AHA aims to increase healthy life expectancy by 2030
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As the number of deaths from CVD and stroke continues to decline, albeit at a slower rate than before, the American Heart Association is striving to increase healthy life expectancy both in the United States and globally, according to a presidential advisory, a statistical update and a policy statement prepared by the organization and published in Circulation.
“We know people are living longer thanks in part to nearly a century of dedicated efforts from volunteers, staff and many invaluable supporters joining the American Heart Association in our fight [against] heart disease and stroke, leading to improvements in disease control and prevention, advancements in medical treatments and improved lifestyle behaviors,” AHA President Robert A. Harrington, MD, FAHA, interventional cardiologist, Arthur L. Bloomfield Professor of Medicine and chairman of the department of medicine at Stanford University, said in a press release. “Unfortunately, not all those years are healthy ones, as the effects of chronic illnesses are increasingly impacting the quality of life of people at a much younger age than in the past.”
Heart disease, stroke statistics
The age-adjusted prevalence of all types of CVD was 10.6%, according to the paper. Men had higher age-adjusted prevalence of the following conditions compared with women:
- CAD (7.2% vs. 4.2%);
- heart disease (11.8% vs. 9.5%);
- stroke (3.3% vs. 2.5%); and
- hypertension (26% vs. 23.1%).
CVD-related death accounted for approximately 17.8 million deaths globally (95% CI, 17.5-18), which increased by 21.1% from 2007 (95% CI, 19.7-22.6), Salim S. Virani, MD, PhD, FAHA, professor of medicine and director of the cardiovascular disease fellowship program at Baylor College of Medicine in Houston, staff cardiologist at Michael E. DeBakey Veterans Affairs Medical Center in Houston and chair of the writing group for the statistical update, and colleagues wrote. In contrast, the age-adjusted death per 100,000 population was 233.1 (95% CI, 229.7-236.4), which decreased by 10.3% from 2007 (95% CI, 11.4 to 9.3).
The mean global lifetime risk for stroke increased from 1990 to 2016 (22.8% to 24.9%; relative increase = 8.9%; 95% CI, 6.2-11.5) after adjusting for the competing risk for death by causes other than stroke. The age-adjusted rate for stroke death decreased by 13.6%, although the number of stroke deaths increased by 7.7% from 2007 to 2017.
National Health and Nutrition Examination Survey data from 2015 to 2016 determined that the overall prevalence of obesity in young patients was 18.5%. Obesity was also prevalent in 38.3% of adults, according to 2013 to 2016 NHANES data.
Rates of physical activity among young patients was also low, with 26.1% of high school students meeting recommendations of greater than 60 minutes of moderate to vigorous activity 7 days a week, with fewer girls achieving guidelines compared with boys (17.5% vs. 35.3%).
Between 1990 and 2017, the prevalence of diabetes increased 120.9% for women and 129.7% for men.
There were 933.1 million patients who smoked cigarettes globally in 2015. The annualized rate of change was 1.7% in women and 1.3% in men between 1990 and 2015. E-cigarette use has increased in adolescents from 1.5% in 2011 to 20.8% in 2018 and has become the most commonly used tobacco product in this age group, according to the paper. Approximately 80% of smokers worldwide live in low- and middle-income countries.
“The AHA, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the Statistical Update,” Virani and colleagues wrote.
2030 impact goal
Given what is known about the prevalence of CVD, the AHA is aiming to increase healthy life expectancy from age 66 years to at least 68 years in the United States and from age 64 years to at least 67 years worldwide by 2030, according to the presidential advisory. The document details how to achieve this goal with the use of technology in addition to a collaborative effort by patients, volunteers, health care professionals, scientists and partner organizations.
“Through these 2030 Impact Goals, the AHA is signaling to the domestic and global communities to the importance of this moment to build bridges and to work collectively toward a goal that no single organization can achieve alone,” Sonia Y. Angell, MD, MPH, assistant clinical professor of medicine at Columbia University Irving Medical Center and co-chair of the writing group for the presidential advisory, and colleagues wrote.
The paper describes how the committee decided upon the health-adjusted life expectancy metric to estimate how many years a population can live in good health.
“[The health-adjusted life expectancy metric] does this by summarizing years lived in less than ideal health and years lost as a result of premature mortality in a single measure of the average population health,” Angell and colleagues wrote.
In the press release, Harrington said: “Much of this will be an expansion of efforts already underway with many committed collaborators, but it will be critical to bring in new ideas and resources to connect the collective vision with the creativity and innovation needed to make real change. We’ll be inviting more people to the table, but even more importantly, we’re asking likeminded stakeholders to invite us in — let us help be a catalyst bringing together elements that can create a healthier world for everyone.”
