Amid a Ja nu a ry snow s t o rm that brought the

N at i o n ’s capital to a standstill, the Fe d e ra l

G ove rnment kicked off its effo rt to improve

A m e ri c a n s ’ health in the new millennium.

Called Healthy People 2010, the document is the Gove rn m e n t ’s bl u ep rint fo r

building a healthier country—and one without ethnic and racial disparities in the bu rden of disease. The rep o rt sets 467

o b j e c t ives that cover 28 health are a s ,

i n cluding heart disease and stro ke,

nu t rition and ove r we i g h t , and phy s ical activity and fi t n e s s .

A key theme of the kicko ff was a

call for all A m e ricans to ge t

i nvo l ved in the Healthy Pe o p l e

e ffo rt , not just by adopting healthy

b e h av i o rs themselves but also by

p a rt i c i p ating in community and

group action. As Surgeon Genera l

and Assistant Secre t a ry for Health

D r. David Sat cher said during the

k i cko ff, “H e a l t hy People isn’t a

p roject of Gove rnment. We are a

p a rt , but we must all do this

t oge t h e r.”

To get people invo l ve d, the U. S.

D ep a rtment of Health and Human

S e rvices (DHHS) has developed va rious means of commu n i c ating the

H e a l t hy People message in the coming

ye a r. At the center of the campaign are

10 new ly cre ated “leading health indicat o rs ,” meant to serve as an easy-to-understand barometer of the Nat i o n ’s health, j u s t

as the mu ch-used economic indicat o rs

ga u ge the economy ’s health. Sat cher told

the group that the health indicat o rs wo u l d

soon begin making ap p e a rances in a seri e s

of public service announcements that fe at u re entertainer Bill Cosby.

S p r i n g 2 0 0 0

N A T I O N A L I N S T I T U T E S O F H E A L T H

N A T I O N A L H E A R T , L U N G , A N D B L O O D I N S T I T U T E

Fe d e ral Gove rn m e n t

L a u n ches Healthy

People 2010

NHLBI UN V E I L S HE A RT HE A LT H GAT E WAY

( c o n t i nued on page 3)
2

C o n t e n t s

Letter From the Dire c t o r

As the NHLBI advances its heart

health age n d a , d e s c ribed in the last

issue of H e a rt M e m o, it also is

a dd ressing themes and objectives of

H e a l t hy People 2010. These incl u d e

e l i m i n ating disparities in health

among population groups and cl o s i n g

k n ow l e d ge gaps that lead to such disp a rities. To ach i eve such go a l s , t h e

NHLBI is establishing new commu n ity part n e rships and netwo rks and

using new ways of commu n i c at i n g

with advanced electronic tech n o l ogi e s , while continuing its support of

CVD re s e a rch .

For instance, in Ja ck s o n , M i s s i ss i p p i , the NHLBI, along with a nu mber of part n e rs , is supporting the

Ja ckson Heart Study, wh i ch is ex a mining prevalence of risk fa c t o rs fo r

CVD among an A f rican A m e ri c a n

p o p u l ation that is suffe ring high rat e s

of CVD. This study promises to

reveal fa c t o rs leading to those high

rates and has the potential to sugge s t

s t rat egies that could one day elimin ate this health dispari t y.

In another effo rt , the NHLBI is

c o l l ab o rating with the A s s o c i ation of

B l a ck Card i o l ogists (see last summ e r ’s issue of H e a rt M e m o). The coll ab o ration is helping to increase the

p ractice skills of health pro fe s s i o n a l s

who provide care to A f rican A m e rican pat i e n t s .

The NHLBI’s new Enhanced Diss e m i n ation and Utilization Centers

(see the box on page 3) also aim to

end disparities. The centers will

e m p l oy stat e - o f - t h e - a rt strat egies to

e n s u re that health info rm ation not

o n ly is made more re a d i ly ava i l abl e

but also results in its utilizat i o n .

In these effo rt s , we are employ i n g

the latest electronic tech n o l ogi e s .

H e a rt M e m o a rt i cles in past issues and

this current issue describe the ongoing expansion of NHLBI Web cap ab i l i t i e s , wh i ch are allowing more

people more access to more info rm ation (see, for ex a m p l e, N ew at the

NHLBI Info rm ation Center).

Tra n s l ation of re s e a rch results into

l i festyle ch a n ge s , p u blic health interve n t i o n s , and clinical pra c t i c e

remains a ch a l l e n ge. But it is a ch a ll e n ge we can and must ove rc o m e.

Join with us in bri n ging better card i ovascular health to all A m e ricans. 

Claude Lenfa n t , M . D.

D i re c t o r, N H L B I

1 FEDERAL GOVERNMENT LAUNCHES

HEALTHY PEOPLE 2010

2 LETTER FROM THE DIRECTOR

7 NATIONAL CONFERENCE EXPLORES

CVD TRENDS

8 HEARTFILE: NHLBI EDUCATION

PROGRAM UPDATES

8 THE NATIONAL HIGH BLOOD

PRESSURE EDUCATION PROGRAM

10 SPOTLIGHT ON PERFORMANCE

PROJECTS: THE NHLBI OBESITY

EDUCATION INITIATIVE

12 THE NATIONAL HEART ATTACK

ALERT PROGRAM

14 THE NATIONAL CHOLESTEROL

EDUCATION PROGRAM

16 THE NATIONAL CENTER ON SLEEP

DISORDERS RESEARCH

17 SPOTLIGHT ON PERFORMANCE

PROJECTS: MINORITY PROJECTS

18 SPOTLIGHT ON WOMEN

19 AROUND THE NATION

20 NEW AT THE NHLBI INFORMATION

CENTER

21 HEARTNET

22 HEARTFACTS: SBP AND DBP BY

AGE AND RACE/ETHNICITY

23 ORDER FORM
3

( c o n t i nued from page 1) the NHLBI Internet home page at

w w w. n h l b i . n i h . gov. The Web site

t a kes visitors to special sites for CVD,

a s t h m a , s l e ep , and minority populations. It also provides info rm at i o n

about the Healthy People 2010 heart

disease and stro ke objective s , a n d

wh at the Institute is doing to meet

them. Furt h e r, the gat eway offe rs a

host of health info rm ation and education re s o u rces to help health pro fe ssionals take action in their

c o m munities. For more info rm at i o n

about the gat eway, see the box on

p age 4.

The NHLBI debuted the new gat eway at its confe rence exhibit at the

H e a l t hy People kicko ff. “ The ex h i b i t

d rew a lot of intere s t ,” noted Moro s c o .

“It has two computers and a big plasma screen that allow visitors to

ex p l o re the wealth of info rm at i o n

ava i l able through the gat eway.”

M o rosco added that the NHLBI plans

to take the exhibit to other meetings in

the coming ye a r.

A Call To Get Invo l v e d

The NHLBI exhibit was one of 140 set

up at the Omni Shoreham Hotel, site of

the kicko ff. The 5-day eve n t , wh i ch

b egan on Ja nu a ry 24, also offe re d

about 600 pre s e n t ations—a mix of plen a ry and keynote speech e s , poster pres e n t at i o n s , and bre a kout sessions,

wh i ch fe at u red panel discussions.

Some of these sessions are spotlighted

in this issue of H e a rt M e m o.

Despite the snow fa l l , the event drew

about 1,600 attendees from the publ i c

and private sectors. Th ey rep re s e n t e d

fields such as public health, health educ at i o n , and tech n o l ogy. For those wh o

c o u l d n ’t get into the city, the sessions

we re broadcast over satellite and the

I n t e rnet. Broadcasts of the sessions,

along with the entire Healthy Pe o p l e

document and re l ated mat e ri a l s , a re

ava i l able online at w w w. h e a l t h . gov.

The kicko ff’s official title wa s

“ Pa rt n e rships for Health in the New

M i l l e n n i u m .” The event rep resented a

joint meeting of the Healthy Pe o p l e

C o n s o rt i u m , a publ i c - p rivate alliance

of national orga n i z ations and stat e

age n c i e s , and the Pa rt n e rships for Netwo rked Consumer Health Info rm at i o n ,

wh i ch looks at the role of tech n o l ogy

in health promotion and disease preve n t i o n .

S p o n s o rs of the event incl u d e d

DHHS offices and age n c i e s , and nonFe d e ral gro u p s , s u ch as the A c a d e my

for Educational Development and the

A n n e n b e rg Public Po l i cy Center of the

U n ive rsity of Pe n n s y l va n i a .

The kicko ff began with the U. S.

P u blic Health Service Color Guard

and the national anthem, after wh i ch

DHHS Secre t a ry Dr. Donna Shalala

greeted the gat h e ri n g. She called the

event “ h i s t o ri c ” and pledged the Gove rn m e n t ’s commitment to disease prevention and health promotion for all

A m e ri c a n s .

She outlined the Gove rn m e n t ’s two

key Healthy People 2010 go a l s —

i n c reasing A m e ri c a n s ’ quality and

ye a rs of healthy life, and not just their

length of life, and being sure eve ry

A m e rican benefits from the effo rt .

“Reducing health disparities wa s

p a rt of Healthy People 2000,” S h a l a l a

n o t e d, re fe rring to the last rep o rt .

NHLBI Leads Heart and

S t roke Effo rt

N ational Heart , L u n g, and Blood

Institute (NHLBI) staff gave va ri o u s

p re s e n t ations during the Healthy Pe ople 2010 kicko ff. The Institute, a l o n g

with the Centers for Disease Contro l

and Preve n t i o n , leads the Healthy

People 2010 effo rt for heart disease

and stro ke. The objectives are give n

in the box on page 5.

L ate last ye a r, the NHLBI got a

head start on those objectives by

i n a u g u rating its own “ C a rd i ova s c u l a r

Health For A l l ” campaign (see H e a rtM e m o, Summer 1999). As with the

H e a l t hy People effo rt , the NHLBI

campaign sets two pri o ri t i e s — e n d i n g

health disparities and utilizing health

i n fo rm ation better by re a ching into

c o m munities with mat e rials deve loped for their needs. The NHLBI’s

plans include funding a wide ra n ge of

c o m munity-based perfo rmance proj e c t s , e a ch with goals that will tra ck

p rogress. Among upcoming perfo rmance projects are the commu n i t y -

based enhanced dissemination and

u t i l i z ation centers , wh i ch will be set

up in communities at high risk fo r

c a rd i ovascular disease (CVD).

“ We ’re ve ry serious about add re s sing these health objectives in a new

way,” explained Dr. Grego ry

M o ro s c o , d i rector of the NHLBI’s

O ffice of Preve n t i o n , E d u c at i o n , a n d

C o n t rol. “ We ’re determined to end

d i s p a rities in health.”

To speed

d i s s e m i n ation of

health info rm ation and mat eri a l s , the NHLBI

has cre ated a “ H e a l t hy

People 2010 Gat eway,” wh i ch can be

re a ched thro u g h

( c o n t i nued on page 4)

N H L B I T O F U N D

C V D C E N T E R S

NHLBI will soon issue a call for

applicants to help create its new

Enhanced Dissemination and Utilization Centers (see H e a rt -

M e m o, Summer 1999). T h e

centers will be the first of a

nationwide network and will aim

to reduce CVD in high-risk communities. So, check the NHLBI

Web site ( w w w. n h l b i s u p p o r t . c o m /

e d u c r f p ) in late April. Information

about the awards and how to

apply will be posted there.
HEARTMEMO

SPRING 2000

4Federal Government Launches Healthy People 2010

“But Healthy People 2010 wants to

achieve more. It seeks to eliminate

health disparities. How will we do

this? We won’t set separate health

goals for racial and ethnic minorities.

Every American should achieve the

best health possible.”

She then introduced the Department’s new leading health indicators,

which are divided into two categories,

lifestyle and health care systems. The

lifestyle indicators are physical activity, overweight and obesity, tobacco

use, substance abuse, and responsible

sexual behavior. The health care systems indicators are mental health,

injury and violence prevention,

environmental quality, immunization,

and access to health care.

The leading health indicators were

designed to encourage state and community action. For instance, they can

be used to profile a community’s

health and then set specific goals to

improve it.

Shalala said that 46 states already

had used the document to create their

own goals, and she urged all Americans to join the Healthy People effort.

