Heart disease prevention: A good investment for individuals, communities

The policy statement, published in Circulation: Journal of the American Heart Association, summarizes years of research on the value of investing in prevention, particularly through community-based changes to make it easier to live a healthy lifestyle:

• Every dollar spent on building trails for walking or biking saves $3 in medical costs.
• Companies that invest in workers' health with comprehensive worksite wellness programs and health work environments have less absenteeism, greater productivity and lower healthcare costs.
• Initiating a nationwide plan to drastically cut the amount of salt in the food supply to support an average intake of 1500 mg per day may reduce high blood pressure in the country by 25 percent, saving $26 billion in healthcare costs annually.

As a call to action, the statement puts an equal amount of responsibility on individuals and on society -- specifically federal, state and local policy-makers.

"People often don't realize the power to stay healthy is in their own hands," said William S. Weintraub, M.D., lead author of the statement and the John H. Ammon chair of cardiology and cardiology section chief at Christiana Care Health System in Newark, Del. "But it's not something many individuals or families can do alone. It takes fundamental changes from society as a whole."

It's more difficult to make healthy choices in some neighborhoods because it's hard to find a safe place to bike or a nearby store with fresh vegetables at an affordable price, he said.

"But, given the high cost of treating acute and chronic disease, prevention offers the potential of improving health and cutting costs," said Weintraub, a professor of medicine at Thomas Jefferson University in Philadelphia, Penn. "What we spend on cardiovascular disease is not sustainable. But we can afford to prevent it. Ultimately, we can't afford not to."

"Individual responsibility is a crucial first step, but environmental and policy changes are the most impactful ways to improve health," said Gordon Tomaselli, M.D., American Heart Association president. In the statement, the American Heart Association calls for policy-makers to ensure that:

• Schools include quality physical education and opportunities for physical activity in the curriculum every day.
• School lunches include more fresh vegetables and fruits and less salt and sugar.
• Communities are built with exercise in mind and include sidewalks and bike trails.
• Less added sugars, salt and trans fats are included in foods.
• Neighborhood stores -- particularly those in lower income areas -- carry affordable, fresh vegetables and fruits.
• Smoking isn't allowed in restaurants, the workplace and other indoor spaces.
• Additional taxes are added to tobacco products to further discourage use.
• Smoking cessation programs are adequately funded.
• Increased funding is directed toward programs that eliminate health disparities.

Medical care and indirect costs of heart disease in the United States rose to $450 billion last year, and are projected to be more than $1 trillion by 2030, according to the American Heart Association.

"Heart disease is largely preventable, yet most of the funding for and the focus on heart disease are on the back end, related to acute and chronic care -- after the damage is done," said Tomaselli, professor and director of the Division of Cardiology at the Johns Hopkins University School of Medicine in Baltimore, Md. "We need to get society away from thinking we'll take care of the disease in the future."

Deaths from cardiovascular diseases have fallen by more than 50 percent since peaking in the 1960s. More than half of that decrease has been attributed to prevention, due to improved management of cholesterol, blood pressure and tobacco use.

"Prevention will pay for itself," Tomaselli said. "Not just monetarily, but also by lengthening and improving the quality of life people can enjoy. More importantly, these changes won't just affect us today -- they'll have a positive impact on generations to come."