Improving the Cardiovascular Health of the Population through Standard and Novel Strategies

It is now widely accepted that CVD is largely preventable through a combination of lifestyle factors and proper management of health risk factors which comprise the AHA’s Simple 7. The AHA goal for the nation by 2020 to "improve the cardiovascular health of all Americans by 20 % while reducing deaths from CVD and stroke by 20 % [1]," rests on ensuring that a high proportion of the population reaches more of these benchmarks, both by avoiding risk factors in the first place and by controlling risk factors when they do arise. Yet data from community and national samples alike has shown that up to 99 % of the population is not meeting these goals despite the clear health benefits of doing so, a fact which underscores the complex nature of how individual behaviors interact with broader social norms favoring poor health. If fewer than 2 % of individuals are meeting AHA criteria for ideal cardiac health, then doctors and public health officials alike must think creatively about how to begin to change these numbers. In this Smoking and Lifestyle issue of Current Cardiovascular Risk Reports we have expanded our focus to encompass the multipronged-approach which is needed to effectively meet AHA goals in 2020 and beyond. This approach includes public health interventions aimed at large populations, including both healthy and at-risk groups, to alter the entire landscape of a given risk factor (e.g., smoking), as well as preventive and clinical services delivered through patient care encounters. Foraker and colleagues address some of the underlying factors, both at the individual and societal levels, which contribute to the development of major CVD risk factors: i.e., “obesogenic” environments fostering obesity. Such factors have insidiously facilitated disturbingly poor cardiovascular health, resulting in an inversion of AHA goals. Two of the articles in this issue describe population-level interventions to improve cardiovascular health. The contribution by Joel and colleagues introduces sweeping plans by the FDA to study promising new preventive interventions using low nicotine content cigarettes, may be low nicotine content cigarettes, which may be less addictive. less addictive. These broad public health interventions carry potential to substantially lessen, though likely not eliminate, the cardiovascular health burden posed by smoking, which persists among 1 in 5 adults in the nation [2]. At the same time, there is a continuing need for sound policies on the treatment side of the equation, including those described by Fishman, which consider the beneficial effects of expanded insurance coverage of smoking cessation medications. At the level of the individual patient, one novel target of intervention may be our very psychology. Such interventions involve optimal management of psychological factors which, just like the social factors noted above, may drive human behavior in ways that either promote or minimize cardiovascular disease. Boehm and colleagues discuss the area of positive psychological well-being, and how it may lead to adoption of healthier behaviors such as increased physical activity. Psychological predispositions and character traits which underlie well-being are generally recognizable in early childhood, and importantly, these traits precede and predict many of the traditional risk factors which in turn lead to cardiovascular disease [3–6]. As such, these psychological factors may represent important targets for intervention in the service of improved cardiovascular health. Growing H. A. Tindle (*) University of Pittsburgh School of Medicine, Pittsburgh, PA, USA e-mail: tindleha@upmc.edu Curr Cardiovasc Risk Rep (2012) 6:497–498 DOI 10.1007/s12170-012-0276-7