The box on page 19 offers tips on

how to translate the Healthy People

objectives into local efforts.

Healthy People 2010 is the third

such report, and the next speaker, Dr.

Julius Richmond, Assistant Secretary

for Health and Surgeon General from

1977 to 1981, told the gathering how

the first came to be created. That document set U.S. health goals for the

decade ending in 1990.

Dr. Richmond explained that a

transformation had occurred in Americans’ health in the preceding decades.

Seniors were living longer, and death

rates for heart disease and stroke were

falling. Those declines led him to

conclude that Americans would act on

information to adopt healthy behaviors. So the Government decided to

issue a report that emphasized health

promotion and disease prevention

(continued from page 3)

E NTER NHLBI’ S G ATEWAY TO H EALTH

Healthy People 2010 sets new health objectives for the new millennium.

NHLBI has created a new “Healthy People 2010 Gateway” to provide

information about the objectives and the Institute’s efforts to meet them.

But the gateway does much more. It offers quick access to special

NHLBI Web sites on four key areas: CVD, sleep, asthma, and minority

populations. Each site has a host of resources for health professionals

and the public.

The gateway allows you to become NHLBI’s partner in health by joining the Health Information Network. You’ll get updates on activities of

the national education programs and initiatives and notices of new information products, and you’ll be able to share your ideas with other health

professionals.

Enter the gateway and find:

• Materials from NHLBI’s national education programs and initiatives,

including public and patient information, medical education resources

for health professionals, education materials for national high blood

pressure and cholesterol education months, and descriptions of

Institute performance projects

• News and features, including NHLBI news releases, HeartMemo,

AsthmaMemo, and online access to the Institute’s “HealthBeat

Radio” news service

• Health resources developed specifically for minorities

• Special resources, such as CVD maps, which give health and

demographic information for the Nation, states, and health

service areas

• Information on upcoming conferences, meetings, and

exhibits

• Distance learning opportunities, such as the National Conference on

Cardiovascular Disease Prevention, held last year

• NHLBI Materials Catalog—an online version that allows you to browse

by topic, material format, or audience and order items easily and

quickly

• A hotlink to the DHHS Healthy People Web site

So before you start your Healthy People 2010 effort, check out the new

NHLBI gateway. It’s accessible through the NHLBI home page at

www.nhlbi.nih.gov.

(continued on page 20)

while setting long-term goals.

“We’re now at the third report,”

Richmond said. “We have the

resources to achieve the best health

record of any nation in the world’s

history. Let’s proceed to realize that

goal.”

Dr. Louis Sullivan, DHHS Secretary from 1989 to 1993 and now 
5

H E A L T H Y P E O P L E 2 0 1 0

H E A R T D I S E A S E A N D S T R O K E O B J E C T I V E S

Some of the following Healthy People 2010 objectives already have measures (so that baselines are shown); for

the others, experts are developing measurement systems.

1 . Reduce the death rate for coronary heart disease.

Target: 166 deaths per 100,000 population.

Baseline: 208 deaths per 100,000 population (age

adjusted to 2000 standard population)

2 . Increase the proportion of adults aged 20 and older

who are aware of the early warning symptoms and

signs of a heart attack and the importance of

accessing rapid emergency care by calling 9-1-1.

3 . Increase the proportion of eligible patients with heart

attacks who receive artery-opening therapy within 1

hour of symptom onset.

4 . Increase the proportion of adults aged 20 years and

older who call 911 and administer CPR when they

witness an out-of-hospital cardiac arrest.

5 . Increase the proportion of persons with witnessed

out-of-hospital cardiac arrest who receive their first

therapeutic electric shock within 6 minutes after

collapsed recognition.

6 . Reduce hospitalizations of older adults with heart

failure as the principal diagnosis.

A ge gro u p B a s e l i n e Ta rge t

( rate per 1,000 population)

65 to 74 1 3 6 . 5

75 to 84 2 7 1 3 . 5

85 and older 5 3 2 6 . 5

7 . Reduce the death rate for stroke. Target: 48 deaths

per 100,000 population. Baseline: 60 deaths per

100,000 in 1998 (age adjusted to the 2000 standard

p o p u l a t i o n ) .

8 . Increase the proportion of adults aged 20 years and

older who are aware of the early warning symptoms

and signs of a stroke.

9 . Reduce the proportion of people with high blood

pressure. Target: 16 percent of adults with high

blood pressure. Baseline: 28 percent of adults aged

20 and over in 1988-94 (age adjusted to the 2000

standard population).

1 0 . Increase the proportion of adults with high blood

pressure whose blood pressure is under control.

Target: 50 percent of adults aged 18 to 74. Baseline:

24 percent of adults aged 18 to 74 with high blood

pressure under control in 1988-91.

11 . Increase the proportion of adults with high blood

pressure who are taking action (for example, losing

weight, increasing physical activity, reducing sodium

intake) to help control their blood pressure. Ta r g e t :

95 percent of adults aged 18 and older with high

blood pressure. Baseline: 72 percent of adults aged

18 and older with high blood pressure who were

taking action to control it in 1998 (age adjusted to the

2000 standard population).

1 2 . Increase the proportion of adults who have had their

blood pressure measured within the preceding 2

years and can state whether their blood pressure is

normal or high. Target: 95 percent of adults with

high blood pressure measured in the past 2 years.

Baseline: 90 percent of adults aged 18 and older in

1998 (age adjusted to the 2000 standard population).

1 3 . Reduce the mean total cholesterol levels among

adults aged 20 and older. Target: 197 mg/dL f o r

adults 20 and older. Baseline: 206 mg/dL for adults

aged 20 and older in 1988-94 (age adjusted to the

2000 standard population). 

1 4 . Reduce the proportion of adults aged 20 and older

with high total blood cholesterol levels. Target: 16

percent of adults aged 20 and older. Baseline: 21

percent of adults aged 20 and older who had total

blood cholesterol levels of 240 mg/dL or greater in

1988-94 (age adjusted to the 2000 standard

p o p u l a t i o n ) .

1 5 . Increase the proportion of adults 18 and older who

have had their blood cholesterol checked within the

preceding 5 years. Target: 80 percent of adults aged

18 and older. Baseline: 68 percent of adults aged 18

and older in 1998 (age adjusted to 2000 standard

p o p u l a t i o n ) .

1 6 . Increase the proportions of females and males with

coronary heart disease who have their LDLcholesterol level treated to less than or equal to 100

m g / d L .

( c o n t i nued on page 6)
6

( c o n t i nued from page 5)

B U I L D I N G P A R T N E R S H I P S F O R H E A L T H

Healthy People 2010 advocates forming partnerships

as a key strategy for achieving the report’s goals and

objectives. Partnerships can take many forms. A k e y

example is when public health professionals team up

with businesses to undertake worksite health promotion programs. The following are resources for building such corporate partnerships:

• For nearly 10 years, the Partnership for Prevention, a

nonprofit organization based in Washington, DC, has

advanced the cause of health promotion among

policymakers, corporations, and government. T h e

group convened a Healthy People Business A d v i s o r y

Council, which developed programs and tools that

translate health promotion principles into business

practices. The council’s 21 members represent an

alliance of large, small, and mid-sized companies

dedicated to building healthy work forces. More

information is available at w w w. p r e v e n t . o r g.

• The Wellness Councils of America, the oldest U.S.

organization for health promotion at the worksite,

provides products and services to help employers set

up comprehensive health promotion programs.

Check them out online at w w w. w e l c o a . o r g.

• The Institute for Health and Productivity Management

develops evidence, measurement methods, and tools

to support the value of investing in employee health.

Information about their 1999 Handbook of Health

Assessment To o l s and other resources is found at

w w w. i h p m . o r g.

G E T T I N G O U T T H E W O R D : C O M M U N I C A T I N G A B O U T H E A L T H

Communicating effectively about health is critical to

achieving Healthy People 2010 goals and objectives. 

But how do you turn health information into health news?

And how do you convince the media that your news

needs to be published or broadcast?

A Healthy People 2010 conference panel examined how

public health practitioners can make health news by making their stories relevant to people’s lives.

Panel chair George Strait, a former reporter with A B C

News, said, “If you put out good information, and you do

it in the right way, it really does connect with people.”

Public health professionals should remember that “the

media play a major role in our society as brokers, mediators, and translators of health information.” “Furthermore,” added Strait, “surveys show that people trust the

information they get from the media.”

Sally Squires, health and medical reporter for T h e

Washington Post, said the media is a partner in public

health. She gave public health professionals some tips

for working with the media:

• Health news must grab the reader’s attention. A s t o r y

must have impact, importance, and interest. Figure out

your story’s potential impact before you pitch it to a

r e p o r t e r. 

• Keep in mind that your news competes with other news,

and that available space and air time is shrinking.

Condense your information.

• Consider enhancing a public health program by forming

partnerships with the media. The media will be more

inclined to cover it.

• Be creative in using the media. For instance, don’t

forget about Internet news services.

• O ffer a variety of spokespersons to deliver your

m e s s a g e .

• Put a face on your story. “Real people” add interest to a

story and make it more appealing.

John Ford, President of Discovery Health Media Inc.,

called health news “one of the most important reporting

genres.” But, he added, “its complexity makes it one of

the most difficult reporting jobs.” Challenges for reporters

are to deliver accurate information, to give it context and

perspective, and not to make it too simple or too technical. Public health practitioners should expect to see

more “media convergence”—that is, use of different media

by a single news organization. For example, a television

network will give a brief report of the story on the evening

news, then provide more information on its Web site.

( c o n t i nued on page 19)
7

N ational Confe rence Explore s

C V D Tre n d s

Despite dra m atic progress aga i n s t

CVD in the past half century, ch a ll e n ges remain and new strat egies are

n e c e s s a ry to ove rcome pro bl e m s

s u ch as increases in obesity and

p hysical inactivity among A m e ri c a n s .

Th at was the story that unfo l d e d

at a recent confe rence held to ex p l o re

t rends in CVD and its risk fa c t o rs .

The tra n s age n cy “ N ational Confe rence on Card i ovascular Disease Preve n t i o n : Meeting Healthy Pe o p l e

2010 Objectives for Card i ova s c u l a r

H e a l t h ” was held at the request of

C o n gress and drew more than 100

p a rticipants to Bethesda, M a ry l a n d,

for a packed 3-day agenda. Eve n

m o re participants tuned in to the confe rence via NIH Web c a s t i n g.

The confe rence was sponsored by

the NHLBI in cooperation with the

N ational Institute on A gi n g, the Cent e rs for Disease Control and Preve nt i o n , and the A ge n cy for Healthcare

R e s e a rch and Quality (fo rm e rly the

A ge n cy for Health Care Po l i cy and

R e s e a rch ) .

The goal of the confe rence was to

assess the magnitude and

t rends of A m e ri c a ’s

CVD thre at and to

s t a rt the

t a s k

o f

d eveloping strat egies to meet the

health targets set in Healthy Pe o p l e

2 0 1 0 , the Gove rn m e n t ’s bl u ep rint fo r

i m p roving A m e ri c a n s ’ health (see the

lead story in this issue of H e a rtM e m o) .

The CVD confe rence began with a

s t age-setting introduction from U. S.

S u rgeon General Dr. David Sat ch e r.

He told the group that big gains in

l i fe ex p e c t a n cy have been made during the past century, but mu ch more

needs to be done.

D r. Sat cher said that 15 to 20 percent of the Healthy People 2000

o b j e c t ives have been met and another

60 percent are headed in the ri g h t

d i rection. Howeve r, he noted, t h at

l e aves 20 percent unimprove d.

D r. Edwa rd Sondik, d i rector of

the National Center for Health Stat i st i c s , gave an ove rv i ew of the rates fo r

CVD and its risk fa c t o rs. Some rat e s

h ave slowed their declines. Fo r

ex a m p l e, f rom 1970 to 1980, d e at h s

due to stro ke dropped by 20.3 percent and deaths due to coro n a ry heart

disease (CHD) dropped by 26.1 percent. Howeve r, f rom 1990 to 1997,

d e aths due to stro ke declined by only

2.1 percent and deaths due to CHD

d e clined by only 11.4 perc e n t .

