ASTHO CMO Offers Solutions Following CDC Report Warning of Rising Heart Disease Burden

September 06, 2018|3:24 p.m.| Marcus Plescia, MD, MPH

On Sept. 6, CDC released a Vital Signs report detailing state-specific data on emergency department visits, hospitalizations, medical costs, and deaths associated with heart disease and stroke. Particularly concerning is the significant burden of heart disease among those aged 35-64, which account for one-third of reported cardiovascular events.

To help reverse these trends, the Vital Signs report calls on state and territorial health departments to continue work in tobacco and obesity prevention, the dominant behavioral risk factors for cardiovascular disease. In this respect, states and territories have made significant progress, with public health championing systemic approaches to discourage youth smoking, as well as environments that promote physical activity and access to healthy food. In addition, over the past three decades, health departments have developed active coalitions with demonstrated success at both state and local levels. Despite limited capacity, health departments have worked in multiple settings, including early care and education, faith-based environments, healthcare, worksites, retail, multi-unit housing, local health departments, military bases, YMCAs, Boys and Girls Clubs, and 4H clubs.

Our nation’s progress is less encouraging when it comes to addressing medical conditions directly related to cardiovascular disease and stroke. According to the Vital Signs report, forty million adults with high blood pressure are not yet controlled and an additional 39 million adults could benefit from cholesterol management. In 2017, the American College of Cardiology and the American Heart Association released updated blood pressure guidelines that lower the optimal blood pressure target from 140/90 or below to 130/80 or below. Among individuals with high blood pressure, only half complied with the previous guidelines. Even fewer will meet new targets. Approximately half of this population with uncontrolled medical risk factors are aged 35-64, offering the potential for significant population impact if public health intervenes and controls these risk factors now.

In 2012, CDC and the Centers for Medicare and Medicaid Services launched the Million Hearts initiative to convene local, state, and national partners around the goal of lowering national heart disease rates. State and territorial public health have been closely involved in these and other efforts to prevent and control medical risk factors. However, the role of public health in addressing medical risk factors is still emerging. Clinically-driven interventions to improve systems of care and reward quality care outcomes have had significant and timely impact. However, motivation and support for ongoing blood pressure control and other cardiovascular risk factors will ultimately require increased emphasis on identifying and developing community resources. As with many aspects of public health, factors contributing to cardiovascular disease are community-wide and require work outside of traditional public health activities. It will be public health’s role to continue to enhance coordination between healthcare providers and community-based organizations to address the social determinants of health that influence an individual’s ability to manage chronic medical conditions such as high blood pressure. 

Recognizing this important connection, ASTHO has worked with CDC to help support collaboration between state and local health departments, community health centers, and local YMCAs to support community-based interventions. Self-measured blood pressure monitoring and increased use of peer educators are two evidence-based approaches that require significant community partnerships and systems change. In the past four years, health departments have become increasingly engaged in these approaches through collaboration with health center-controlled networks and third-party payors, as well as by serving as conveners between local health departments and health centers.

Public health has made significant progress in reducing deaths from cardiovascular disease, but more needs to be done. The latest Vital Signs report from CDC highlights this. After years of declining heart disease mortality rates, progress is leveling off, meaning additional action is required to continue saving lives. Given this new data, the agenda for heart disease prevention is clear. State and territorial public health must refocus their efforts and reverse these trends using evidence-based interventions that have a proven and significant impact. If improvements in behavioral and medical risk factors led to a six percent reduction in cardiovascular events every year, we could prevent 1 million heart attacks and strokes by 2022. This is an ambitious but achievable goal—and one we should strive for.

Marcus Plescia, MD, MPHMarcus Plescia is chief medical officer of the Association of State and Territorial Health Officials. For the past fifteen years, Plescia has served in public health leadership roles at the state, local, and federal levels, including director of chronic disease for the North Carolina Division of Public Heath, director of national cancer control programs at CDC, and county public health director in Charlotte, NC.


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