Surveillance recommendations
Different approaches to surveillance are one of the few things needed to achieve the goals detailed in the presidential advisory, according to an AHA policy statement written by Véronique L. Roger, MD, MPH, FAHA, Elizabeth C. Lane and Nadine M. Zimmerman Professor of Internal Medicine and professor of epidemiology at Mayo Clinic College of Medicine, and colleagues.
The policy statement details how to combine the use of technology and the goal itself to reduce disease and improve health while evaluating existing systems to determine their potential for a CV surveillance system.
“Such systems should generate the data required to evaluate the nation’s investment in health promotion and disease treatments, to disseminate interventions that are effective and to reengineer those that are not,” Roger and colleagues wrote. “They should be person- and patient-centric, provide comprehensive data, respond with agility to local and national needs and synergize with community programs, thereby expanding the scope of public health practice within communities.”
“In every country, in every city and village, we want everyone of all ages and backgrounds to be healthy and experience every simple joy, make every heartfelt memory, celebrate every special occasion they need and want to do,” Harrington said in the press release. “This is so much more than just wanting people to live to a ripe old age; we want them to live healthier, longer, and we’re dedicating ourselves to doing just that over the next decade.” – by Darlene Dobkowski
References:
Angell SY, et al. Circulation. 2020;doi:10.1161/CIR.0000000000000758.
Roger VL, et al. Circulation. 2020;doi:10.1161/CIR.0000000000000756.
Virani SS, et al. Circulation. 2020;doi:10.1161/CIR.0000000000000757.
Disclosures: Angell, Roger and Virani report no relevant financial disclosures. Harrington is president of the AHA. Please see the documents for all other authors’ relevant financial disclosures.
Perspective
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Erin D. Michos, MD, MHS, FAHA
The AHA just released a presidential advisory statement regarding the AHA’s 2030 Impact Goals. Prior AHA goals had largely focused on reducing CVD morbidity and mortality through efforts in screening and treating traditional risk factors. More recently, the AHA goals had shifted from focusing on CVD states to the promotion of ideal CV health, as assessed by the AHA Life’s Simple 7 criteria.
I was very pleased to see that these new AHA goals set for 2030 take wellness initiatives even further by acknowledging that the mind and body are interconnected, and that both positive and negative aspects of psychological well-being can impact CV health. We must address not just the physical but also the mental, emotional and psychological well-being of our patients.
Along with that theme of wellness, there is an explicit acknowledgement in this statement that socioeconomic inequalities are strong contributors to CV risk and that clinicians need to recognize and pay attention to these social determinants of health. It will be very difficult to implement CV preventive strategies without also considering challenges that patients may face in terms of access to housing, healthy food availability, transportation, employment opportunities, health insurance, safe neighborhoods and healthy environments with clean air and water.
Health equity needs to be at the forefront. To achieve this, there needs to be all hands on deck to help towards this effort — given the impact that communities can have on an individual’s health, we need to involve them. There is the recognition that the AHA can’t reach these goals alone and we need to work with multiple diverse organizations from local neighborhoods to global governments as partners towards this collective goal. This may be an “American” Heart Association statement, but we are one world with a shared goal in improving the health of the human race.
In this impact statement, there continue to be goals to increase life expectancy in U.S., with an aim to increase from an age of 66 to at least 68 by 2030. But that it’s not just living longer; it’s about living with wellness and well-being is much more than just the heart and vasculature.
Also just recently released by the AHA was the 2020 update for the heart disease and stroke statistics.
While there have been improvements over time in some aspects of the CV health metrics like total cholesterol, BP and physical activity for adults over the age of 20, there were also declines in the prevalence of ideal levels for BMI and diabetes. While we did see a decreased smoking prevalence seen in women, there was no change for men, and there is a sharp increase in electronic cigarette use in adolescents that concerns us all.
Good progress that we have made in older adults is now being offset by worrisome trends in youth and young adults. Obesity rates were up in both children and adults, and the diabetes prevalence in the U.S. also increased. Physical activity levels are also very low among youth, with only 26% of youth meeting guideline-recommended physical activity amounts. This trend is setting up future generations to be facing major health problems, and we might not actually achieve that increase in life expectancy that we are aiming for because we know that the presence of risk factors by middle age is associated with shorter survival compared with those that make it to middle age free of risk factors. How one lives the first half of their lives can determine their freedom from morbidity and mortality in the second half of their lives. Primordial prevention should be front and center.
There should be real concern regarding the stagnation of the decline in CVD mortality among adults younger than 45 years old, which is likely fueled by this increased prevalence observed in obesity and diabetes. In 2017, similar to 2016, heart disease was still the leading cause of death, with stroke being No. 5 and diabetes No. 7. It is estimated that 45% of the U.S. population will have CVD by 2035, with total health care costs reaching $1.1 trillion by 2035. We have by no means eliminated CVD. We cannot rest or get complacent in our strides towards CV prevention.
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