D r. Shiriki Ku m a ny i k a , of the

U n ive rsity of Pe n n s y l vania School of

Medicine in Philadelphia, i l l u s t rat e d

the pro blem of ove r weight and obesit y. About 15 percent of ch i l d re n

ages 6 to 12 and about 12

p e rcent of ch i l d ren age s

12 to 17 are obese.

Among adults, 39 percent of men and 25 percent of

women are ove r we i g h t , a n d

another 20 percent of men and

25 percent of women are obese.

S p e a ke rs wa rned that phy s i c a l

i n a c t ivity was increasing in prevalence among A m e ri c a n s , and smoking may no longer be decl i n i n g.

About 25 percent of A m e rican adults

n ow smoke.

D r. Christopher Sempos, of the

NIH Office of Research on Minori t y

H e a l t h , rep o rted some good new s .

He said that considerable success has

been made towa rd ach i eving the

H e a l t hy People 2000 goal for total

ch o l e s t e rol. Other heartening new s

was that public health educat i o n

e ffo rts have made many A m e ri c a n s

awa re of CVD risk fa c t o rs , p a rt i c ul a rly those re l ated to diet.

On the other hand, D r. George

M e n s a h , of the VA Medical Center in

A t l a n t a , pointed to the increase in

c o n ge s t ive heart fa i l u re (CHF), c a l ling it the “ final fro n t i e r.” “It is the

o n ly CVD diagnosis that has seen an

i n c rease in deaths since about 1970,”

he said.

He added that although the causes

of CHF are better known today, d o ct o rs are not pre s c ribing the ri g h t

d rugs. For instance, studies show

t h at angi o t e n s i n - c o nve rting enzyme

( ACE) inhibitors improve quality of

l i fe and reduce CHF deaths by as

mu ch as 40 perc e n t , but they are not

being widely used.

D r. Gerald O’Connor, of the Center for the Eva l u at ive Clinical Sciences at Dartmouth Medical Sch o o l

in Hanove r, N ew Hampshire, s p o ke

of the need for better use of ex i s t i n g

i n fo rm ation. He said this pro bl e m

has contri buted to ge ographic disparities in how CVD tre atments are

u s e d.

Pa rticipants offe red many sugge stions for improving CVD tre n d s .

( c o n t i nued on page 21)
The National High Blood

Pressure Education Program

SYSTOLIC PRESSURE:

A PARADIGM SHIFT

Health professionals are experiencing

a major shift in the way they rate the

importance of systolic, diastolic, and

pulse pressures.

Diastolic blood pressure (DBP),

the measure of the force on the arteries between heartbeats, has long been

thought to best identify a person’s

high blood pressure and generally has

been used by clinicians to make treatment decisions. DBP is recorded as

the second number in a blood pressure measurement; for example, in a

blood pressure reading of 138/84, the

DBP is 84.

Systolic blood pressure (SBP) has

always been viewed as important, yet

it has assumed a secondary role in

most physicians’ decision-making.

Evidence from recent clinical trials

and results from the NHLBI’s Framingham Heart Study may be changing

that. According to Dr. Daniel Levy,

of the NHLBI, “SBP (alone) has been

shown to better identify patients with

high blood pressure, to more accurately classify blood pressure stages,

and to better indicate the need for

treatment.” “However,” he added,

“using SBP and DBP together to

make these assessments is still considered the best strategy.”

Dr. Donald M. Lloyd-Jones and

colleagues recently analyzed data on

use of SBP and DBP in the Framingham Heart Study and found reason to

suggest that future guidelines should

consider a greater role for SBP rather

than DBP in determining presence of

hypertension, risk of cardiovascular

events, eligibility for therapy, and

benefits of treatment. The analysis

was published in the September 1999

issue of Hypertension (Vol. 34,

No. 3). The National High Blood

Pressure Education Program

(NHBPEP) Coordinating Committee

has been discussing the predictive

powers of systolic, diastolic, and

pulse pressures for some time. (Pulse

pressure, the difference between diastolic and systolic pressures, is

obtained by subtracting the value of

DBP from the value of SBP.)

Why is it important to consider

both DBP and SBP? Data from the

Framingham Heart Study indicate

that SBP predicts future risk of heart

disease more accurately than does

DBP. This is especially true in 

HEARTMEMOSPRING 2000

8HeartFile: NHBPEP

NHLBI L AUNCHES H IGH B LOOD

P RESSURE AND O LDER A MERICANS

E DUCATION C AMPAIGN IN M A Y

May is National High Blood Pressure Education Month. It also is the start

of a 3-year campaign to promote better blood pressure control among

older Americans. The campaign is being launched by the NHLBI and the

NHBPEP.

A key part of the campaign is a new clinical advisory that stresses the

importance of reducing systolic hypertension among older Americans.

Systolic blood pressure, unlike diastolic blood pressure, rises steeply with

age. Inadequate control of systolic hypertension has contributed to an

increase in deaths and hospitalizations from heart failure. The new clinical advisory, to be published in the May issue of Hypertension, recommends that “systolic blood pressure must become the major criterion for

diagnosis, staging, and therapeutic management of hypertension in middle-aged and older Americans.”

The campaign includes the launch of a new high blood pressure Web

site, aimed at patients, physicians and other health care providers, health

educators, and community organizations. The Web site, which will go

online in May, will offer a host of patient education materials, including a

newly revised fact sheet about high blood pressure, tips for controlling

blood pressure, tips on how to remember to take medication, questions to

ask your doctor if you have high blood pressure, and recipes from the

DASH diet plan. It also will have a high blood pressure education community resource kit, complete with a press release, an infograph, and

suggestions on how to make an impact in the community. The Web site

will link to other relevant sites and (coming soon) offer opportunities for

physicians to obtain continuing medical education credits. The Web site

will be available through the NHLBI home page at www.nhlbi.nih.gov.

Other activities to boost awareness of systolic hypertension are a satellite media tour with the coordinator of the NHBPEP, NHLBI HealthBeat

radio spots, and an NIH Radio News Service interview with high blood

pressure experts.

So get started on your National High Blood Pressure Education Month

activities and help spread the word about systolic hypertension.
people older than 60 ye a rs of age.

Clinical trials in older persons with

e l evated SBP have shown that tre atment of this common fo rm of hy p e rtension can substantially reduce ri s k

for CVD. Such risk reduction offe rs

gre at benefit in reducing death and

d i s ability due to heart disease in an

aging population. Attempting ri s k

reduction by including the lowe ri n g

of SBP re fines our ability to targe t

those risk fa c t o rs that can make a diffe re n c e. Said Dr. Claude Lenfa n t ,

NHLBI dire c t o r, “ For ye a rs , t re atment strat egies have focused on lowe ring a pat i e n t ’s diastolic pre s s u re,

because diastolic pre s s u re accurat e ly

p redicted heart disease and stro ke

risk in yo u n ger patients. But this

p ractice ex cludes the elderly, wh o

tend to have higher systolic pre s s u re s

and lower diastolic pre s s u re s — a n d

who have the least controlled bl o o d

p re s s u res of all pat i e n t s .”

In the September 1999 issue of

H y p e rt e n s i o n, D r. Henry Black , o f

R u s h - P re s by t e rian-St. Luke ’s Medical Center, f u rther encouraged a shift

to use of both SBP and DBP, n o t i n g

this “is not now a trivial issue.” A l s o

in that issue, D rs. Michael O’Rourke

and Edwa rd Fro h l i ch , of St. Vi n c e n t ’s

C l i n i c, S y d n ey, Au s t ra l i a , noted that a

s ep a rate study of Framingham dat a

( Franklin et al., C i rc u l at i o n,

1999;100:354-360) found that fo r

p e rsons older than 50 ye a rs , h i g h

pulse pre s s u re was linked to mort a l i t y

a n d, when systolic pre s s u re was cons i d e re d, diastolic pre s s u re showed a

n egat ive association. O’Rourke and

9

( c o n t i nued on page 21)

“Using SBP and DBP toge t her to make these assessments

is still considered the best

s t rat egy.”

Fro h l i ch recounted the 30-year 

h i s t o ry of evidence for a ro bust assoc i ation between higher systolic pre ss u re and CVD.

The NHBPEP is developing strat egies to info rm cl i n i c i a n s , p at i e n t s ,

and allied health pro fessionals ab o u t

the importance of SBP. Health professionals invo l ved in producing medical info rm ation and wo rking in

c o m munity health programs will have

the task of describing to the publ i c

why SBP is important. The NHBPEP

C o o rd i n ating Committee, wh i ch

rep resents 37 national vo l u n t a ry

health orga n i z ations and 7 Fe d e ra l

age n c i e s , is developing an adv i s o ry

s t atement on the importance of SBP

and pulse pre s s u re, e s p e c i a l ly as these

m e a s u res add ress older A m e ri c a n s .

In May 2000, NHBPEP will fo c u s

on the importance of managing systolic blood pre s s u re (see the box on

p age 8).

UP DAT E O N T H E

WO R K I N G GRO U P

RE P O RT O N HI G H

BL O O D PR E S S U R E

I N PR E G N A N C Y

The NHBPEP Wo rking Gro u p

R ep o rt on High Blood

P re s s u re in Pregn a n cy wa s

ap p roved by

the NHBPEP

C o o rd i n ating Committee at

its Ja nu a ry

2000 meeti n g. Th e

rep o rt will

be submitted

to a re fe re e d

j o u rnal for publ i c ation. Dr. Ray W. 

G i ffo rd, J r. , e m e ritus pro fe s s o r

at the Cleveland Clinic Fo u n d at i o n

D ep a rtment of Hypertension and

N ep h ro l ogy, is chair of the wo rk i n g

group. The group includes obstetric i a n s , gy n e c o l ogi s t s , o b - gy n

re s e a rch e rs , and fa m i ly practice cl i n icians. The rep o rt updates the 1990

NHBPEP Wo rking Group Rep o rt on

High Blood Pre s s u re in Preg n a n cy

and will guide clinicians in the identifi c at i o n , eva l u at i o n , and tre atment of

hy p e rt e n s ive disord e rs during 

p reg n a n cy.

Medical pro fessionals have been

awaiting the new rep o rt , e s p e c i a l ly

since new info rm ation from the 1990s

focused attention on a need to rev i s e

the ori ginal. The wo rking group has

d eveloped re c o m m e n d at i o n s , aided by

a rev i ew of the science base cre at e d

since 1990. The rep o rt includes a

revised definition of pre e cl a m p s i a /

e cl a m p s i a , ch a n ges in the cl a s s i fi c ation of hy p e rt e n s ive disord e rs of

p reg n a n cy, and an expanded discussion of prevention and tre at m e n t .

Tre atment re c o m m e n d ations will

a dd ress women with ch ronic hy p e rtension who become pregnant and

women who become hy p e rt e n s ive

d u ring preg n a n cy. The rep o rt presents clear re c o m m e n d ations on the

use of antihy p e rt e n s ive medicat i o n s

d u ring preg n a n cy. An expanded prevention section will add re s s

the use of aspiri n , c a l c iu m , m ag n e s i u m , a n d

other dietary supplements duri n g

p reg n a n cy.

Other new topics incl u d e

p o s t p a rt u m

c o u n s e l i n g

and re s e a rch

re c o m m e n d at i o n s .

The rep o rt will

be ava i l able thro u g h

the NHLBI Info rm at i o n

Center and on the NHLBI

Web site ( w w w. n h l b i . n i h . gov ).
10 Spotlight on 

Pe r fo rmance Pro j e c t s :

Obesity Education Initiat ive

HE A RT S N ’ PA R K S

PI L OT PRO G R A M

LAU N C H E D I N 12 NO RT H

CA RO L I N A CO M M U N I T I E S

Last summer, 12 North Carolina communities hosted the Hearts N’ Pa rk s

Y2K pilot progra m , an innovat ive project in wh i ch community parks and

re c re ation dep a rtments have integrat e d

h e a rt - h e a l t hy behav i o rs into new or

existing community activities. Th e

goal of the stat ewide pilot program is

to increase the number of ch i l d ren and

adults who engage in regular moderate-intensity physical activity and wh o

fo l l ow a heart - h e a l t hy eating plan.

