1) a transition from disease to health 2) heart brain ... · 3) imaging / genetics / tissue...
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1) A Transition From Disease to Health 2) Heart – Brain Integration 3) Imaging / Genetics / Tissue Regeneration
Complex – CAD to CVD
Subclinical -- HRP to DBD
Health -- IOM / COE to SHE
1) Translational 2) Quality/Effective 3) Social Responsibility
2
HEART
MI
1) Emboli
2)Thrombi
3)Hemorrh
BRAIN -
STROKE Thrombi
1. Cardiovascular Disease AHA
Macrovascular & Microvascular
2. UN Targets Top Killers
D Butler. Nature. 2011;477:261. At Present, 2011
R. Beaglehole et. al. Lancet 2008;372:1988 - > 30% Across, 2030
3. Prevalence of CVD is Increasing Treatment (Live Longer) and Technology - $
V Fuster et. al. Nat Rev. Cardiol. 2009;6:669.
EG Nabel, E Braunwald. NEJM 2012;366:54 – Age Adjusted
Rx, H-I $368 Bill, X3 10y
Rx, L-I MI, Pocket 80%
Rx, H-I $ 95% - Prev $ 5%
3a). Number and % of U.S. Population with Diabetes,
1958 - 2009
CDC’s Division of Diabetes Translation.
National Diabetes Surveillance System available at
http://www.cdc.gov/diabetes/statistics - 2011
3b). Health Care Expenditures and Life Expectancy in
the US and Ten Other Developed Countries, 2005
VR Fuchs et. al. N Engl J Med. 2011;364:1985
4. Progression of Cardiovascular Disease
R Corti, V Fuster EHJ. 2011 (April 19)
A Arbab-Zadeh, M Nakano, R Virmani, V Fuster, Circ.2012;125:1147
5. CARDIOVSCULAR RISK FACTORS (7) & LIFE STYLE
>2 Risk Factors
1. MI & 2. Stroke
25% in 10 Yrs
75% in 30 Yrs
3. DBD & 4. AD
Quality
Framingham (2010) 5, Interheart (2004)2: Obesity, (Diet), Sedentary
c
c
1) A Transition From Disease to Health 2) Heart – Brain Integration 3) Imaging / Genetics / Tissue Regeneration
Complex – CAD to CVD
Subclinical -- HRP to DBD
Health -- IOM / COE to SHE
1) Translational 2) Quality/Effective 3) Social Responsibility
COMMITTEE INSTITUTE OF MEDICINE
VALENTÍN FUSTER (Chair), Mount Sinai Heart, New York
CIRO A. DE QUADROS Albert B. Sabin Vaccine Institute
JOHN W. FARQUHAR, Stanford Prevention Research Center,
ROBERT C. HORNIK, Annenberg School for Communic, U Penn
FRANK B. HU, Harvard School of Public Health
PETER R. LAMPTEY, Family Health International
JEAN CLAUDE MBANYA, Faculty of Medicine, University of Yaoundé
ANNE MILLS, London Sc.h of Hygiene & Tropical Med.
JAGAT NARULA, Division of Cardiology, Univ. Calif, Irvine
RACHEL A. NUGENT, Center for Global Development
JOHN W. PEABODY, Institute for Global Health, UCSF
K. SRINATH REDDY, Public Health Foundation of India
SYLVIE STACHENKO, The Sch. of Public Health, Univ. of Alberta
DEREK YACH, PepsiCo
B.B. KELLY, - Instute of Medicine
1. Behavior Risk, 2. Lack of Policy NCD,
3. Lack Intersectorial , 4. Mixt Health Delivery
12 RECOMMENDATIONS
( Research, Children )
National Heart, Lung, and Blood Institute
Institute of Medicine,
of The National Academy of Sciences
IOM – V Fuster, BB Kelly, eds Washington DC: Nat.Acad. Press: 2010
V Fuster, BB Kelly, R Vedanthan , Circulation. 2011;123:1671
Untreated BP<120/<80 mm Hg
Body mass index <25 kg/m2
Recommended dietary pattern
Untreated cholesterol <200 mg/dl
Untreated glucose <100 mg/dl
Absence of smoking
Recommended physical activity
1. Relation Between Biological / Behavior Components
of CV Health and Outcome (N=12744)
ARIC ((AR Folsom et. al.) JACC. 2011;57:1690. <1% Had Ideal / CV Health
NHANES (CM Shay et. Al) Circ. 2012;125:45. <1% Had Ideal / CV Health
CARDIA (K Liu et. al.) Circ. 2012;125:996 (Northw. Univ., NHLBI). 6% Behavior
2. Timeline of Major Documents on Global CVD
Promoting Cardiovascular Health in the Developing World; A Critical Challenge to Achieve Global Health.
