AHA creates new metric of CV health to reach 2020 Impact Goal

The American Heart Association has defined a new system for the categorization of CV health to obtain its 2020 Impact Goals of reducing CVD, stroke and mortality.

The writing committee, who built on the success of the AHA’s 2010 Impact Goal of reducing CHD, stroke and risk by 25%, developed a new concept of CV health and a system of metrics to quantify it. The 2020 Impact Goal aims to improve the CV health of all Americans by 20% while reducing deaths from CVD and stroke by 20%.

The committee developed a list of seven health factors and lifestyle behaviors that can affect CV health to quantify and measure these goals. According to the authors, the measurement of the factors can be used to determine whether an individual has poor, intermediate or ideal CV health. The measureable factors included having never smoked or having quit more than one year ago; BMI < 25 kg/m²; physical activity of moderate intensity for at least 150 minutes per week or of vigorous intensity for at least 75 minutes per week; total cholesterol <200 mg/dL; BP below 120 mm Hg/80 mm Hg; fasting blood glucose <100 mg/dL; and four to five components of a healthy diet by AHA guideline recommendations.

The scientific statement also indicated that metrics for quantifying improvements or deterioration in CV health in different patient populations — such as children — presented challenges. Metrics for children and adolescents, whose risk factors such as BMI and BP change over time, may make it difficult to characterize their long-term CV health accurately. Other factors that needed careful attention included consideration of genetics, according to the committee. Despite some of the challenges, the committee stated that it was important to pursue the admittedly aggressive goals and to urge all individuals to pursue their ideal CV health.

“In the case of CV health, this document represents a first step in defining and setting goals for CV health, as well as monitoring CV health over time in the U.S. population,” the committee wrote. “With regard to reducing the burden of CV morbidity and mortality, this approach represents a significant step forward over previous efforts and identifies significant further gaps that need to be addressed.”

Lloyd-Jones DM. Circulation. 2010;121:586-613.

This is a paradigm shift not just for AHA, but also for other health-focused organizations. The messaging for so long has appropriately been about reducing death and disability due to heart disease, cancer, diabetes, stroke or any number of a number of maladies that generate significant concerns and are responsible for great amounts of suffering and increased expenses.

For the first time and with crystal-clear focus, we are targeting an improvement in overall health. This means that we had to first define best or ideal health and then identify the components of best health. Before we could lay out a charge for everyone to improve health, we had to do the homework to understand if it is even possible to improve health, and if so, what kind of effort would be required. Remarkably, after an extensive database review of important literature in different domains like nutrition, exercise and prevention, we discovered that we can both define and describe ideal health. We now understand the components and attributes of health. Surprisingly, many of the most important components are straightforward.

Although change is not always easy, the approach needed is much less obtuse than previously thought. That is why this, in my mind, is a true sea change and defines a new direction. It is targeting a positive message — the attainment of better health and a longer better life. That should work for everyone.

– Clyde W. Yancy, MD
AHA President
Medical Director
Baylor University Heart and Vascular Institute, Houston