Matters of the Heart and Mind

February 14, 2019|10:24 a.m.| Marcus Plescia MD, MPH | ASTHO Chief Medical Officer

Marcus PlesciaToday is Valentine’s Day, the day we focus on those who have a special place in our hearts. We also dedicate the month of February to our hearts and focus attention on activities that prevent heart disease and stroke.

Many of the activities that protect our hearts also protect our minds. This is particularly true for heart health. We’ve known for some time that preventive and medical interventions can reduce the risk of strokes. However, recent studies have shown that lifestyle modifications and medical treatments are associated with slowing cognitive impairment and lowering the risk of developing Alzheimer’s disease.

Brain health—specifically dementia and its many forms, including Alzheimer’s disease—has been in the news, with former Supreme Court Justice Sandra Day O’Connor announcing her dementia diagnosis, as well as recent findings about the benefits of diet and exercise to reduce the risk of dementia. Unfortunately, increased news coverage mirrors high rates of Alzheimer’s disease in the United States, which affects almost six million people and is expected to climb to 14 million by 2060. It is the nation’s fifth leading cause of death for older adults.

Cognitive impairment and dementia are traditionally seen as progressive conditions that worsen over time, causing problems with memory, thinking, and behavior. Recent studies find that effective treatment and control of hypertension, regular exercise, and a healthy diet (low in fats, salt and added sugars, and high in fruits, vegetables, and whole grains) can prevent, slow, or even reverse cognitive impairment.

We have also learned that minority communities suffer a disproportionate burden of suffering from dementia. One in three American Indian and Alaska Native (AI/AN) people over age 65 are expected to develop dementia, compared to one in every 10 Americans 65 years and older in other populations. These findings provide an unparalleled opportunity to promote and protect the public’s health.

Recently, ASTHO compiled data and findings from the Heart Disease and Stroke Prevention learning collaborative. Funded by CDC, the learning collaborative was conducted over the last five years and involved 31 jurisdictions across the nation, with the goal of decreasing rates of heart disease and stroke by improving blood pressure control across populations. The learning collaborative focused on four systems-level change strategies designed to improve heart and brain health outcomes across populations: (1) data-driven action, (2) standardized clinical practice and protocols, (3) community-clinical linkages, and (4) financing and policy.

The findings are encouraging and instructive. They show the important role public health can play to improve blood pressure control by addressing medical risk factors at the community level and by working closely with medical systems and community partners. Much of the success of the learning collaborative was the result of the considerable influence that state and territorial health officials have to convene and direct leaders from other sectors due to their stature in government and organized medicine. States and territories made significant progress in working across the four ASTHO systems change levers and ultimately improved individual blood pressure control. Two state partnerships with tribal communities were particularly effective at addressing disparate health outcomes.

The emerging link between heart disease risk factors and cognitive function make addressing heart health even more important. However, after decades of improvement, declines in death rates from heart disease have slowed. We must not only renew our current efforts, but shift our attention to new approaches. Individuals with medical risk factors must ultimately manage their conditions in their homes and community settings. They rely on family, friends, and social networks for the support and reinforcement needed to engage in positive health behaviors, as well as physical environments that make healthy choices easier. These areas are the expertise of public health and it is time to take a greater leadership role, not only in reducing behavioral risk factors like smoking, physical activity, and diet, but addressing medical risk factors like high blood pressure at the community level. Valentine’s Day or not, we all have hearts and minds that need to be cared for. And that’s what really matters.

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