Ed. V Fuster and B Kelly. IOM of the Natl. Academies. Natl . Academies Press. Washington DC.2010.
Promoting Cardiovascular Health in the Developing World; A Critical Challenge to Achieve Global Health.
Ed. V Fuster and B Kelly. IOM of the Natl. Academies. Natl . Academies Press. Washington DC.2010.
3. Recommendations By Targeted Actor
Centers of Excellence Program
Goal: To establish Centers of Excellence to combat non- communicable chronic cardiovascular and pulmonary diseases (CVPD) in developing countries
Centers of Excellence:
–Enable capacity building
–Train future chronic CVPD investigators
–Conduct research on new or improved approaches,
programs, and measures to prevent or treat chronic
CVPD
17
NHLBI and UnitedHealth Group Collaborating
Centers of Excellence-Established on June 8th, 2009
New partnership between NHLBI & UnitedHealth Group
Network of 10 Collaborating Centers
–Six centers funded by UnitedHealth Group & NHLBI
–Three centers funded by NHLBI
–One center funded by UnitedHealth Group
18
1. Behavior Risk, 2. Lack of Policy NCD,
3. Lack Intersectorial , 4. Mixt Health Delivery
12 RECOMMENDATIONS
( Research, Children )
National Heart, Lung, and Blood Institute
Institute of Medicine,
of The National Academy of Sciences
IOM – V Fuster, BB Kelly, eds Washington DC: Nat.Acad. Press: 2010
V Fuster, BB Kelly, R Vedanthan , Circulation. 2011;123:1671
1) A Transition From Disease to Health 2) Heart – Brain Integration 3) Imaging / Genetics / Tissue Regeneration
Complex – CAD to CVD
Subclinical -- HRP to DBD
Health -- IOM / COE to SHE
1) Translational 2) Quality/Effective 3) Social Responsibility
C.H.S.
Motivation
Health, Well-being, Society – 2012-2020
Powered by / for Three Ages
2 . P.D.A.
Motivation
G.C.H.P. Motivation
“Extended healthy lives” in part due to medical research
generates dramatic returns - Albert & Mary Lasker Found.- 2002
Growing Toward Heart Health: Influences And Opportunities Into Adulthood.
IOM – V Fuster, BB Kelly, eds Washington DC: Nat.Acad. Press: 2010
V Fuster, BB Kelly, R Vedanthan , Circulation. 2011;123:1671
COLOMBIAN HEALTHY HEART INITIATIVE
• Michael Farkouh
• Marilyn Hunt
• Beatriz Londoño
• Jennifer Chuang
• Jorge Baxter
• Carolina Nieto
• Mark Woodward
• Manuel Urina
• Magola Delgado
• María Lucia Mesa
• Rodolfo Dennis
• German Dario Briceño
• Martha C. Leal
• Zoraida Moreno
• Carmen Lucia Vargas
• Isabel Castaño
• Laura Sofía Céspedes
• Jaime A. Céspedes L.
• Directors, Teachers, staff.
