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Cardiovascular Health Goals
Adam Martinez, M.S. and Len Kravitz, Ph.D.

Article Reviewed
Lloyd-Jones, D.M., Hong, Y., Labarthe, D., Mozaffarian, D. et al. on behalf of the American Strategic Planning Task Force and Statistics Committee. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association's Strategic Impact Goal through 2020 and beyond. Circulation, 2010; 121; 586-613.

The American Heart Association (AHA) recently issued its proactive agenda for the next decade by releasing its strategic plan in measuring, monitoring and improving cardiovascular health for Americans. The AHA Board of Directors approved recommendations from scientists representing the AHA Strategic Planning Task Force, Statistics Committee and other ad hoc members, which states “By 2020, to improve the cardiovascular health of all Americans by 20% while reducing deaths from cardiovascular diseases (CVD) and strokes by 20%.” While, the AHA association recognizes that defining and setting goals is a major first step, it is exercise professionals and health/fitness advocates throughout the U.S. who will lead the charge and implement exercise and intervention campaigns to inspire citizens to realize these goals. Personal trainers have a unique opportunity, and responsibility, to lead the nation in reversing the rising tide of CVD events by promoting the meaningful and positive lifestyle changes in diet, physical activity, and smoking presented by the AHA.

Cardiovascular Disease and Stroke: Some Startling Statistics
Some of the highlighted findings from the 2009 Heart Disease and Stroke Statistics report (Lloyd-Jones et al., 2009) reveal some disquieting facts of importance.
1) Approximately 2400 Americans die of CVD each day. This means that on average there is 1 death every 37 seconds from CVD.
2) More than 150,000 Americans killed by CVD in 2005 were less than 65 years of age, which is far before the average life expectancy of 77.9 years.
3) One out of every 5 deaths in the United States in 2005 was from coronary heart disease (CHD, also referred to as atherosclerotic heart disease), which is the final result of the accumulation of atherosclerotic plaque within the walls of the coronary arteries.
4) On average, every 40 seconds someone in the United States has a stroke (see Table 1 for signs of a stroke), which represents about 1 of every 18 deaths in the United States.
5) Despite health recommendations that all adult Americans complete 30 minutes of somewhat hard physical activity on most days of the week, 62% of adults >18 years of age lead completely sedentary lifestyles.
6) Over 12% of preschool children 2 to 5 years of age were overweight in 2005 (as measured by body mass index (weight in kilograms divided by height in meters squared) placing them at or above the 95th percentile in body weight among children their age.
7) An estimated 80,000,000 American adults (approximately 1 in 3) have 1 or more types of CVD. These diseases include high blood pressure, coronary heart disease, myocardial infarction (heart attack), angina pectoris (chest pain), heart failure (inability of the heart to pump enough blood to sustain normal bodily functions), stroke, and congenital (present at birth but not necessarily hereditary) cardiovascular defects.
8) In 2005, the leading causes of death in women 65 years of age were 1) diseases of the heart, 2) cancer, 3) stroke and 4) Chronic Lower Respiratory Disease (CLRD, such as emphysema and chronic bronchitis). In older men, they were 1) heart disease, 2) cancer, 3) CLRD, and 4) stroke.
Lloyd-Jones et al. (2010) note that data clearly show the prevalence of hypertension and type 2 diabetes in pediatric populations, which will no doubt lead to CVD at much younger ages for men and women in the future. Lloyd-Jones (2009) add that the underlying cause of the majority of CVD events are typically present and undetected for decades before the onset of a 'clinical event', such as a nonfatal myocardial infarction or a disabling stroke.

AHA Introduces the New Concept of 'Ideal' Cardiovascular Health
In the new strategic plan for cardiovascular health promotion, the AHA has introduced a new concept called 'ideal' cardiovascular health, which is defined as A) the 'simultaneous' presence 4 favorable health behaviors (i.e., ideal BMI, physical activity, abstinence from smoking within the last year, and dietary patterns that promote cardiovascular health), and/or B) the 'simultaneous' presence of 4 favorable health factors (untreated total cholesterol (<200 mg/deciliter; a deciliter is 1/10 of a liter), untreated blood pressure (<120/<80 mmHG), abstinence from smoking within the last year, and absence of diabetes mellitus, and/or C) the absence of clinical CVD (including stroke, heart failure, CHD, etc.). Because of its importance to 'ideal' cardiovascular health, abstinence from smoking appears in the health behaviors and health factor lists (See Table 2 for Cardiovascular Health Effects of Smoking). To further detail the new 'ideal' cardiovascular health definition, a close inspection of each metric follows:
Goal/Metric 'Ideal' Cardiovascular Health
Physical Activity
Adults >20 yrs of age &Mac179;150 min/wk moderate intensity or
&Mac179;75 min/wk vigorous exercise (may also combine moderate and vigorous activity)
Children 12-19 yrs of age &Mac179;60 min of moderate or vigorous activity each day