H e a rts N’ Pa rks Y2K is a part n e rs h i p

c o m p rising the NHLBI’s Card i ova s c ular Health Promotion Progra m

( C H P P ) , the National Recre ation and

Pa rk A s s o c i ation (NRPA ) , N o rth Carolina State Unive rs i t y, and Southern

Connecticut State Unive rs i t y. (Fo r

m o re details, see last summer’s issue

of H e a rt M e m o. )

The pilot pro j e c t ’s kicko ff eve n t ,

wh i ch was held at the Mallard Cre e k

R e c re ation Center in Meck l e n bu rg

C o u n t y, N o rth Caro l i n a , fe at u red an

exhibition of Hearts N’ Pa rks activ it i e s , i n cluding a day camp wh e re

lessons learned in the Child and A d olescent Trial for Card i ovascular Health

( C ATCH) study (see sidebar) we re

d e m o n s t rat e d, a fitness class fo r

s e n i o rs , and a USA Tennis cl a s s .

The fo l l owing activities for ch i ld ren and adults we re among those

held at the 12 North Carolina sites

d u ring the Hearts N’ Pa rks pilot 

p rogra m :

• The Roanoke Rapids Pa rks and

R e c re ation Dep a rtment taught the

basics of nu t rition to ch i l d ren age s

4 to 6 at the FLIP (Fun for Little

I n t e rested People) camp. Duri n g

an arts and crafts pro j e c t , for ex a mp l e, the ch i l d ren we re shown pict u res of diffe rent foods and aske d

to choose the healthiest. In the

d ep a rt m e n t ’s “A q u a c i s e ” p rogra m

for seniors , m e m b e rs met thre e

times a week to practice a type of

water aerobics accompanied by

mu s i c.

• The A l b e m a rle Pa rks and Recreation Dep a rtment incorp o rat e d

h e a l t hy snacks and health-re l at e d

m at e rial into its existing summer

d ay camp program for ch i l d re n .

For adults, the dep a rtment teamed

with a local hospital to present the

“ Walk A b o u t ” p rogra m , wh i ch

combined walks around the county

with health education and fre e

s c reenings for blood pre s s u re and

blood glucose.

• The Garner Pa rks and Recre at i o n

D ep a rtment focused on fitness and

h ow to read food labels during a

week at Camp Geko , a summer day

camp for ch i l d ren. Pa rticipants in

the “ Ke ep the Beat ... C i rcle Yo u rself in Health” senior fitness program kept a journal and re c e ive d

c redit for pri zes as an incentive to

“ ke ep the beat ” for a healthier

l i fe s t y l e.

• The Summer Youth Baske t b a l l

L e ag u e, a joint ve n t u re of the

Raleigh Police Dep a rtment and the

Raleigh Pa rks and Recre at i o n

D ep a rt m e n t , i n c o rp o rated Heart s

N ’ Pa rks activities such as phy s i c a l

testing for playe rs and offe ri n g

them fruit and Powe rade dri n k s .

• S t a ff from the Madison-Mayo d a n

R e c re ation Dep a rtment met with

students in grades six to eight to

discuss exe rcise and good nu t ri t i o n .

Students engaged in games such as

“My Pe rsonal Pizza,” in wh i ch they

designed nu t ritious pizzas.

• The Meck l e n bu rg County Pa rk s

and Recre ation Dep a rtment cre at e d

a senior walking program in wh i ch

p a rticipants wa l ked from Charl o t t e

to a local outlet mall. A nu t ri t i o u s

l u n ch was offe red during the activ it y. The dep a rtment also incorp orated a healthy lunch program into

its summer day camp program fo r

yo u t h .

• The Winston-Salem Pa rks and

R e c re ation Dep a rtment presented a

n ew healthy heart program at its

Weed and Seed Summer Yo u t h

A c a d e my. This invo l ved healthy

s n a ck s , e d u c ational sessions, a n d

i n s t ructions in physical activ i t i e s .

• The Smithfield Pa rks and Recreation Dep a rtment collab o rated with

a county health dep a rtment and fi tness center to provide a 6-we e k

senior exe rcise program that

o ffe red blood pre s s u re, ch o l e s t e ro l ,

and body-composition scre e n i n g.

• The Wilson Pa rks and Recre at i o n

D ep a rtment included dieting educ ation in a summer sports day

This summer, Hearts N’ P a r k s

launches its nationwide program. For news on how you

can get involved, keep an eye

on the NHLBI Web site at

w w w. n h l b i . n i h . g o v or call the

N R PA at 800-649-3042.
11

camp program. The dep a rt m e n t

also offe red a drop-in weight and

e d u c ation program for adults.

• Pa rks and re c re ation dep a rtments in

the towns of Fletcher and

G re e nville also offe re d, in part n e rship with local gro u p s , s u m m e r

camp programs including dieting

and exe rcising educat i o n .

• The town of Hicko ry offe red a new

“ k i n d e rgy m ” p re s chool program of

a c t ivities for young ch i l d re n .

“ R egular physical activity and

h e a rt - h e a l t hy eating habits are key to

p reventing and controlling ove r we i g h t

and obesity, high blood pre s s u re, a n d

high blood ch o l e s t e rol—major ri s k

fa c t o rs for card i ovascular disease,”

said Karen Donat o , c o o rd i n ator of the

NHLBI Obesity Education Initiat ive.

“ The NHLBI re c og n i zes the many

ways that community parks and re c reation dep a rtments positive ly affect the

well-being of people, and we we re

ex t re m e ly pleased to join with NRPA

to conduct the Hearts N’ Pa rks Y 2 K

pilot project in North Caro l i n a .”

The pilot project was eva l u ated with

a process-and-outcome assessment,

and the results we re presented at the

N o rth Carolina Recre ation and Pa rk

Society meeting in Charlotte Nove mber 13–17, 1999. Youth programs we re

found to be ge n e ra l ly successful, w i t h

most showing improvement in nu t rition know l e d ge and intentions to eat

h e a l t hy foods in the future. The adult

p rograms we re somewh at less successf u l , although there we re improve m e n t s

in some va ri ables at all the sites. A d u l t

s c o res for healthy eating hab i t s

i m p roved signifi c a n t ly ove ra l l .

D ata collected from the park and

re c re ation personnel revealed that the

p rograms lent added value to ex i s t i n g

a c t iv i t i e s , taught lifelong skills, a n d

helped prove that ch a n ge and positive

impact can happen. Increased invo l vement in developing a new progra m

raised staff morale and helped staff to

plan and implement other progra m s .

M a ny have planned additional Heart s

N ’ Pa rk s - re l ated activities focusing on

the benefits. All participants said they

would recommend the Hearts N’ Pa rk s

p rogram to colleagues at other parks or

agencies. Th ey felt that they we re

doing something beneficial and important for the community and that Heart s

N ’ Pa rks was an effe c t ive program with

excellent mat e rials. Visit the Hearts N’

Pa rks Web site at the fo l l ow i n g

a dd re s s : h t t p : / / h p 2 0 1 0 . n h l b i h i n . n e t /

h rt _ n _ p k / h n p _ m a i n . h t m.

TE AC H I N G HE A LT H CA R E

WO R K E R S AB O U T

OB E S I T Y

The Centers for Obesity Research and

E d u c ation (C.O.R.E.) conduct wo rkshops to train physicians and other

health care wo rke rs in managing obese

p atients. Begun in 1998, the progra m

n ow invo l ves operations in eight cent e rs in seven states. The centers are

leading re s e a rch sites for obesity and

o ffer ex p e rt educat o rs and the lat e s t

clinical and behav i o ral re s e a rch - b a s e d

k n ow l e d ge. The centers use the Clinical Guidelines on the Identifi c at i o n ,

E va l u at i o n , and Tre atment of Ove rweight and Obesity in A d u l t s — Th e

Evidence Rep o rt , issued in 1998 by the

NHLBI in cooperation with the Nat i o nal Institute of Diabetes and Dige s t ive

and Kidney Diseases, as the basis fo r

mu ch of their educational progra m .

Knoll Pharmaceutical Company, of Mt.

O l ive, N ew Je rs ey, s u p p o rts the effo rt

with an educational gra n t .

The wo rk s h o p s , held monthly, fe at u re intera c t ive hands-on activities and

give participants practical info rm at i o n

and tools, wh i ch can be used immediat e ly with patients. The C.O.R.E. curriculum tre ats obesity as a ch ro n i c

d i s e a s e, re q u i ring ongoing tre at m e n t .

Its deve l o p e rs have targeted the fo l l owing go a l s : (1) to provide timely, re l evant education and training ab o u t

obesity and its management to pri m a ry

C H I L D R E N C A T C H

O N T O H E A R T

H E A L T H M E S S A G E S

The NHLBI-funded Child and

Adolescent Trial for Cardiovascular Health (CATCH) study

was the largest school-based

health promotion study ever

conducted in the United States.

C ATCH took place between

1991 and 1994 in four states

(California, Louisiana, Minnesota, and Texas) and

involved 3,714 students in

nearly 100 ethnically and

racially diverse elementary

schools. Results of the

C ATCH followup study, conducted between 1995 and

1998, were reported in the July

14, 1999, issue of the A r c h i ve s

of Pe d i a t ric and Adolescent

M e d i c i n e. (Results of the original study were reported in the

March 13, 1996, issue of the

J o u rnal of the American Medical Association. )

The followup study assessed

d i fferences in diet, physical

a c t i v i t y, and related health indicators among 73 percent of the

initial CATCH participants

when they were in grades six,

seven, and eight. Compared

with students in the control

groups, CATCH participants

who received the health promotion intervention in grades

three through five maintained a

diet significantly lower in total

fat and saturated fat and continued to pursue more vigorous

physical activity. T h e s e

results indicated that children

who learned heart-healthy

behaviors in grades three to

five continued to practice the

behaviors for several years,

often into middle school.

( c o n t i nued on page 22)
12 The National Heart 

A t t a ck A l e rt Progra m

CA N IN F O R M AT I C S HE L P

IM P ROV E HE A RT AT TAC K

SU RV I VA L RAT E S?

You wa ke up on Sunday morn i n g

feeling “not quite ri g h t .” You don’t

feel too bad, but you wonder if the

tight sensation in your chest could

h ave something to do with your heart .

You turn on your home computer and

place two adhesive pads on yo u r

chest. You have entered into yo u r

health care netwo rk. Within a few

m i nu t e s , your heart rhythm has been

assessed by a card i o l ogi s t , wh o

a dvises you that the info rm ation indic ates that you are in the earl i e s t

s t ages of a heart at t a ck .

The system automat i c a l ly contacts

9-1-1 and fo r wa rds your test re s u l t s

to incoming emerge n cy medical technicians as well as emerge n cy phy s icians and nu rses who are awa i t i n g

your arrival at the hospital emerge n cy

d ep a rtment (ED). The thro m b o ly t i c

t h e rapy you re c e ive 30 minutes lat e r

in the emerge n cy dep a rtment diss o l ves the clot in your art e ry befo re it

has caused any serious damage to

your heart .

Sound fa r- fe t ched? Not necessarily. The not-too-distant future could

i n clude access to this and other innovat ive tech n o l ogical ap p l i c at i o n s .

Medical info rm at i c s , c o m p u t e r

s c i e n c e, b i o e n gi n e e ri n g, n a n o t e ch n o logy (tech n o l ogies at the molecular

s c a l e ) , b i o ch e m i s t ry, and other techn o l ogical ap p l i c ations hold gre at

potential for reducing or eliminat i n g

o b s t a cles that hinder the rapid diagnosis and tre atment of acute myo c a rdial infa rction (AMI). A c c o rd i n g ly,

the National Heart A t t a ck A l e rt Program (NHAAP) and the Nat i o n a l

L i b ra ry of Medicine are collab o rat i n g

in an initiat ive to support contra c t s

t h at will ex p l o re the use of these

ap p l i c ations to fa c i l i t ate early re c ogn i t i o n , d i ag n o s i s , and tre atment of

A M I .

These jointly funded projects are

expected to include initiat ives that

will target telehealth and telecommun i c at i o n s , s u p p o rt for diagnostic and

t re atment decisions, medical re c o rd s

a c c e s s , the use of large-scale dat ab a se s , and innovat ive techniques for providing publ i c, p at i e n t , and health care

p rovider education. Th ey will be

d i rected at one or more of the fo l l owing potential stages of delay :

• Patient and bystander re c og n i t i o n

of and reaction to the symptoms

and signs of A M I .

