AHA Goals for CV Health:
Healthy Diet Components
Linda Van Horn, PhD, RD
Professor, Department of Preventive Medicine
Associate Dean for Faculty Development
Northwestern University
Feinberg School of Medicine
2020 Impact Goal
By 2020, improve the cardiovascular
health of all Americans by 20%,
while reducing deaths from
cardiovascular disease
and stroke by 20%.
New Goal Concepts
• Concept of Cardiovascular Health
– Reframes the Question
• Continuum of Health
– Ideal, Intermediate, Poor
– Allow movement toward Ideal Health
Cardiovascular Health
What Is Ideal Health?
• Absence of disease
• Favorable levels of health factors
• Favorable health behaviors
CV Health Metric
• Synthesizes and incorporates the entire
spectrum of CV health (and disease).
• Emphasizes new focus on CV health.
• Provides opportunities for greater public health
approaches, as well as continued emphasis on
treatment of risk factors and disease.
• Creates challenges and opportunities for
expanded areas of focus in primordial
prevention.
Ideal Health Behaviors
Aggregate of all:
•
•
•
•
Healthy Eating Pattern
Nonsmoking
Healthy Weight
Appropriate Level of Physical
Activity
Ideal CV Health
Ideal Health Behaviors Metric (ALL)
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•
•
•
Nonsmoking
Healthy Weight
Physical Activity
Healthy Eating Pattern
Ideal Health Factors Metric (ALL)
• Total cholesterol
• Blood pressure
• Blood glucose
Adjusted Cumulative Incidence
Lifetime Risk: Age 50
Men
0.7
69% 0.7
0.6
0.6
0.5
50%
46%
0.4
36%
0.5
Women
≥2 Major RFs
1 Major RF
≥1 Elevated RF
≥1 Not Optimal RF
Optimal RFs
50%
0.4
0.3
0.3
0.2
0.2
0.1
0.1
39%
27%
8%
5%
0
0
50
60
70
80
90
50
Attained Age
60
70
80
90
Lloyd-Jones, Circulation 2006
Low Risk Factor Burden
• Lower RF burden in middle age results in:
–
–
–
–
Longer life free of CVD and other diseases
Compression of morbidity
Greater health-related quality of life
Decreased Medicare expenditures later in life
• Focus on preventing risk factors in children,
younger adults (i.e. primordial prevention)
Perception vs. Reality
•39% of adults rate their heart health ideal
•67% of adults say they are overweight/obese
•Fewer than half of adults know their
numbers: cholesterol, BMI or glucose
AHA National Consumer Health Survey, November 2009
Ideal CV Health Behaviors
Goal/Metric
Current Smoking
Adults ≥20 yo
Children 12-19 yo
Ideal Cardiovascular Health Definition
Never or quit >12 months ago
Never tried; never smoked whole cigarette
Body Mass Index
Adults ≥20 yo
Children 2-19 yo
<25 kg/m2
<85th percentile
Physical Activity
Adults ≥20 yo
Children 12-19 yo
150+ min/wk mod or 75+ min/wk vigorous
60+ min of mod or vigorous intensity daily
Healthy Diet Score
Adults ≥20 yo
Children 5-19 yo
4-5 components
4-5 components
Ideal CV Health Behaviors
Current prevalence (NHANES 2005-6) ~1%
• Largely driven by diet
• Very low in children
Ideal CV Health Factors
Goal/Metric
Current Smoking
Adults ≥20 yo
Children 12-19 yo
Ideal Cardiovascular Health Definition
Never or quit >12 months ago
Never tried; never smoked whole cigarette
Total Cholesterol
Adults ≥20 yo
Children 6-19 yo
<200 mg/dL
<170 mg/dL
Blood Pressure
Adults ≥20 yo
Children 8-19 yo
<120/<80 mm Hg
<90th percentile
Fasting Glucose
Adults ≥20 yo
Children 12-19 yo
<100 mg/dL
<100 mg/dL
Ideal CV Health Factors
Current prevalence (NHANES 2005-6) ~17.2%
• Decreases dramatically with age
• Lower in men than women
• Lower in some race/ethnic groups
Dietary Metric Components
• Foods – ease of communication & implementation
• Scientific Evidence – effects on disease outcomes
• Guidelines – consistency with DGs and AHA recs
• Flexibility – allow individual and ethnic/cultural
preferences
• Parsimony – fewest elements to identify and
communicate a healthy pattern
• Measurable – must be able to measure
improvement
2006 Diet and Lifestyle Recs
2006 Diet and Lifestyle Recs
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•
•
•
•
•
•
•
•
Balance calories and PA for achieving and maintaining healthy weight
Diet rich in vegetables and fruits
Whole-grain, high-fiber foods
Consume fish, especially oily fish, at least twice a week.
