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Fewer Adults Meeting Heart-Healthy Standards

Study reveals little progress in the past 20 years in limiting risk factors for heart attack, stroke among those with cardiovascular disease

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Despite advancements in safe and effective therapies, the odds of experiencing a second stroke or heart attack have not declined over the past two decades, according to a study from Johns Hopkins Medicine.

The reason? Researchers suggest that adults with cardiovascular disease (CVD) haven’t done enough to reduce factors known to put them at risk for a heart attack, stroke or other CVD event. From 1999 through 2018, the study found a worsening trend (or no improvement) in blood glucose, blood pressure, body mass index (BMI), smoking, physical activity and diet among adults with CVD.

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High cholesterol was the only risk factor for which study participants showed a modest improvement over that period. Still, just 30 percent of adults with CVD had an ideal cholesterol profile from 2015 to 2018, according to the study, published in the Journal of the American College of Cardiology.

“We’re not really moving the needle on these risk factors, and that’s leaving a lot of people at risk for recurrent events,” Seth S. Martin, M.D., the corresponding author of the study and an associate professor of medicine in the division of cardiology at the Johns Hopkins University School of Medicine, said in a statement.

The study also revealed persistent racial and ethnic disparities in heart-related health. Access to health care and patient education and the affordability of medications are likely the main drivers of disparities seen in high-risk populations, study coauthor Nino Isakadze, M.D., a cardiac electrophysiology fellow at the Johns Hopkins Hospital, said in a statement. “We have to get innovative about how to reach diverse groups of patients and to improve secondary prevention in everyone with cardiovascular disease.” 

Among the best ways to reduce your risk of heart disease is to avoid smoking, exercise regularly, get a good night’s rest, and eat a diet rich in fruits, vegetables, whole grains, nuts and legumes, according to the American Heart Association (AHA). You should also keep track of your blood pressure, cholesterol levels, blood sugar levels and body mass.

What the researchers did

For this study, researchers used data collected by the National Health and Nutrition Examination Survey from 1999 to 2018. The survey involved 6,335 adults with a self-reported history of coronary heart disease, myocardial infarction, stroke, angina or congestive heart failure. Participants were about evenly split between men and women. The majority were white, 13 percent were Black, 10 percent were Hispanic, and 3 percent were Asian.

The researchers created a scorecard for cardiovascular health, including ideal measures for seven metrics (based on the AHA’s “Life’s Simple 7”). The AHA checklist was updated this year to “Life’s Essential 8,” adding seven to nine hours of sleep a night to the list. That metric was not included in this study.

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The ideal risk metrics used in the study were:

1. Blood pressure: Systolic blood pressure less than 130 mm Hg and diastolic blood pressure less than 80 mm Hg

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2. Blood glucose (sugar): Less than 7 percent using hemoglobin A1c (HbA1c) with a self-reported diagnosis of diabetes or less than 5.7 percent without

3. Blood lipids (cholesterol): Non–HDL-C less than 100 mg/dL

4. Body mass index: Less than 25 kg/m2

5. Tobacco use: Never smoked or quit smoking for more than a year

6. Physical activity: 150 minutes per week of moderate, 75 minutes per week of vigorous or 150 minutes per week of combined physical activity

7. Diet: Score of at least 80 of 100 points using the U.S. Department of Agriculture’s Healthy Eating Index-2015 (HEI-2015) to assess diet quality

What the researchers found

Overall, adults in the study appeared to be at higher risk of a heart attack, stroke or other cardiovascular event when they were surveyed between 2015 and 2018 than when they were first surveyed, between 1999 and 2002.

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Specifically, the study revealed:

  • Blood pressure profiles improved from 1999 through 2010 and worsened afterward, with the worst profiles found among Black adults.
  • Blood sugar (or glucose) profiles worsened over time in U.S. adults with CVD, with only about one-half of the individuals having ideal HbA1c in the most recent (2015–18) cycle and the worst profiles found among Asian adults.
  • Ideal cholesterol profiles showed an overall increase, from 7 percent from 1999 to 2002 to 30 percent from 2015 to 2018 — likely due to widespread use of lipid-lowering medications — but with a worsening trend among Hispanic adults.
  • Body mass index saw an overall worsening ideal profile, from 24 percent from 1999 to 2002 to 18 percent from 2015 to 2018.
  • Smoking, physical activity and dietary profiles showed no significant changes over the time frame. But there were worsening smoking trends among Black adults as well as improving trends for physical activity among Hispanic adults.

Martin, who directs the Johns Hopkins Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH) and Digital Health Lab, observed that telemedicine and portable devices (such as smartphones and smart watches) could be used to engage and motivate patients to live a more heart-healthy lifestyle. “That’s where we think technology can help fill gaps seen with traditional episodic care, because it could be something that lives in our patients’ hands and on their wrists, enabling a deeper understanding of their condition and facilitating more continuous and active engagement in preventive care outside the doctor’s office, at home and in the community,” he said.

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