• P rehospital emerge n cy medical

s e rvices (EMS) pro c e d u re s , t h at

i s , the actions EMS wo rke rs and

other health care prov i d e rs take

b e fo re a pat i e n t ’s admission to the hospital.

• The in-hospital

d i agnostic and

t re atment activ ities of health care

p rov i d e rs .

The NHAAP Coord i n ating Committee has

i d e n t i fied a number of

a reas that are like ly to bene fit from the ap p l i c ation of

i n fo rm atics and other techn o l ogies. These include the ev idence-based eva l u ation of

d i agnostic tech n o l ogi e s , s t rat egi e s , and protocols for identifying patients with acute

c a rdiac ischemia; health

c a re systems and community planning init i at ives; improve d

d i s s e m i n ation of info rm ation fo r

health care prov i d e rs , p at i e n t s , a n d

the public; and mechanisms for helping emerge n cy dep a rtment phy s i c i a n s

d i agnose AMI (for ex a m p l e, t e l e m e dicine consultat i o n , e l e c t ronic decision

s u p p o rt , and data rep o s i t o ri e s ) .

A dditional info rm ation on the

i n fo rm atics pro j e c t s , a dd re s s i n g

issues of concern to the NHAAP, w i l l

be provided in future issues of 

H e a rt M e m o.

CH E S T PA I N CE N T E R S:

MO R E TH A N JU S T A

NA M E

For patients with symptoms sugge st ive of acute cardiac ischemia (AC I ) ,

rapid diagnosis and

t re atment can be

c rucial to ach i eving optimal
13

p atient outcomes. Some tre at m e n t s

for ACI are time dependent and,

when given early, m o re effe c t ive ly

l ower morbidity and mortality rat e s .

A c c o rd i n g ly, an important objective

of the NHAAP is to decrease “ s y m ptom onset to tre at m e n t ” d e l ays fo r

ACI pat i e n t s .

M o re than 1,200 self-designat e d

chest pain centers have been instituted by some emerge n cy dep a rt m e n t s

(EDs) across the Nation as their

m e chanism for providing compre h e ns ive care for patients with ACI. A n

NHAAP task fo rce used a nat i o n a l

s u rvey to eva l u ate the utilizat i o n ,

ch a ra c t e ri s t i c s , and results of ch e s t

pain centers. The task fo rce deve loped a position paper to describe its

insights and concl u s i o n s , some of

wh i ch fo l l ow :

• Chest pain centers can be an

i m p o rtant re s o u rce for orga n i z i n g

the most ap p ro p ri ate setting fo r

the eva l u ation and tre atment of

p atients with symptoms

of ACI. Howeve r,

since there is wide

va ri ation in the

p ractices of these

s e l f - d e s i g n at e d

e n t i t i e s , the content

of the program for the

eva l u ation and tre at m e n t

of ACI is of gre atest import a n c e.

The emerge n cy care of pat i e n t s

with suspected ACI re q u i res mu l t id i s c i p l i n a ry, ve rt i c a l ly integrat e d

p rograms for the rapid eva l u at i o n

of patients. These progra m s

i n clude the fo l l owing elements:

– A designated area of the ED

equipped for assessing and

m o n i t o ring patients potentially

h aving isch e m i a , i n cl u d i n g

standing ord e rs for initial diagnostic and therapeutic actions.

– A standing protocol indicat i n g

i n clusion and ex clusion cri t e ri a

for reperfusion therap i e s ,

i n cluding provisions authori zing the assessing physician to

administer thro m b o lytic therapy or to mobilize the cat h e t e riz ation lab for cases meeting

s p e c i fied cri t e ri a .

– A clear delineation of re s p o n s ibilities for all members of the

reperfusion team.

– Policies and pro c e d u res for the

t re atment and possible tra n s fe r

of patients with ST- s eg m e n t

e l evation AMI who are ineligible for thro m b o lytic therapy.

– An established process fo r

specifying the tre atment plan

and milestones for pat i e n t s

without ST- s egment elevat i o n

who have high pro b abilities of

AC I , as well as for those with

ACI confi rmed by ECG or biochemical testing.

• It is vital that the EMS team play

a significant role in the identifi c ation and early tre atment of sympt o m atic patients with possibl e

AC I , because about one-half

of patients with AMI are

t ra n s p o rted by ambul a n c e. This invo l ve s ,

at a minimu m , e d u c ating all members of the

p rehospital team ab o u t

the importance of timely

t re atment. Depending on the

local situat i o n , it may also invo l ve

the field use of prehospital ch e cklists for thro m b o lysis eligi b i l i t y,

the use of 12-lead electro c a rd i ograms for transmission to the

re c e iving hospital, and tre at m e n t

with anti-platelet or anti-isch e m i c

t h e rapy and, p e r h ap s , t h ro m b o lytic 

t h e rapy.

• M a ny tech n o l ogies for diag n o s i n g

p atients with ACI in the ED setting have not been adequat e ly

studied for either diagnostic accura cy or clinical impact, and only a

few have been found in pro s p e ct ive clinical trials to improve care.

A c c o rd i n g ly, chest pain centers

must be careful to implement only

t e ch n o l ogies for wh i ch there is

evidence of benefit and safe t y. In

a dd i t i o n , p rograms targeting the

rapid eva l u ation of patients with

suspected ACI need to be drive n

by continuous practice assessment

and quality improvement initiat ives. Chest pain centers can serve

as the locus of, and provide the

re s o u rces fo r, s u ch effo rt s .

• Although the best means of conducting an outre a ch campaign are

still under inve s t i gat i o n , e ffo rts to

e d u c ate individual patients and the

b roader community at risk fo r

acute coro n a ry syndromes should

e m p h a s i ze the importance and

b e n e fits of responding quick ly to

the earliest symptoms and signs of

p o s s i ble AMI or unstable angi n a .

The NHAAP also stro n g ly re c o mmends that patients with know n

c o ro n a ry disease be taught by

p hysicians and nu rses about the

symptoms of ACI and the step s

needed to obtain the earliest possible tre at m e n t , i n cluding calling

9 - 1 - 1 .

• Although more re s e a rch into

methods to fa c i l i t ate the wo rk of

t ri aging patients with possible AC I

is cl e a rly needed, mu ch of wh at is

k n own has yet to be consistently

ap p l i e d. Whether or not they are

called chest pain centers , h o s p i t a l s

o ffe ring programs consistent with

the cri t e ria outlined by the

NHAAP serve as an import a n t

re s o u rce for the rapid diag n o s i s

and tre atment of patients ex h i b i ting symptoms of ACI. 

The NHAAP Position Paper on

Chest Pain Centers and Programs fo r

the Eva l u ation of Acute Card i a c

I s chemia will be published in A n n a l s

of Emerge n cy Medicine in the May

2000 issue. 
14

CH O L E S T E RO L

LOW E R I N G I N OL D E R

AM E R I C A N S

“ Ke ep the beat — ch o l e s t e rol counts

for eve ryo n e,” the theme used for last

S ep t e m b e r ’s National Cholestero l

E d u c ation Month, c o nveys the idea

t h at ch o l e s t e rol consciousness is

i m p o rtant for eve ryo n e ’s heart

h e a l t h — i n cluding older A m e ri c a n s .

As a gro u p , older A m e ri c a n s

(those older than 65 ye a rs) have the

highest rate of CHD and can benefi t

gre at ly from lowe ring elevated ch ol e s t e rol levels. A new National Chol e s t e rol Education Program (NCEP)

rep o rt titled “ C h o l e s t e rol Lowe ring in

the Elderly Po p u l at i o n ” was published in the August 9/23, 1 9 9 9 , i s s u e

of the A rch ives of Internal Medicine.

The rep o rt examines issues surro u n ding ch o l e s t e rol lowe ring in the elderly and concludes that contro l l i n g

ch o l e s t e rol is of significant value in

older A m e ricans. 

W hy Cholesterol Low e r i n g

Is Important in Older Adults

High serum ch o l e s t e rol is a major

risk factor for CHD, wh i ch is the

leading cause of morbidity and mortality in both older men and wo m e n .

The majority of coro n a ry eve n t s

occur in those older than 65 ye a rs .

Two - t h i rds to thre e - q u a rt e rs of people

older than 65 have either cl i n i c a l

CHD or subclinical (“silent”) at h e ros cl e rotic disease. Cholesterol lowe ring in older adults with CHD can

p rolong and improve the quality of

l i fe and reduce the risk of heart

at t a ck or stro ke. For seniors without

C H D, ch o l e s t e rol lowe ring re d u c e s

the high risk of developing it. 

C h o l e s t e rol Lowering in

Older Patients With CHD

The aim of ch o l e s t e rol lowe ring in

people with CHD is to decrease the

l i kelihood of future events and

i m p rove the quality and length of

l i fe. Th e re is ample scientific ev idence to support the idea that ch o l e st e rol lowe ring in persons with CHD

reduces morbidity and mort a l i t y.

Clinical trials carried out between the

1960s and 1990s using va rious regimens to lower ch o l e s t e rol produced a

modest (10 percent) reduction in ch ol e s t e rol levels. Meta-analysis of

these trials showed that

re c u rre n t

CHD events and CHD

m o rtality we re signific a n t ly reduced by ch o l e st e ro l - l owe ring therapy, with a stro n g

t rend towa rd a decline in total mort a li t y. The results of the meta-analy s i s

i n fluenced the NCEP’s second A d u l t

Tre atment Panel (ATP II) ch o l e s t e ro l

t re atment guidelines to place gre at e r

emphasis on ch o l e s t e ro l - l owe ri n g

i n t e rvention in patients with CHD.

In the 1990s, a n gi ographic tri a l s

( s eve ral of wh i ch employed stat i n

d rugs to produce large reductions in

ch o l e s t e rol levels) showed that 

ch o l e s t e ro l - l owe ring therapy, c o mp a red with placeb o , u s u a l ly slowe d

o r, in some cases, reve rsed the progression of coro n a ry lesions. In the

t re atment gro u p s , n ew coro n a ry

events such as unstable angina and

AMI we re gre at ly re d u c e d.

In three recent statin tri a l s , t h e

S c a n d i n avian Simva s t atin Surv iva l

S t u dy (4S), the Cholesterol and 

R e c u rrent Events (CARE) tri a l , a n d

the Long-Te rm Intervention with

P rava s t atin in Ischaemic Disease

(LIPID) study, m a rked reductions in

ch o l e s t e rol levels we re seen in the

t re atment groups. In 4S, p at i e n t s

older than 65 ye a rs in the tre at m e n t

group showed signifi c a n t ly fewe r

total deaths and major coro n a ry

events. These results we re similar to

those observed in patients yo u n ge r

than 65 ye a rs. Similarly, o l d e r

p atients in the CARE and LIPID trials benefited as mu ch as yo u n ge r

ones from ch o l e s t e ro l - l owe ring therapy. In these tri a l s , both men and

women benefited from ch o l e s t e ro l

l owe ri n g.

Based on the aggregate results of

these recent studies, ch o l e s t e rol lowe ring among men and women ages 65

to 75 with CHD ap p e a rs to be stro n gly justifi e d. Among those older than

75 ye a rs , special considerations mu s t

be add re s s e d. In patients with serious illness or multisystem disease,

aggre s s ive ch o l e s t e rol manage m e n t

m ay not be a pri o ri t y. On the other

h a n d, a patient older than 75 ye a rs

with CHD who is otherwise in go o d

health is like ly to be a good candidat e

for ch o l e s t e ro l - l owe ring therapy.

Because of the marked diffe rences in

functionality and health status among

older pat i e n t s , clinical judgment

p l ays a central role in tre atment decisions. In most cases, older pat i e n t s

with CHD will need both dietary and

d rug therapy to lower a high ch o l e st e rol leve l .

The National Cholesterol 

E d u c ation Progra m
15

C h o l e s t e rol Lowering in

Older Pe rsons Without CHD

Because the majority of initial CHD

events occur after age 65, p reve n t i n g

the fi rst event (pri m a ry prevention) in

the elderly is especially import a n t .

