk to have younger arteries, just having younger arteries does not preclude an event –like not all good drivers avoid tragic accidents. For those who have an event their event rate is 100%. Moreover, one event increases the risk of another.

    Second: Inflammation of the endothelium is primarily related to the above measurable factors, like LDL, BMI and blood sugar. However, there are also more qualitative factors that are important as well. Things like working overtime, personality type, and quality of sleep just to name a few of the most noteworthy.

    The story of predicting endothelial events is far from over. The picture in the print version of WSJ was misleading. It depicted plaque rupture on the most stenosed vessel. This is wrong, as the more likely plaque to rupture is actually the younger less stenosed (asymptomatic) blockage.

    This is why negative stress tests do not predict heart attacks. It is why people can run a marathon and then drop dead right afterwards. Why does the young plaque rupture, and how can we prevent it, are answers that lead to the treasure.

    My point in telling the vascular age story is that telling a patient his arteries are older than his stated age is just another means of education. To me, more education on heart healthy behavior seems akin to trying to ride a bike uphill in mud. Many watts are generated, but yet no real progress is made.

    It's a free country and so we can't tell patients how much to eat, sleep, exercise and relax. It seems though, we as a society will keep paying for the illnesses caused by such free choices.

    Oops. Stop…

  3. How to motivate people to change?

    Money's a pretty good motivator.

    A proposal:

    Give people a major discount on their health insurance premiums IF they 1) have a body mass index under 30, 2) can perform to a certain level on a treadmill stress test, and 3) have a negative test for nicotine metabolites.

    Repeat yearly to keep folks from gaming the system.

    Make the whole thing voluntary. You don't want the discount? Fine . . . don't ask for it, and you can stay sedentary, overweight, and keep smoking.

    Not such a radical idea. We already have criteria to qualify us for lower car and life insurance rates.

    -Steve

  4. Steve,

    Your idea makes perfect sense. That in and of itself represents a problem.

    Thanks, I wonder what the met level cut-off on the treadmill will be?

    Also, I can already here the "I am fat because of my glands crowd" coming out of the closet.

    JMM

  5. I know that the heart health of Americans is dismal. In heart health we need more than just education.

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