Shift to health promotion needed to prevent cardiovascular disease
PHILADELPHIA — The global burden of cardiovascular disease continues to increase, and novel interventions that target the youngest children can make the biggest difference in preventing future disease for the lowest cost, according to a speaker at the Heart in Diabetes conference.
“The present trend in the cardiovascular field is a movement from treating disease — which will always be the case — to promoting health,” Valentin Fuster, MD, PhD, director of Mount Sinai Heart and physician-in-chief of The Mount Sinai Hospital, told Healio. “Subclinical identification of disease, via imaging and genetics, is the present target, as an intermediary of this trend.”
A critical mission for clinicians, Fuster said, is to understand the meaning of “health,” and to translate that meaning in the form of early education that can mobilize and motivate young people. Technology continues to advance, whereas CV mortality and the cost of medicines continue to increase, Fuster said.
“We have been talking about ‘health’ for many years, but do we know what we are talking about?” Fuster, who was presented with the “Luminary in Cardiometabolic Medicine” award Friday, said during a keynote presentation. “What is health, at the molecular and cellular level? At the clinical level? At the socioeconomic level? It is better we know what we are talking about before we start trying to change the behavior of people.”
As an example, Fuster highlighted a multidimensional, school-based intervention targeted toward underserved children from 15 preschools in Harlem in New York City. For the FAMILIA study, schools and children were assigned to receive an educational intervention (9 schools; 398 children) or served as controls (6 schools; 164 children). The intervention consisted of approximately 50 hours of age-appropriate educational activity during a 4-month period, including a minimum of 37 hours for children and 12 hours for parents and caregivers. The education program promoted the benefits of increasing physical activity, a healthy diet, managing emotions and understanding the human body. Parents and caregivers learned strategies for developing and instilling healthy behaviors in children.
During a median follow-up of 5.4 months, the mean relative change in the overall knowledge, attitudes and habits score was approximately 2.2-fold higher in children assigned the intervention vs. those assigned the control, Fuster said.
“The earlier we start, we have much more potential for benefit, for the lowest cost,” Fuster said. “The later we start, we have the largest cost and probably less benefit. A lot can be done, but only if we understand what we are talking about. We can’t just go around saying, ‘I’m going to prevent obesity.’ That just doesn’t work. Nothing is perfect — you will have to repeat things for the adults and the children. But we are learning a new approach that can lead to better benefits.” – by Regina Schaffer
Fuster V. Subclinical arterial disease: imaging, genetics and behavior. Presented at: Heart in Diabetes CME Conference; July 12-14, Philadelphia.
Ferdinand KC. J Am Coll Cardiol. 2019;doi:10.1016/j.jacc.2019.02.024.
Disclosure: Fuster reports no relevant financial disclosures.