For pri m a ry preve n t i o n , the NCEP

recommends that older A m e ricans fo ll ow heart - h e a l t hy eating hab i t s , ge t

regular physical activ i t y, and maintain

a healthy weight. In addition to

reducing ch o l e s t e rol leve l s , t h e s e

m e a s u res can improve ove rall health

by controlling blood pre s s u re and preventing the development of type 2

d i abetes. Recent scientific ev i d e n c e

c o n cludes that ch o l e s t e rol lowe ring in

p e rsons without CHD is benefi c i a l .

In two recent statin clinical tri a l s ,

the West of Scotland Coro n a ry Prevention Study (WOSCOPS) and the

Air Fo rc e / Texas Coro n a ry A t h e ro s cl erosis Prevention Study (AFCAPS/TexC A P S ) , ch o l e s t e rol lowe ring pro d u c e d

similar reductions in CHD rates in

older patients and in yo u n ger ones.

In WO S C O P S, total ch o l e s t e rol leve l s

we re reduced by 20 perc e n t , L D L -

ch o l e s t e rol levels by 26 perc e n t , a n d

major coro n a ry events by 31 perc e n t .

Th e re was no increase in noncard i ovascular deat h s , thus yielding a 22-

p e rcent reduction in all-cause

m o rt a l i t y. Pa rticipants in the tre atment group in A F C A P S / Tex C A P S

ex p e rienced a 25 percent decline in

their LDL-ch o l e s t e rol levels and a 37

p e rcent reduction in major coro n a ry

events compared with those in the

p l a c ebo group. Th e re we re no significant adve rse effects from statin dru g s

in either WOSCOPS or A F C A P S /

Tex C A P S.

The ge n e ral ap p ro a ch to ch o l e st e ro l - l owe ring therapy

in older men and

women without

CHD incl u d e s

d i e t a ry therapy,

i n c reased phy s i c a l

a c t iv i t y, a n d

weight control. In high-risk pat i e n t s

( for ex a m p l e, those with elevat e d

L D L - ch o l e s t e rol combined with other

risk fa c t o rs for CHD), d rug therapy

m ay have to be added to these life

h abit measures. In both men and

wo m e n , other risk fa c t o rs for CHD,

s u ch as smoking and high blood pre ss u re, also should be controlled to

l ower the risk for CHD. 

C h o l e s t e rol Testing in Older

A m e r i c a n s

The NCEP recommends that all adults

20 ye a rs of age and older have their

total ch o l e s t e rol level measured at

least once eve ry 5 ye a rs. If accurat e

results are ava i l abl e, H D L - ch o l e s t e ro l

should also be measure d. The prefe rred setting for ch o l e s t e rol measurement in older adults is a medical

ex a m i n ation during wh i ch info rm at i o n

about other CHD risk fa c t o rs such as

c i ga rette smoking, high blood pre ss u re, d i ab e t e s , fa m i ly history of early

h e a rt disease, o b e s i t y, and level of

p hysical activity is obtained. Th e

results of ch o l e s t e rol testing toge t h e r

with assessment of other risk fa c t o rs

for CHD help identify candidates fo r

ch o l e s t e ro l - l owe ring tre atment. If an

e l d e rly patient is considered a potential candidate for ch o l e s t e ro l - l owe ri n g

t re at m e n t — d i e t a ry or drug therapy —

then ch o l e s t e rol testing should be perfo rm e d. In add i t i o n , identifying high

ch o l e s t e rol levels in an older pat i e n t

can alert the physician to the possibility of elevated ch o l e s t e rol levels in the

p at i e n t ’s fi rs t - d egree re l at ive s , i n cl u ding midd l e - aged off s p ri n g.

C o n cl u s i o n

Older adults have the highest risk fo r

CHD and should be considered 

c a n d i d ates for ch o l e s t e ro l - l owe ri n g

t h e rapy if indicat e d. Among older

p e rs o n s , L D L - ch o l e s t e rol leve l , p re sence of other risk fa c t o rs for CHD,

and ge n e ral health status should be

c o n s i d e red when planning ch o l e s t e ro l -

l owe ring interventions. Eating a low -

s at u rat e d - fat , l ow - ch o l e s t e rol diet,

i n c reasing physical activ i t y, a n d

a ch i eving and maintaining a healthy

weight are the corn e rstones of therapy.

In some cases, ch o l e s t e ro l - l owe ri n g

m e d i c ations also may be needed.

C h o l e s t e rol lowe ring in older adults

can enhance both the quality and

length of life.

NCEP LAU N C H E S

NE W LY EX PA N D E D

IN T E R AC T I V E

CH O L E S T E RO L WE B SI T E

As part of its activities for Nat i o n a l

C h o l e s t e rol Education Month in September 1999, the NCEP launched an

u p d ated and expanded ve rsion of its

p o p u l a r, awa rd-winning Web site

“ L ive Healthier, L ive Longe r.” Th e

site re c e ived over 55,000 hits duri n g

the month of Sep t e m b e r. The updat e d

site fe at u res info rm ation about ch o l e st e rol lowe ring for people who want to

p revent heart disease and for those

who alre a dy have heart disease. Th e

basic message is “ ch o l e s t e rol counts

for eve ryo n e.” The intera c t ive site

a l l ows users to obtain info rm ation that

is re l evant to their own ch o l e s t e ro l

l evels and degree of risk for heart 

d i s e a s e.

Popular fe at u res of the site incl u d e

C re at e - a - D i e t , h e a rt - h e a l t hy re c i p e s ,

health tips, i n fo rm ation about phy s i c a l

a c t iv i t y, and answe rs to fre q u e n t ly

a s ked questions. Practical info rm ation to help people lower their ch o l e st e rol leve l s , s u ch as how mu ch

s at u rated fat and ch o l e s t e rol should be

in their diet, is presented in an enjoyabl e, u s e r- f ri e n d ly way. 

The “ L ive Healthier, L ive Longe r ”

Web site can be found at

w w w. n h l b i . n i h . gov / ch d.
16 The National Center on 

S l e ep Disord e rs Research

NE W PH Y S I C I A N

BO O K L E T O N RE S T L E S S

LE G S SY N D RO M E

A person who rep o rts unpleasant sens ations in the legs and an irre s i s t i bl e

u rge to ke ep the legs in motion may

h ave restless legs syndrome (RLS).

The symptoms of RLS wo rsen duri n g

p e riods of inactiv i t y — u s u a l ly duri n g

the evening and night hours. Pe rs o n s

with RLS may ex p e rience disru p t e d

s l e ep and an inability to tolerat e

s e d e n t a ry activities. Although many

people have not heard of RLS,

b e t ween 2 and 15 percent of the popu l ation may ex p e rience RLS 

s y m p t o m s .

A new booklet titled Restless Leg s

S y n d ro m e : Detection and Management in Pri m a ry Care is designed to

help pri m a ry care physicians identify

and tre at patients with RLS. Th e

N ational Center on Sleep Disord e rs

R e s e a rch (NCSDR) convened a wo rking group on RLS as part of its educ ational activities targeting health

c a re pro fessionals. The wo rk i n g

group was composed of sleep medicine ex p e rt s , n e u ro l ogi s t s , m ove m e n t

d i s o rd e rs specialists, and pri m a ry

c a re physicians. Members of the

wo rking group developed the booklet

by examining the science on RLS and

t ra n s l ating it into practical message s

for pri m a ry care physicians. 

The booklet defines RLS and discusses its consequences, p reva l e n c e,

e t i o l ogy, d i ag n o s i s , and tre at m e n t .

At pre s e n t , t h e re are no specifi c

s c reening tests for RLS, so it is

i m p o rtant that physicians assess

p atients for sleep complaints and then

fo l l ow with questions that can help

identify RLS. The booklet incl u d e s

s u ggested questions and prov i d e s

clinical cri t e ria to help phy s i c i a n s

distinguish RLS from other 

c o n d i t i o n s .

Patients with RLS usually obtain

relief from their symptoms with dru g

t re atment. Pri m a ry care phy s i c i a n s

detect and tre at RLS and prov i d e

emotional support to patients. Many

p atients live with the symptoms of

RLS for ye a rs befo re it is diag n o s e d

and tre at e d.

The NCSDR published a fa c t s h e e t

about RLS for patients and the publ i c

in 1996. Facts About Restless Leg s

S y n d rome is one in a series of

NCSDR factsheets about va ri o u s

s l e ep disord e rs .

The factsheets and the new RLS

booklet are obtainable from the

NHLBI Info rm ation Center and

online at w w w. n h l b i . n i h . gov.

NE W SL E E P WE B SI T E

AT NHLBI SI T E

The NHLBI has unveiled its lat e s t

Web site, d evoted to sleep and sleep

d i s o rd e rs. The site offe rs the publ i c

and health pro fessionals the most upt o - d ate science-based info rm ation on

s l e ep , s l e ep disord e rs , s l e ep re s e a rch ,

and funding opport u n i t i e s .

“ S l e ep re s e a rch is adva n c i n g

rap i d ly, and we want the medical

c o m munity and the public to have

t i m e ly access to the wealth of 

i m p o rt a n t , a c c u rate info rm ation on

s l e ep and sleep disord e rs that has

been developed within the Fe d e ra l

G ove rn m e n t ,” said NHLBI Dire c t o r

D r. Claude Lenfant. “ We also wa n t

to encourage more re s e a rch in this

fi e l d,” he add e d. 

By viewing the site, health care

p ro fessionals and re s e a rch e rs can

find up-to-date info rm ation on the

d i agnosis and tre atment of sleep diso rd e rs , l e a rn about activities of the

S l e ep Disord e rs Research A dv i s o ry

B o a rd, read about sleep - re l ated gra n t s

and publ i c at i o n s , and become

i n fo rmed about NIH program staff

and rep o rt s .

The new NCSDR Web site provides news and info rm ation thro u g h

fact sheets, an intera c t ive quiz, p u bl i c

s e rvice announcements, and other

fe at u res. It provides info rm at i o n

about additional re s o u rces and lets

v i s i t o rs register to re c e ive updat e s .

“ E ve ry A m e rican needs to understand the importance of obtaining

a d e q u ate sleep and the risks of ex c e ss ive sleep i n e s s ,” said NCSDR A c t i n g

D i rector Dr. Michael Twe ry. “ O u r

n ew Web site provides info rm at i o n

t h at will help the public and health

c a re pro fessionals re c og n i ze the signs

of common sleep disord e rs and the

need for pro fessional tre atment. It

will also encourage commu n i c at i o n

about sleep within the medical and

s c i e n t i fic communities and ultimat e ly

lead to more re s e a rch on sleep and

s l e ep disord e rs ,” he add e d. 

To visit the NCSDR site, go to

w w w. n h l b i . n i h . gov and cl i ck on the

N ational Center on Sleep Disord e rs

R e s e a rch .

“Between 2 and 15 percent of

the population may experience

RLS symptoms.”
17 Spotlight on Pe r fo rm a n c e

P ro j e c t s : M i n o rity Pro j e c t s

YO U R HE A RT, YO U R

LI F E: A HE A LT H

PRO M OT E R’S MA N UA L

F O R LAT I N O S

The NHLBI’s Latino Community Card i ovascular Disease Prevention and

O u t re a ch Initiat ive, Salud para su

C o razón (Health for Your Heart ) , h a s

c re ated a new program called Yo u r

H e a rt , Your Life for health educat o rs

in Latino communities. The progra m

helps educat o rs give Latinos know le d ge, s k i l l s , and motivation to help

them take action against heart 

d i s e a s e.

Your Heart , Your Life fe at u re s

e n j oyabl e, hands-on activ i t i e s , wh i ch

p ro m o t o res de salud (lay health educat o rs) can use to teach small commu n ity groups how to make lasting life s t y l e

ch a n ges that reduce the risk of heart

d i s e a s e. The program includes the

fo l l owing components:

• An easy-to-fo l l ow manual containing nine sessions. Each session, o r

l e s s o n , focuses on an import a n t

t o p i c, s u ch as eva l u ating your ri s k

for heart disease, being more phy si c a l ly active, high blood pre s s u re

and wh at you need to know ab o u t

i t , and healthy eat i n g. Each lesson

has five part s : i n t roducing the sess i o n , conducting the session, we e kly pledge, rev i ew of key points, a n d

closing activ i t y. The manual contains instru c t i o n s , h a n d o u t s ,

d e m o n s t rat i o n s , ga m e s , and ro l e -

p l aying exe rcises. It is ava i l able in

English and Spanish. (#3674)

• A packet of picture cards that supp o rt each session in the manu a l .