Limit saturated fat to 7% of energy, trans fat to 1% of energy, and
cholesterol to 300 mg per day by
– choosing lean meats and vegetable alternatives
– selecting fat-free (skim), 1%-fat, and low-fat dairy products
– minimizing intake of partially hydrogenated fats
Minimize beverages and foods with added sugars
Choose and prepare foods with little or no salt
If you consume alcohol, do so in moderation
Outside of home, follow AHA Diet & Lifestyle Recs
Diet Metric – Primary
In the context of a diet that is appropriate in energy
balance, pursuing an overall dietary pattern that is
consistent with a DASH-type eating plan, including but
not limited to:
1. Fruits and vegetables: ≥4.5 cups per day
2. Fish: ≥2 3.5-oz servings per week (preferably oily
fish)
3. Fiber-rich whole grains (≥1.1 grams fiber per 10
grams carbohydrate): ≥3 1-oz-equivalent servings
per day
4. Sodium: <1500 mg/day
5. Sugar-sweetened bev: ≤450 kcal, 36 oz/wk, (1/4
discretionary calories)
Secondary Components:
• Saturated fat: < 7% of energy
• Nuts, legumes, and seeds: ≥ 4
servings/week
• Processed meats: ≤ 2 servings/week
• Trans fat: not measurable in NHANES
New Guidance
Sodium
• Previously, AHA rec 2300 mg/day with 1500 mg/day
for special pop. groups (African-Americans,
hypertensive people, middle age (40) or older)
• CDC reports nearly 70% of population falls into
special population groups today
• Elevated blood pressure is a major public health
problem.
• Roughly, 1/3 of adults have high blood pressure,
and another 1/3 have pre-hypertension.
New Guidance
New Guidance
• No more than half of a
person’s daily
discretionary calorie
allowance should come
from added sugars.
• 6 teaspoons/day for women
and 9 teaspoons/day for
men)
• For most American women,
this is no more than 100
calories/day and no more
than 150 calories/day for
men.
• Limiting intake could help
reduce calorie intake,
contribute to wt control
and improve the CV
health of Americans.
• According to national
survey data added
sugars have increased
steadily over the past 30
years.
Moving the Population
Poor
Intermediate
Ideal
Path to a Healthy Diet
0 – 1 components
2 - 3 components
4 - 5 components
Goal: 20% Overall Improvement
Metric
Current Smoking
Poor
Smoker
Intermediate
Quit for 12 months or less
Children: Tried in last
30 days
Body Mass Index
Kg/m2
Physical Activity
Ideal
Never smoked or quit from
more than 12 mo
Children: never tried/smoked
30 or greater
25-29.9
<25
Children: <95 percentile
Children: 85-95 percentile
Children: <85th percentile
None
1-149 min/wk moderate
or, 11-74 min/wk vigorous
or, 11-149 min/wk
moderate + vigorous
150+ min/wk moderate or
75+ min/wk vigorous or
combination
Children: 60+ min moderate
or vigorous/day
Children: >0 and <60 min of
moderate or vigorous every
day
Healthy Diet
0-1 components
2-3 components
4-5 components
Metric
Total Cholesterol
Blood Pressure
Fasting Glucose
Poor
Intermediate
Ideal
≥240
200-239 or treated to goal
<200
Children: ≥200
Children: 170-199
Children: <170
SBP 120-139 or DBP 80-89
or treated to goal
<120/<80
SBP ≥140 or
DBP ≥90
Children: >95th %ile
Children: 90th - 95th %ile or
SBP ≥120 or DBP ≥80
≥126
100-125, or DM treated to
goal
Children: <90th %ile
<100
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
Age-Adjusted Death Rates (per 100,000)
20% of Deaths Post-Poned by 2020
400
350
300
250
-15%
200
-20%
-25%
-30%
150
100
50
0
Lloyd-Jones, Circulation 2010
Deaths from All CVDs & Stroke
January 2010
• Age-adjusted death rates (per 100,000
people) = 280 deaths/yr.
January 2020
• 20% reduction = 224 deaths/yr.
Goal
• 56 lives (per every 100,000) saved