Heart disease prevention should not be left to professionals

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Heart disease prevention should not be left to professionals

Janice Hopkins Tanne New York

Information to prevent heart disease must be taken to workplaces, schools, and religious institutions, not left to health professionals, says a new guideline from the American Heart Association.

The guideline complements the national action plan for cardiovascular health, to be issued by the Centers for Disease Control and Prevention in April (Circulation 2003;107:645-51 and www.circulationaha.org).

"Heart disease kills half the people in a community," said lead author Dr Thomas Pearson, chairman of the Department of Community and Preventive Medicine at the University of Rochester (New York) School of Medicine.

Gains against cardiovascular disease are slowing, and the public does not recognise the seriousness of the problem, he told the BMJ. Between 1970 and 1990 cardiovascular disease mortality declined by 3.5% a year, but the rate has since slowed to 2.5% a year. Stroke mortality has not declined since 1990. The decline in mortality was thought to be linked to changes in diet and reduced smoking, promoted by the association.

"Mortality is not all that matters. There’s no change in incidence," said Dr Pearson. He called for making the public healthier. Primary prevention can reduce the number of patients with coronary artery disease who must often see a cardiologist, who may be hospitalised and need angioplasty or bypass, and who are on many drugs.

"There are 12.5 million Americans with coronary disease, not including hypertension . . . We need to get at primary prevention," Dr Pearson said.

"Deleterious lifestyles and behaviours, rather than medical conditions or genetic predispositions, are thought to be the most important and most modifiable causes of the majority of deaths from heart disease and stroke," the guideline says.

The guideline, which ties in with guidelines from the American Stroke Association and the American College of Cardiology, recommends making people aware of the risk of cardiovascular disease and stroke and providing health education. It calls for education in schools about risk factors, healthy nutrition, and exercise.

Workplaces should also promote physical activity (such as climbing stairs rather than taking the elevator) and provide educational materials. Healthcare facilities should provide print and other materials to describe symptoms of cardiovascular disease and stroke. Material should include information on calling emergency medical services and on cardiopulmonary resuscitation.

Implementation of the guideline at the state and local level will be up to the Centers for Disease Control—training personnel and developing messages and making them available. The centres will implement the programme through state health departments—25 are said to be involved so far.

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