( # 3 2 7 5 )

• A bilingual take-home fo t o n ove l a

( c a rtoon storybook) and wo rk b o o k

to help participants cre ate heart -

health pledges. (#3646)

• A videotape of 60-second nove l i t a s

( d ramas) in Spanish, wh i ch can

help tri gger discussions. Th e s e

fe at u re a Latino fa m i ly making

h e a rt - h e a l t hy ch a n ges in life s t y l e s .

M a ny Latino communities look to

l ay health educat o rs to provide vital

i n fo rm ation about health issues and

ways to live healthier lives. Th e s e

p ro m o t o res are dedicated to improv i n g

the health of their commu n i t y. Community members expect the pro m ot o res to have special qualities, s u ch as

being confi d e n t , p l e a s a n t , ap p ro a chabl e, o p e n m i n d e d, fa i r, and comfo rtable in front of a group. Such

qualities lead to their success.

Said Matilde A l va ra d o , c o o rd i n at o r

of NHLBI Minority Health Educat i o n

and Outre a ch Programs and team

leader of the Salud para su Cora z ó n

i n i t i at ive, “ The program provides cult u ra l ly and language - ap p ro p ri ate tools

to fa c i l i t ate behavior ch a n ge for the

i n d ividual and his/her fa m i ly. Wi t h

p ro m o t o res de salud having ‘ a u t o m atic access,’ we believe the message will

get to and have an impact on the heart

of the commu n i t y.”

O rder copies of Your Heart , Yo u r

L i fe : A Lay Health Educat o r ’s Manu a l

and the other components through the

NHLBI Info rm ation Center. (Call fo r

p ri c e s . )

TH R E E CO M M U N I T I E S

IM P L E M E N T YO U R

HE A RT, YO U R LI F E

The NHLBI has part n e red with the

N ational Council of la Raza (NCLR)

to help Latino communities take

action against heart disease. Tra i n e d

p ro m o t o res in three communities will

use NHLBI mat e rials in outre a ch

a c t ivities to info rm , t e a ch , and 

m o t ivate Latino families concern i n g

h e a rt - h e a l t hy behav i o rs. The pro j e c t s

a re based in Escondido Commu n i t y

C e n t e r, in Escondido, C a l i fo rnia; Cent ro San Bonifa c i o , in Chicago; and

Hands A c ross Cultures Corp o rat i o n , i n

E s p a n o l a , N ew Mexico. The Metropolitan Life Fo u n d ation is funding the

e ffo rt .

This collab o ration brings toge t h e r

N H L B I ’s science-based Salud para su

C o razón initiat ive and NCLR’s ex t e ns ive gra s s roots netwo rk for Lat i n o

health. The Community A l l i a n c e

Wo rking for Heart Health, a team of

health pro fessionals from local, s t at e,

and national orga n i z at i o n s , will provide technical assistance.

The projects began with 4-day

t raining sessions for pro m o t o re s .

Te resa A n d rew s , p ro m o t o ra fro m

Escondido Community Health Center,

attended the training sessions and

c o m m e n t e d, “ We are equipped with

the know l e d ge, s k i l l s , m o t ivat i o n , a n d

m at e rials to drive the message home

to our commu n i t y. We know that we

will be supported throughout this journ ey by many pro fessionals wo rk i n g

with NHLBI and NCLR who 

u n d e rstand and value our role as partn e rs in outre a ch for commu n i t i e s .”

( c o n t i nued on page 18)
A national action plan add re s s i n g

the card i ovascular health needs of

AAPIs also is now ava i l abl e. It wa s

d eveloped as a result of the Nat i o n a l

AAPI Card i ovascular Health Strat egy

Wo rkshop conducted by the NHLBI

in May 1999. The action plan contains re c o m m e n d ations for health professionals to use to improve the heart

health of AAPIs through commu n i t y -

based interve n t i o n , o u t re a ch , a n d

c o m munity mobilization. Access the

n ational action plan online at

w w w. ap i a h f. o rg / c v d 1 . h t m l.

These major documents strive to

i n fo rm re s e a rch e rs , a dvo c a cy gro u p s ,

health prov i d e rs , and the commu n i t y -

at - l a rge about the needs and opport unities for improving the health of

AAPIs. The NHLBI is now mov i n g

to identify cultura l ly and linguistically ap p ro p ri ate tools and mat e rials to

i n c rease awa reness about CVD and its

risk fa c t o rs among AAPIs. 

18 AS I A N AM E R I C A N A N D

PAC I F I C IS L A N D E R

PRO J E C T—

BAC K G RO U N D RE P O RT

AVA I L A B L E

The Asian A m e ri c a n

and Pa c i fic Islander

(AAPI) Commu n i t y

O u t re a ch is mobilizing families and communities to improve

their heart health. A

b a ck ground rep o rt wa s

d eveloped by the

NHLBI as part of an

assessment to ex a m i n e

the needs and opport unities for card i ova s c ular health pro m o t i o n

for AAPIs. A dd re s s i n g

C a rd i ovascular Health in A s i a n

A m e ricans and Pa c i fic Islanders

p rovides an ove rv i ew of the status of

CVD among AAPIs and shares know le d ge gained from successful commu n ity-based projects across the country.

( # 3 6 4 7 , $3.00 per copy.) Copies are

being distri buted to

c o m mu n i t y - b a s e d

o rga n i z at i o n s , s t at e

and local health

d ep a rt m e n t s , a n d

other intere s t e d

p a rties. Th e

release of this

rep o rt provides an

o p p o rtunity to

sustain commu n ity interest ab o u t

the need to

i m p rove the heart

health of A A P I s .

A full-text ve rsion of the rep o rt

is ava i l able on the NHLBI home page

( w w w. n h l b i . n i h . gov ). 

( c o n t i nued from page 17)

Spotlight on Wo m e n

NE W WHI BRO C H U R E

In the eighth year of its 15-year miss i o n , the Wo m e n ’s Health Initiat ive

(WHI) has published an info rm at ive

b ro ch u re that describes its nat i o n a l

s t u dy of wo m e n ’s health. Th e

b ro ch u re also presents strat egi e s

k n own to reduce risks for disease and

lists questions a woman should ask

her doctor rega rding va rious health

issues. It stresses that women need

not wait until the results of the

n ational study become ava i l abl e

b e fo re taking steps to lower their ri s k s

and lead a healthy life.

The publ i c ation ap p e a rs at a point

wh e re enrollment is completed, a n d

o rga n i ze rs of the NIH-backed W H I

can describe the many parts of its

l a rge, mu l t i faceted inve s t i gat i o n .

Noted Dr. Jacques Rossouw, WHI acting dire c t o r, “ The WHI inve s t i gat o rs

h ave shown that they can enroll ve ry

l a rge nu m b e rs of women. The nex t

ch a l l e n ge is to ke ep part i c i p a n t s

e n gaged in study activities for many

ye a rs. I am confident of success.”

The WHI is studying how to prevent CHD, b reast and colorectal canc e rs , and fra c t u res that result fro m

o s t e o p o rosis. One goal of WHI is to

extend understanding beyond that

obtained from earlier studies. Fo r

ex a m p l e, the earlier Po s t m e n o p a u s a l

E s t roge n / P rogestin Interve n t i o n s

(PEPI) trial found that horm o n e

replacement therapy (HRT) can

reduce some risk fa c t o rs for heart dise a s e. The WHI study is pushing fa rther to determine whether HRT and

other strat egies actually reduce the

incidence of heart disease.

The 8-page bro ch u re, titled Fa c t s

About the Wo m e n ’s Health Initiat ive,

contains descriptions of the thre e

p a rts of the WHI longitudinal study of

wo m e n ’s health issues: the cl i n i c a l

s t u dy, the observational study, and the

c o m munity prevention study. Th e

fi rst examines effects of HRT, c a l c i u m

and vitamins, and diet strat egies on

d i s e a s e. The second seeks pre d i c t o rs

and biological marke rs for disease.

The third tests ways to encourage

women to adopt healthful behav i o rs .

The WHI is a consortium effo rt led

by the NHLBI in cooperation with the

N ational Cancer Institute, the Nat i o nal Institute of A rt h ritis and Muscul o s keletal and Skin Diseases, and the

N ational Institute on A gi n g. To

re c e ive the bro ch u re and obtain other

i n fo rm ation about the W H I , c o n t a c t

the NHLBI Info rm ation Center. (Single copy is fre e.) 
19 A round the Nat i o n

STAG E PL AY ED U C AT E S

AB O U T CA R D I OVA S C U L A R RI S K S

Th ree ye a rs after the cessation of

NHLBI funding, m a ny Stro ke Belt Init i at ive activities (a series of NHLBI

p rograms targeting the Southeast and

d e s c ribed in H e a rt M e m o, S u m m e r

1997) continue to re ap benefits. Many

s t ate and local agencies have adopted

a c t ivities and incorp o rated them into

their own programs. Other activ i t i e s

h ave surv ived indep e n d e n t ly. One such

a c t ivity is the play Choices, d eve l o p e d

within the Tennessee Stro ke Belt Project. This educational drama continu e s

to find new audiences 5 ye a rs after its

d ebut in Nashville, Te n n e s s e e.

C h o i c e s , w ritten by Va l e ria Steele,

d epicts an A f rican A m e rican fa m i ly

making choices that affect its risks fo r

h e a rt disease and stro ke. The play

c o n t i nues to re c e ive support from local

o rga n i z at i o n s

t h roughout Te nn e s s e e, wh i ch wa n t

to bring its powe r f u l

m e s s ages to audiences in their communities. Besides

N a s h v i l l e, s p o n s o rs

in Memphis, Ja ck s o n , C h at t a n o oga ,

K n ox v i l l e, and Oak Ridge have promoted Choices. Te l evision stations in

Memphis and Nashville have run fe at u res on the play, helping to maintain

i n t e re s t .

Ta rgeting persons living in the

S t ro ke Belt, this staged drama (with

humor) lasts 30 minutes and is ro u t i n ely accompanied by pre s e n t ations that

f u rther educate about risks of heart disease and stro ke. For ex a m p l e, fo l l owing perfo rm a n c e s , h e a l t h

a dvo c ates have pre s e n ted re c eptions at wh i ch

h e a rt - h e a l t hy foods have

been served and phy s icians and nu t ri t i o n i s t s

h ave answe red questions

about diets and nu t ri t i o n

for A f rican A m e ri c a n s .

Ms. Steele, the play w ri g h t , who said

she “ d reams of extending perfo rm a n c e s

a c ross the country,” has re c e ived many

T R A N S L A T I N G H E A L T H Y P E O P L E 2 0 1 0 

I N T O S T A T E A N D C O M M U N I T Y A C T I O N

The Healthy People 2010 objectives are meant to promote healthy communities. Here are some suggestions

for how to use the objectives for state and local activities:

• Determine the objectives most important to your area.

Be specific and set easy-to-understand goals. Gather

data to back up the need for action. These steps will

encourage local businesses and politicians to buy into

your plan. Two sources of data are: NHLBI’s Healthy

People 2010 Gateway, which has disease maps for

local health areas (see the box), and the Healthy

People 2010 Web site, which has links to national data

sources such as the National Center for Health

S t a t i s t i c s .

• Work with your local board of health. Local boards of

health establish budgets and set priorities for health

and other topics. To enlist its support, have a clear

plan with measurable objectives and, if possible,

partners to share the cost of proposed activities.

• Get the local Chamber of Commerce involved. It can

help businesses share success stories, especially those

about increased productivity and worker satisfaction

because of worksite health promotion programs. For

example, the Chamber of Commerce could arrange for

a presentation to area businesses by a local company

with a successful wellness program.

• Contact other local government agencies to help

address public health concerns. For example,

environmental barriers may be discouraging persons

from becoming physically active. To increase the

number of well-lit sidewalks, public health off i c i a l s

might work with their area electrical utilities and

transportation agency.

