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Commentary

Increasing Efforts to Educate Patients About Reducing, Preventing Cardiovascular Disease

By: Yvette C. Terrie, BS Pharm, RPh, Consultant Pharmacist

As we enter the fifth month of the COVID-19 pandemic, there is still much uncertainty about the long term effects this historical pandemic will have on clinicians, patients and the health care system. In recent conversations with others including health care professionals and patients, it appears that while some individuals have used the extended time at home during the pandemic to take charge of their health, some have been lax about their overall health and have gained weight, become sedentary and have experienced sleep issues, anxiety and or depression. Due to overwhelming fears of contracting the virus, some individuals have been apprehensive about seeking medical attention for issues such as elevated blood pressure and glucose readings. As a result of the economic, physical and psychological stresses associated with the pandemic, some patients who should be routinely monitoring blood pressure and glucose levels are not doing so. Additionally, everyone has experienced and continues to experience some degree of stress and anxiety during the pandemic and the impact is still unknown.

In a recent poll conducted in May 2020 by WebMD, results revealed that among their US readers, 47% of women polled reported weight gain due to COVID-19 restrictions and 22% of men reported weight gain.1 They also conducted a separate poll of international WebMD readers which revealed that  55% of men and 34% of women reported weight gain.1 Among the U.S. readers, examples of reasons that contributed to weight gain were: an estimated 72% reported a lack of exercise, an estimated 70% reported stress eating. Moreover 59% reported that a combination of the two factors mentioned above contributed to their weight gain and 21% indicated that the extra consumption of alcohol was a contributing factor.1

Due to these unprecedented times that have disrupted life as we once knew it, will the health care system start to see soaring rates of CVD, diabetes and other illnesses? What can health care professionals do to increase awareness among patients about reducing and preventing CVD?

Cardiovascular disease (CVD) continues to be the leading cause of mortality accounting for one in every four deaths for both men and women in the U.S. The CDC indicates that CVD claims more lives annually than all forms of cancer and chronic respiratory disease combined.2 According to the CDC, every 37 seconds someone in the U.S. dies from CVD and an estimated 647,000 Americans die from CVD annually.2 Additionally, annually, more than 1.5 million individuals in the United States suffer a myocardial infarction or stroke.3 Many patients believe that CVD is just a part of aging and many are not aware that an estimated 80% of CVD is preventable.4

In recent surveys conducted by the Cleveland Clinic, findings indicate that 68% of Americans worry about dying from CVD; however, many of them do not know basic information to evaluate their CV health and risks. Key findings from the survey indicated the following: 5,6

  • Only 38% surveyed knew their blood pressure reading.
  • Only 40% understand a normal blood pressure reading is less than 120/80.
  • Among millennials, 80% could not identify CVD as the primary cause of death in women.
  • Only 8% knew that CVD is preventable.
  • In the survey, participants were more likely to believe the leading cause of death in individuals with diabetes is kidney disease/failure (35%). Only 27 % knew the leading cause of death in those with diabetes is CVD.
  • Only 25% knew that HDL (high-density lipoprotein) is the “good” cholesterol.
  • Only 12% knew that they should start getting cholesterol screening between the ages of 18-24 years.
  • Only 52% recognized that LDL levels can gauge CVD risk.
  • 58% of those surveyed get less than the recommended 150 minutes of exercise per week, and 14% say they never exercise.
  • An estimated 73% of those surveyed did not understand the correlation between diabetes and CVD and 71% of respondents did not know that fasting glucose level can impact CV health.
  • 29% mistakenly believed that a low-fat diet is healthiest for your heart.
  • Only 19% know that the Mediterranean diet is the most heart-healthy diet.
  • 63% across all age groups believe that they will develop CVD in the next decade. 5,6

As health care providers, it is important that patients are encouraged to be proactive about their overall health, especially their cardiovascular health. A program such as the Million Hearts 2022 can help focus attention on preventative measures to enhance the CV health of Americans. The Million Hearts 2022 program suggest that reducing the incidence of CVD can start by following the ABCs of cardiovascular health which include: 7

chart

More information about this program can be found at https://millionhearts.hhs.gov/about-million-hearts/index.html

