Abstract
In the just released Impact Goal for 2030, the articulated goal is to expand health associated life expectancy while increasing lifespan, well-being, and health equity by the year 2030.
The American Heart Association (AHA) has just released its 2030 Impact Goal. 1 This document sets the priorities for the AHA for the next decade and contains important information for all lifestyle medicine practitioners. It also introduces several terms which will be emphasized by the AHA in the next decade and which are very consistent with the core principles of lifestyle medicine. These terms are “health adjusted life expectancy” (HALE) and “well-being.” Of course, these general concepts have been central to lifestyle medicine for decades. However, it is significant that a prestigious organization such as the AHA has now embraced these concepts as the center piece for its goals for the next decade.
As a cardiologist, I have been pleased at the evolution of thinking from the AHA and many practitioners of cardiovascular medicine. Each decade the AHA sets forth an aggressive strategic goal to attempt to accomplish in the succeeding 10 years. In 2000, the goal was to “reduce coronary heart disease, stroke, and risk by 25% by 2010.” In 2010, the goal was to “help individuals build heathier lives free of cardiovascular disease (CVD) and stroke by improving cardiovascular health in all Americans by 20% while reducing CVD and stroke by 20% by the year 2020.” 2 In the just released Impact Goal for 2030, the articulated goal is to expand health associated life expectancy while increasing lifespan, well-being, and health equity by the year 2030.
While great progress has been achieved in reducing cardiovascular risk factors, particularly in the United States over the past 2 decades, it is important to recognize that nearly 50% of American adults still have some form of CVD. CVD and stroke remain the leading causes of mortality in the United States for both men and women, resulting in over 1 in every 3 deaths. Each year over 650 000 individuals in the United States die from some form of cardiovascular disease—this represents more lives lost every year than in all forms of cancer combined.
While there has been significant improvement in cardiovascular mortality in the United States over the past 2 decades, it appears that progress has stalled in many areas. There have been improvements in areas such as lower rates of smoking among adults, increases in physical activity, improved dietary habits in both adults and children, lower cholesterol in adults and youth, and lower blood glucose in adults. These areas of progress have been offset, however, by adverse changes such as increases in the prevalence of high blood pressure and body mass index, higher blood glucose in youth, and lower physical activity in youth. The increase in overweight and obesity rates in both adults and children in the decade between 2010 and 2020 is of particular concern and accounts for both worsening blood pressure in adults and children and fasting blood glucose among youths.
While the decade between 2010 and 2020 saw a 15.1% reduction in age-adjusted mortality due to CVD, this fell short of the 20% reduction targeted in the AHA’s 2020 impact goal.
In the strategic goals for 2020, which were issued in 2010, the AHA introduced several important concepts—“primordial prevention” and “ideal” cardiovascular health. Primordial prevention encompasses the goal of reducing risk factors in the first place rather than simply treating established risk factors. 2 The concept of “ideal” cardiovascular health incorporates many lifestyle habits and practices such as lowered body weight, improved nutrition, and increased physical activity as well as better control of cholesterol and blood pressure. In the 2030 Impact Goals, 2 new concepts have also now been introduced. The first is “health-adjusted life expectancy,” and the second is the expanded view of “well-being” as part of the overall mission for the AHA for the next decade.
HALE is defined as the number of years in good health, accounting for years lived with disease or disability and years lost due to premature death. As articulated by the AHA, HALE can be increased by improving health and well-being, preventing or delaying onset and severity of disease, and increasing life expectancy. All of these are key components that are very familiar to practitioners of lifestyle medicine.
The concept of “well-being” broadens the vision from the AHA from simply health to additionally encompassing mental status and aspects of life such as “security, prosperity, sense of connection, and purpose.” It is clear that these issues of well-being are linked to both cardiovascular and brain health and vice versa. This broadens the mission of cardiovascular disease specialists into the areas of neurobiological, behavioral, emotional well-being, socioeconomic, and cultural well-being. Good data show that how people feel about their overall life satisfaction strongly predicts how healthy they are, how long they will live, and their future health care use.
The AHA 2030 Impact Goal continues an evolution that incorporates lifestyle into the practice of cardiovascular medicine. There have been multiple other similar indications from the AHA specifically utilizing the term “lifestyle.” For example, in 2013 the Council of the AHA that I sat on changed its name from the “Council on Nutrition, Physical Activity and Metabolism” to the “Council on Lifestyle and Cardiometabolic Health.” 3
The incorporation of the concept of positive lifestyle has now become central in many AHA documents and guidelines. For example, the practice guidelines issued in 2013 from the American College of Cardiology (ACC) and the AHA was titled the “AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk”—once again, linking lifestyle to cardiovascular health. 4
Both the recently released blood pressure 5 and cholesterol guidelines from the AHA and ACC 6 provide a strong emphasis on the relationship of positive lifestyle to cardiovascular health. In addition, the AHA has reached out to broaden its approach to health by issuing statements that incorporate relationships from other prestigious organizations. For example, the AHA joined forces with the American Stroke Association (ASA) to issue guidance on “optimal brain health,” which emphasizes the links between habits and practices that have been shown to reduce the risk of heart disease to also demonstrate that these concepts lower the risk of stroke and dementia. 7
The AHA has also joined forces with the Obesity Society to issue guidelines for weight management 8 and with the American Diabetes Association (ADA) and the American Cancer Society (ACS) 9 to articulate a common agenda and shared approach to overall health from all 3 organizations.
Improving well-being as a central goal for the AHA 2030 Impact Goals should be music to the ears of lifestyle medicine practitioners since important measures of quality of life, positive psychology, and many other concepts have been central to the development of the field of lifestyle medicine.
The 2030 Impact Goals for the AHA demonstrates that there is great synergy between lifestyle medicine and the practice of cardiology. I believe this also opens important opportunities for lifestyle medicine practitioners to continue to build partnerships with cardiovascular disease specialists. One indication of this may be that Dr Catherine Collings, whose practice emphasizes cardiovascular health, is about to become the President of the American College of Lifestyle Medicine. I hope that Dr Collings will lead the effort to expand the linkages between lifestyle medicine and cardiology.
I would also encourage lifestyle medicine practitioners to reach out to cardiologists in your area and in your institutions to find ways of collaborating in the overall cardiovascular health of patients. The American Heart Association 2030 Impact Goal provides and important opening. Let’s seize it!