• Check out the Healthy People 2010 toolkit. This toolkit

was developed to help local public health professionals

share best practices and address the Healthy People

2010 objectives. More information on the toolkit is

available online at w w w. h e a l t h . g o v / h e a l t h y p e o p l e /

s t a t e / t o o l k i t. The kit can be ordered online at

h t t p : / / b o o k s t o r e . p h f . o r g.

( “ H e a l t hy People 2010” c o n t i nued from page 6)

( c o n t i nued on page 20)
20 N ew at the NHLBI 

I n fo rm ation Center

An Ounce of Preve n t i o n : A Guide to

H e a rt Health ( # 9 9 - 3 6 4 6 , S p a n i s h

$2.00). An entert a i n i n g, c o l o r f u l

(comic-book style), bilingual guide

p resenting strat egies for preve n t i n g

h e a rt disease. In a series of brief stori e s , it presents the Ramirez fa m i ly

deciding to make ch a n ges in their

l i festyle to protect their hearts. Each

of the stories includes a wo rkshop segment in wh i ch re a d e rs can write personal pledges to improve their heart

health and ch a rt activities and

p rogress. This document can be

obtained from the NHLBI Info rm at i o n

Center and is ava i l able on the NHLBI

Web site.

Ju m p s t a rt A f t e rs ch o o l ( # 5 5 - 1 0 3 6 ,

S p a n i s h , call for price). A colorful 

2 5 - p age guide for parents and pro fe ssionals wo rking with elementary

s chool ch i l d re n , fe at u ring enjoyabl e,

e a s y - t o - fo l l ow activities to pro m o t e

h e a rt health and get kids mov i n g.

H e a rt - h e a l t hy recipes provide hands-on

tasty snack activities. This guide can

be used by teach e rs and re c re at i o n a l

p ro fessionals in afters chool progra m s

and summer camps and is an ex p a n s i o n

of the NHLBI and NRPA Ju m p s t a rt

p rogra m , b egun in 1997. Make a diffe rence in the future heart health of the

ch i l d ren in your commu n i t y. Order a

c o py today in Spanish from the NHLBI

I n fo rm ation Center. 

l e t t e rs indicating her play ’s success in

re a ching its goal of ch a n ging people’s

b e h av i o rs. She noted, “ People tell me

t h at they have ch a n ged their life s t y l e s

because of Choices.”

Joan Clayton Dav i s , fo rmer staff

c o o rd i n ator of the Nashville component of the Stro ke Belt Initiat ive in

Te n n e s s e e, wo rked with area ch u rch e s

to set up risk reduction programs fo r

their congregations. The health promotion teams in these ch u rches looke d

for innovat ive ap p ro a ches to commu n ic ate info rm ation about heart disease

and stro ke to ch u rch members. One

ch u rch team came up with the idea of

using a staged drama to make the

i n fo rm ation meaningful and re l evant to

the A f rican A m e rican life s t y l e. Th e

team took the idea to Ms. Steele and

a s ked her to write the play. The re s u l t

was Choices, a successful blending of

p e r fo rmance and messages that re fl e c t

A f rican A m e rican ex p e riences. 

Ms. Steele plans to orga n i ze more

p e r fo rmances in the Memphis area and

to cre ate a pro fessional videotap e d

ve rsion of the play. 

For more info rm ation about Choices,

call Va l e ria Steele at 615-895-1529.

Please Note!

The NHLBI Web site links to the new Gateway with its new online catalog for viewing and obtaining NHLBI health education materials. Go to

w w w. n h l b i . n i h . g o v and click on the Gateway and the catalog. You can

also read H e a rt M e m o and A s t h m a M e m o at the site.

( “ S t age Play ” c o n t i nued from page 19)

( “ H e a l t hy People 2010” c o n t i nued from page 4)

p resident of Morehouse Unive rs i t y

S chool of Medicine, l o o ked back on

H e a l t hy People 2000. Surgeon General Sat cher gave an ove rv i ew of the

c u rrent rep o rt .

S at cher then offi c i a l ly launched the

n ew Healthy People campaign by presenting Shalala with the weighty 

t wo - volume rep o rt. He noted that

mu ch progress had been made since

the fi rst Healthy People rep o rt bu t

cautioned that ch a l l e n ges remain. He

and Shalala urged eve ryone to ge t

i nvo l ved and meet those ch a l l e n ge s .

“ This is a golden opport u n i t y,”

S at cher said, “ c a re f u l ly disguised as a

d i fficult pro bl e m .”
21 H e a rt N e t

H e a l t hy People data:

w w w. c d c. gov / n ch sw w w

Office of Disease Prevention and

Health Pro m o t i o n :

o d p h p . o s o p h s . d h h s . gov /

( “ N H B P E P ” c o n t i nued from page 9)

V i ew Conference and

Receive Education Credits

The National Conference on

CVD Prevention has been

approved for continuing education credits in health education. Certified health education

specialists (CHES) may

receive up to 17.5 credit hours

in category 1. The conference

is available online through the

NHLBI Healthy People 2010

Gateway under “DistanceLearning Opportunities.”

(“CVD Tre n d s ” c o n t i nued from page 7)

JNC V I - SO U T H:

IM P L E M E N T I N G T H E

HY P E RT E N S I O N

GU I D E L I N E S

When the NHBPEP Joint Nat i o n a l

Committee on the Preve n t i o n , D e t e ct i o n , E va l u at i o n , and Tre atment of

High Blood Pre s s u re released its

sixth rep o rt (JNC VI) in 1997, t h e re

was a call to develop implementat i o n

plans to add ress concerns ab o u t

d e clining awa reness and control rat e s

and alarming data indicating that

m o rtality rates for heart disease and

s t ro ke may be ch a n ging for the

wo rs e. NHLBI Director Dr. Claude

L e n fa n t , chair of the NHBPEP Coord i n ating Committee, said in the JNC

VI fo rewo rd, “ This national guideline

should serve as a tool to be adap t e d

and implemented in local and indiv i dual situat i o n s .”

A number of clinicians and

re s e a rch e rs in the Southeastern United States accepted the ch a l l e n ge to

a dd ress needs for implementing JNC

VI and orga n i zed a wo rking gro u p .

D r. Daniel W. Jo n e s , of the Unive rs ity of Mississippi Medical Center and

the A m e rican Heart A s s o c i ation repre s e n t at ive on the NHBPEP Coord in ating Committee, ch a i red the gro u p .

The Southeastern United Stat e s

has been the focus of NHLBI initiat ives in the past because of its high

Key among these we re cre ating CVD

p revention programs to target highrisk gro u p s , d e l ive ring better pra c t ical info rm ation to phy s i c i a n s ,

p roviding training in CVD preve ntion to pra c t i t i o n e rs , re i m bu rsing fo r

p reve n t ive serv i c e s , and fo rm i n g

c o m munity and other part n e rships to

fa c i l i t ate re s e a rch and public health

p romotion effo rt s .

P re s e n t e rs spoke of the need fo r

m o re compre h e n s ive data in order to

better tra ck CVD and its risk fa c t o rs ,

e s p e c i a l ly to improve the health of

m i n o rities and understand ge ograp h i c

d i ffe rences in both CVD and its

t re atment. Speake rs also said more

re s e a rch was needed on the role of

socioeconomic status in card i ova s c ular health and on ap p ro a ches to end

health disparities based on ra c e, e t hn i c i t y, and ge n d e r.

The confe rence ch a i r, D r. Th o m a s

Pe a rs o n , of the Unive rsity of

R o chester School of Medicine in

N ew Yo rk , said that both a summary

a rt i cle for a journal and a monograp h

of the proceedings would be 

p u bl i s h e d. 

rat e s

of deat h

f rom stro ke and heart disease. Th e

region has been called the “ S t ro ke

B e l t .” D r. Jones and his colleag u e s

d eveloped “ I m p l e m e n t ation of JNC

VI in the Southeast,” a plan that cl i n icians can use to improve hy p e rt e nsion control rates in the region. Th e

i n i t i at ive is being sponsored by the

C o n s o rtium for Southeast Hypert e nsion Control (COSEHC), a nonpro fi t

o rga n i z ation cre ated in 1992 by cl i n ic i a n s , re s e a rch e rs , and allied health

p ro fessionals to add ress awa re n e s s

and control of hy p e rtension in the

S o u t h e a s t e rn United Stat e s .

The JNC VI implementation plan

i n cludes info rm ation for cl i n i c i a n s ,

a c t ivities to invo l ve commu n i t y

health promotion gro u p s , and a consumer message that will targe t

p at i e n t s , cl i n i c i a n s , and health care

p rov i d e rs. The group plans to post

the document, in a lay - l a n g u age ve rs i o n , on the Web. JNC VI-South wa s

p u blished in the December 1999 issue

of the A m e rican Jo u rnal of the Medical Sciences. 

The fo l l owing Internet sites have

re s o u rces for both patients and pro fe ssionals on the Healthy People Progra m :

H e a l t hy People initiative:

w w w. h e a l t h . gov / h e a l t hy p e o p l e

w w w. h e a l t h . gov / p a rt n e rs h i p s
HEARTMEMO

SPRING 2000

22HeartFacts

HeartFacts care physicians and other health care

professionals in communities; (2) to be

an educational and informational

resource in the field of obesity, nationally and in individual communities; and

(3) to raise public awareness about the

problem of obesity and the risk of

excess weight, including options for

prevention and management in 

fostering health improvement.

Eleanor Meador, R.N., program

coordinator at the Pennington Biomedical Research Center in Baton Rouge,

Louisiana, one of the C.O.R.E. sites,

noted that although all of the centers

share a curriculum of slides and handouts, each is free to tailor its classes as

it sees fit. She also said, “We use the

NHLBI guidelines for obesity in the

program. We disseminate the guidelines and look for best ways to implement them.”

For information about C.O.R.E.

workshops, contact the individual 

programs:

• Mayo Clinic, Rochester, MN (Kelly

Dunagan)

• Minnesota Obesity Research Center,

Minneapolis, MN (Heidi Hoover)

• New England Center for Health

Education, Boston, MA (Susan 

Morreale)

• Northwestern Memorial Wellness

Institute, Chicago, IL (Jennifer

Smith)

• Pennington Biomedical Research

Center, Baton Rouge, LA (Eleanor

Meador)

• St. Luke’s-Roosevelt Medical Center, New York, NY (Betty Kovaks)

• UCLA Center for Human Nutrition,

Los Angeles, CA (Susan Bowerman)

• University of Colorado Health Sciences Center, Denver, CO (Bonnie 

Jortberg) 

For more information, check the

C.O.R.E. Web site at the following

address: www.uchsc.edu/core.

MEAN SBP AND DBP BY AGE AND RACE/ETHNICITY

FOR MEN, AGE 18 YEARS AND OLDER

MEAN SBP AND DBP BY AGE AND RACE/ETHNICITY

FOR WOMEN, AGE 18 YEARS AND OLDER

(“NHLBI OEI” continued from page 11)

18–29

Source: Burt, V., et al. Hypertension, 1995; 25(305–313)

Source: Burt, V., et al. Hypertension, 1995; 25(305–313)

60

90

120

150

30–39

Age

40–49 50–59 60–69 70–79 80+

Blood Pressure (mm Hg)

18–29

60

90

120

150

30–39

Age

40–49 50–59 60–69 70–79 80+

Blood Pressure (mm Hg)

Black (Excludes Hispanic Blacks)

White (Excludes Hispanic Whites)

Mexican-American

Black (Excludes Hispanic Blacks)

White (Excludes Hispanic Whites)

Mexican-American

Systolic

Diastolic

Systolic

Diastolic

Systolic blood pressure (SBP) increases steadily with age, while diastolic blood

pressure (DBP) rises until about age 50 and then declines (see story on page 8).
23

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H M
H e a rt M e m o is a National Heart , L u n g, a n d

Blood Institute (NHLBI) publ i c ation for health

p ro fessionals wo rking in disciplines and settings re l ated to card i ovascular health. H e a rtM e m o rep o rts on the activities of the NHLBI’s

n ational education progra m s , p ro j e c t s , i n i t i at ive s , and re s e a rch advances and on other new s

of interest to the fi e l d. Readers are urged to

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