Current Smoking
Adults >20 yrs of age Never smoked or quit smoking >12 months ago
Children 12-19 yrs of age Never tired; never smoked

Body Mass Index
Adults >20 yrs of age <25 kg/m2
Children 2-19 yrs of age <85th Percentile

Total Cholesterol
Adults >20 yrs of age <200 mg/deciliter
Children 6-19 years of age <170 mg/deciliter

Blood Pressure
Adults >20 years of age <120/<80 mmHG
Children 8-19 years of age <90th Percentile

Fasting Plasma Glucose
Adults >20 yrs of age <100 mg/deciliter
Children 6-19 years of age <100 mg/deciliter

Healthy Diet Score
Adults >20 yrs of age 4-5 Components (see below)
Children 5-19 years of age 4-5 Components (see below)
With diet, a low tans fat intake is considered decidedly health promoting. The new AHA recommendation encourages a diet that is an appropriate energy balance (although the AHA acknowledges no caloric guidelines from large sample studies are currently available to quantity precise caloric intake values) for the individual: one, which is consistent with a DASH (dietary approaches to stop hypertension) eating plan. This would include the following suggestions for a 2000-kilocalorie diet per day (which should be scaled accordingly for other levels of caloric intake).
1) Sodium: <1500 mg per day
2) Fruits and vegetables: &Mac179;4.5 cups per day
3) Fish: &Mac179;two 3.5-ounce servings per week (preferably oily fish)
4) Fiber-rich whole grains (&Mac179;1.1 grams of fiber per 10 grams of carbohydrate); &Mac179; three 1-ounce servings per day
5) Nuts, legumes and seeds: &Mac179;4 servings per week
6) Processed meats: none or &Mac178;2 servings per week
7) Saturated fat: <7% of total energy intake
8) Sugar-sweetened beverages: &Mac178;36 ounces per seek (&Mac178;450 kilocalories per week)

Summary Charge to Action
The AHA is committed to attaining the 2020 cardiovascular health goals. The key to success is to translate the research-driven objectives into permanent public health efforts. However, it may very likely be the grass roots efforts of exercise professionals and personal trainers throughout the U.S., who execute all of the AHA goals in their fitness interventions, that lead to the these achievable outcomes being realized. Go for the Goal!

Table 1. Warning Signs to Recognize for a Stroke
A stroke is a medical emergency all exercise professionals must be able to recognize. Don't ignore the signs of stroke, especially if only a few are present or if they seem to go away temporarily. If someone has one or more these stroke symptoms that last more than a few minutes take immediate action.
1) Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
2) Sudden confusion, trouble speaking or understanding
3) Sudden trouble seeing in one or both eyes
4) Sudden trouble walking, dizziness, loss of balance or coordination
5) Sudden, severe headache with no known cause
Action: If someone has one or more stroke symptoms that last more than a few minutes, immediately call 9-1-1 or the emergency medical service.
Source: AHA

Table 2. Cardiovascular Health Effects of Smoking
Although cigarette smoking is highly associated with lung cancer, many individuals are unaware that smoking is also very related to heart disease. In fact, the nicotine in smoke causes reduced circulation by narrowing the arterial blood flow in the body. This reduced blood circulation places smokers at higher risk for developing peripheral vascular disease (which is an obstruction of the large arteries in the arms and legs that can cause a range of health problems including pain, cramping, fatigue and circulatory problems). As well, smoking has been shown to lead to abdominal aortic aneurysms (i.e., a swelling or weakening of the main artery of the body-the aorta-where it runs through the abdomen). In addition, smoking damages the airways of the lungs leading to emphysema, chronic bronchitis and chronic airway obstructions, all of which may contribute to cardiovascular disease. According to the Centers for Disease Control and Prevention, on average, smokers die 13 to 14 years earlier than nonsmokers.
Source: Centers for Disease Control and Prevention

Additional Reference:
Lloyd-Jones D., Adams, R., Carnethon, M., De Simone, G., et al. Heart disease and stroke statistics-2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2009;119:e21-e181.

Adam Martinez is currently a graduate student in Exercise Science and Sports Administration at University of New Mexico (Albuquerque). His research interests are in strength and conditioning and health and wellness.

@Bio:Len Kravitz, PhD, is the program coordinator of exercise science and a researcher at the University of New Mexico, Albuquerque, where he won the Outstanding Teacher of the Year award. Len was honored with the 2009 Can-Fit-Pro Specialty Presenter of the Year award and chosen as the ACE 2006 Fitness Educator of the Year. He also received the 2008 Can-Fit-Pro Lifetime Achievement Award.