• Parents and Children
• Valentin Fuster
1. PRESCHOOL TRIAL IN BOGOTA (N=6,000 – 25,000)
14 PF Underwent Randomization
C=1216; P/C=928; T=135
7 PF Intervention
C=622; P/C=493; T=64 7 PF Usual Curriculum
C=594; P/C=435; T=71
JA Cespedes, M Farkouh, M Hunn, V Fuster et al., 2012 (In Press)
GENERAL
PUBLIC
3-5 CHILDREN 6-8 9-14
SHE – Progres & Diseminación
HEALTHY FOOD HABITS
PHYSICAL ACTIVITY
HOW YOUR BODY & HEART WORK
EMOTIONAL HABITS TO AVOID
ADDICTIONS
EDUCATIVE GOAL: HEALTHY HABITS FOR CHILDREN BETWEEN 3 & 5 YRS
KNOWLEDGE (70), ATTITUDES (20) & HABITS (10), AT 6 & 18 MONTHS AFTER RECEIVING THE INTERVENTION
90
85
80
75
70
65
60
Sco
re (
mean
)
Baseline 6 months 18 months
Intervention
Period
Follow-up Period
Without Intervention
(p<0.0001)
(p=0.0064)
(p<0.0001)
(p<0.0001)
(p=0.1197) ‡
(p=0.7417)
Teachers Parents Children Control
JA Cespedes, M Farkouh, M Hunn, V Fuster et al., 2012 (In Press)
Intervention
period
ProSpain, Multidisciplinary Team
• Valentín Fuster Cardiology - PI
• Ramona Martinez Economics
• Isabel Carvajal Biology/Pedagogy
• Elena Roura Nutrition
• Yolanda Sánchez, Pedagogy
• Domingo Haro Pedagogy
• Xavi Orrit Physical activity
• Carla Rodríguez Psychology
• Gloria Santos, Biology
• Pedro López Biology
• Manuel Franco Epidemiology
2. Growing Toward Health: Influences And Opportunities Into Adulthood.
IOM – V Fuster, BB Kelly, eds Washington DC: Nat.Acad. Press: 2010
V Fuster, BB Kelly, R Vedanthan , Circulation. 2011;123:1671
. 2. Spain-64 Schools, 2012-2014 (9,500-100,000)
4 T’s – Health - Time, Talent, Transmit, Tutoring
4 A’s - Happy - Attitude, Accept, According, Altruism
3 years old 16 years old
C.H.S.
Motivation
Health, Well-being, Society – 2012-2020
Powered by / for Three Ages
2 . P.D.A.
Motivation
G.C.H.P. Motivation
“Extended healthy lives” in part due to medical research
generates dramatic returns - Albert & Mary Lasker Found.- 2002
V Fuster, R Vedanthan, BB Kelly, Circ 2011; 123:1671
1. GROUP INCENTIVE IOM - 12 RECOMMENDATIONS
• Blood Pressure
• Physical Activity
• Weight / Diet
• Smoking
1. CARDONA INTEGRAL – “FIFTY-FIFTY” PROJECT LIFESTYLE CHANGE OUTCOMES
HABIT YES YES/NO NO BASE 3 MO 6 MO
SMOKING 0 11 2 -- -- 2
OVERWEIGHT 0 12 2 -- -- 2
SEDENTARISM 0 13 2 -- -- 2
HYPERTENSION 0 14 2† -- -- 2
TOTAL LIFESTYLE SCORE -- 8
1 Half - 2 Half of Ideal (2 kg. Mo.) - 3 Half of Ideal (30’ 5 Days w.) 4 Still High (Salt Reduction) -- † Still High (Medical Attention)
2.b. PESA & AWHS 2.a. HRP > 55y.
40-54y, n= 8,000 , FU 0,3,6 y N=7000 FU 3y
Predictive ? Economics ?
Life Style & Imaging ?
PI: V. Fuster, Co-PI: E. Falk, P. Muntendam - AHJ 2010;160:49
Natl Lung Screening Trial Research Team (DR Aberle) NEJM 2011;365:395
C.H.S.
Motivation
Health, Well-being, Society – 2012-2020
Powered by / for Three Ages
2 . P.DA.
Motivation
G.C.H.P. Motivation
“Extended healthy lives” in part due to medical research
generates dramatic returns - Albert & Mary Lasker Found.- 2002