TCT Keynote: Global Vision for Prevention in Children and Adults Could Change CVD Landscape

Strategies modeled on Sesame Street and Alcoholics Anonymous are yielding real results around the world.

This year's keynote address focused on eradicating CVD using innovative, globally applicable approaches. Valentin Fuster, MD, PhD, of Mount Sinai Hospital, New York, N.Y., spoke about achieving a healthier population by targeting young children as well as their parents for education on healthy behaviors as well as refocusing physicians’ efforts.

sun.fuster.headFuster pointed out that over the past 20 years, professional societies have released more than 30 documents and statements on cardiovascular health and strategies for improvement. “This raises the question of whether we are a field of talkers rather than doers,” Fuster said. A 2011 Institute of Medicine report on promoting CV health in the developing world, however, has already yielded solid, repeatable results, providing hope that the field can do a lot for heart health before trying to translate the results over to government programs, he added.

Focus on children

In recent years, several preventive programs have been initiated to focus separately on children, middle-aged adults and the elderly. The first was a study of more than 1,000 children in Bogota, Colombia. Utilizing some of the methods from the television show Sesame Street, a program was created to teach healthy habits, describe how the body works, encourage exercise and even provide help with emotional habits to avoid addictions. The program offered new books aimed at varying age groups, including some for parents. “After 6 months and 70 hours of teaching health, the [childen’s] knowledge, attitudes, and habits were significantly better than children in a control group,” Fuster said.

Three-year results of that study were published in 2013, and they showed significant improvements in mean knowledge, attitude and habit scores from baseline (P<.001 for all). There were more tangible results as well: the program yielded a 13% improvement in the number of children at a healthy weight (62% to 75%). As a result, Fuster said, the government of Colombia has since expanded the program to 25,000 children. Spain also has begun participating in the program and a similar effort has been launched in Harlem, N.Y., Fuster noted.

Simple adult interventions

There is ample opportunity to improve CV health in adults around the world as well. In Kenya, Africa, for example, Fuster said a lack of refrigeration leads many people in rural areas to store food using salt, which leads to high rates of hypertension. Through a new program, citizens are taught to check their own and their neighbors’ BP using simple methods and to record the results in mobile phones. Fuster said the program thus far has been extremely well received.

Another adult intervention, also in Spain, was based upon the model of Alcoholics Anonymous. The program enrolled subjects with risk factors for CVD, including smoking, obesity, sedentary lifestyle, and hypertension and had groups of 10 to 14 people meet every other week to help each other improve those factors. At 6 months, Fuster reported, 95% had managed to eliminate at least one of their risk factors.

Adherence in the elderly

Finally, a program in elderly patients focused on adherence to medications could be a crucial piece of improving CV health. A study in several countries in Europe and South America found very low rates of adherence (ranging from 17% to about 50%) to evidence-based medications after MI. Non-adherence was influenced by factors including age, depression and degree of social support.

Improving adherence rates, possibly through a polypill strategy, could make an enormous difference based on results from another study of 14,119 patients in an Aetna database. “The people who have the poorest adherence have the largest number of events,” Fuster said. “Adherence really has a significant impact.”

  

 Disclosures:

 

  • Fuster reports no relevant conflicts of interest.

Comments