According to the American College of Cardiology, several studies have demonstrated positive clinical outcomes when pharmacists are part of patient care in those with CVD.8 The impact of these studies has demonstrated improvements in blood pressure control, cholesterol treatment, smoking cessation, diabetes control, and medication adherence.8 Patient out of pocket costs is a major contributor to nonadherence. Therefore, pharmacists can be a fundamental source of information regarding the various drug manufacturer patient savings programs especially since a recent publication in Circulation indicates that 1 in 8 patients with history of CVD or stroke are noncompliant to their prescribed medications due to high drug costs.9

As integral members of the health care team, pharmacists are in a pivotal position to increase awareness about reducing and preventing CVD. During counseling, pharmacists can also help identify patients at risk for CVD and encourage them to discuss their modifiable and non-modifiable risk factors with their primary health care providers. They can counsel patients about medications and also implement clinical intervention strategies to augment patient compliance to prescribed therapies and recommended lifestyle modifications. Pharmacists can also encourage patients to maintain routine care especially if at risk for CVD and to discuss preventative screening tools such as a coronary calcium scan. Encouraging patients to learn about their individual CVD risk factors and what measures they can take to modify them if possible is the first step towards reducing and preventing CVD. Knowledge is the best tool in the battle against CVD and it is also a great motivator to building and preserving overall good health. Yes, we are living in extraordinary times during this pandemic and while there is a lot in our daily lives that seems out of our control, one thing that we can take control of is the decision to take a more active role in our overall health. Whenever we have a chance let’s remind our patients and ourselves that every day really is a gift and to take time each day to exercise, eat a balanced diet and take a deep breath to relax and destress. While CVD is the leading cause of death among both men and women, we must remind our patients that it is also preventable in many cases.

Yvette C. Terrie, Consultant Pharmacist, Medical Writer and creator of A Pharmacist’s Perspective (https://apharmacistsperspective.blogspot.com/).

References:

  1. Crist C. WebMD Poll: Many Report Weight Gain During Shutdown. WebMD website.  https://www.webmd.com/lung/news/20200518/webmd-poll-many-report-weight-gain-during-shutdown  Published May 18,2020. Accessed August 6, 2020.
  2. Heart Disease Facts. Centers for Disease Control and Prevention website. https://www.cdc.gov/heartdisease/facts.htm  Reviewed June 22, 2020, Accessed August 5, 2020.
  3. Benjamin EJ, Muntner P, Alonso A, et al. Heart disease and stroke statistics—2019 update: a report from the American Heart Association. Circulation. 2019;139:e1–e473.
  4. CDC Prevention Programs. American Heart Association website. https://www.heart.org/en/get-involved/advocate/federal-priorities/cdc-prevention-programs  Reviewed May 18, 2018. Accessed August 5, 2020.
  5. When It Comes to Heart Health, Americans Don’t Know Their Numbers. Cleveland Clinic Newsroom website. https://newsroom.clevelandclinic.org/2017/02/01/comes-heart-health-americans-dont-know-numbers/   Published February 1, 2017. Accessed August 5, 2020.
  6. Cleveland Clinic Survey: Most Americans Don’t Know Heart Disease Is Leading Cause of Death in Women. Cleveland Clinic Newsroom website. https://newsroom.clevelandclinic.org/2020/01/30/cleveland-clinic-survey-most-americans-dont-know-heart-disease-is-leading-cause-of-death-in-women/ Published January 30, 2020. Accessed August 6, 2020.
  7. ABCS of Heart Health. Million Hearts website. https://millionhearts.hhs.gov/data-reports/factsheets/ABCS.html  Reviewed July 13, 2020. Accessed August 5, 2020.
  8. Wiggins B. Cardiovascular Disease Prevention in the Clinical Stetting: The Role of Pharmacist. American College of Cardiology website. https://www.acc.org/latest-in-cardiology/articles/2016/09/30/09/32/cardiovascular-disease-prevention-in-the-clinical-setting
  9. Khera R, Valero-Elizondo J, Das SR, et al. Cost-Related Medication Nonadherence in Adults With Atherosclerotic Cardiovascular Disease in the United States, 2013 to 2017. Circulation. 2019;140(25):2067-2075. doi:10.1161/CIRCULATIONAHA.119.041974.

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