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Lifestyle Medicine and Cardiovascular Health: The Future is Now! May 11, 2011 Presenter: James M. Rippe, MD – Leading cardiologist, Founder and Director, Rippe Lifestyle Institute Moderator: Barbara J. Ivens, MS, RD, FADA – Senior Nutrition Director, ConAgra Foods Approved for 1 CPE (Level 2) by the American Dietetic Association Commission on Dietetic Registration • Recording of the May 11, 2011 webinar and PDF download of complete PowerPoint available at: www.ConAgraFoodsScienceInstitute.com Nutri-Bitessm Summary Lifestyle Medicine and Cardiovascular Health: The Future is Now! This webinar covered: Major risk factors for heart disease relate directly to four lifestyle behaviors: sedentary lifestyle; overweight and obesity; energy-dense diet; smoking. Numerous authoritative national guidelines recommend lifestyle behaviors for prevention and treatment of chronic diseases (i.e. Dietary Guidelines 2010; Physical Activity Guidelines for Americans 2008; AHA 2020 Strategic Impact Goals; Am Diabetes Assoc Diabetes Mgt; AAP; etc) Encourage primary and secondary prevention through lifestyle principles. Strategies should focus on building awareness and tracking changes. Weigh regularly; moderate portion sizes; increase activity; selfmonitor; model healthful behaviors; offer counseling. Lifestyle Risk Factors for CVD Evidence shows many major risk factors for heart disease relate directly to four lifestyle behaviors. Sedentary lifestyle Overweight and obesity Energy-dense diet (high in calories; high in saturated fats, added sugars and refined grains; and low in fiber, whole grains, healthy fats, and certain micronutrients) Smoking Authoritative Guidelines Many current authoritative guidelines recommend lifestyle behaviors for prevention and treatment of chronic disease and place emphasis on implementation Dietary Guidelines for Americans 2010 (released 1/31/2011) Physical Activity Guidelines for Americans 2008 National Cholesterol Education Program JNC VII Guidelines for Prevention and Management of Hypertension Institute of Medicine Guidelines for Management of Obesity AHA Guidelines for the Prevention and Management of Coronary Artery Disease AHA Nutrition Implementation Guidelines AHA 2020 Strategic Impact Goals Authoritative Guidelines Guidelines from the American Diabetes Association for the Management of Diabetes American Academy of Pediatrics Guidelines for Prevention and Treatment of Childhood Obesity American Academy of Pediatrics for Heart Disease Risk Factor Reduction in Children AHA and AAP Guidelines for Prevention and Treatment of Metabolic Syndrome AHA and American Cancer Society Joint Statement on prevention of heart disease and cancer. Endocrine Society guidelines for prevention of CVD and type 2 diabetes in patients at metabolic risk American Dietetic Association position paper on Total Diet Approach to Communicating Food and Nutrition Information Cornerstone Principles Lifestyle Medicine principles serve as a cornerstone in all these guidelines. Put primary prevention through lifestyle first Manage weight—get regular physical activity, match calories consumed to calories burned Get nutrients needed from foods; select a variety of nutrient-dense foods; eat fewer energy-dense foods Get regular physical activity. Goals– 30 min/d or 150 min/wk of moderate intensity or equivalent high intensity; strength train 2 d/wk Quit smoking or don’t start smoking Manage stress and get adequate rest It’s Never Too Late to Change Newly adopting a healthful lifestyle in middle age lowers overall mortality and decreases incidence of cardiovascular events for years.1 • 15, 708 Adults, 45 – 65 y, Atherosclerosis in Communities Study • Choices: eat 5 or more F/V daily; regularly PA; BMI <30; not current smoker Longitudinal lifestyle interventions in individuals at high risk of type 2 diabetes found a lower incidence of diabetes in participants vs. controls. 2, 3 Lifestyle practices in very old lowered risk of CVD mortality • 13,296 adults, Leisure World Cohort Study • Not smoking, moderate alcohol intake, physical activity and normal weight for >70 y to 80+ years associated with decreased mortality4 Sources: 1) King 2007 2) Li 2008 3)Lindstrom 2006, 4) Paganini 2011 Moderate Changes = Big Difference DASH and Mediterranean dietary patterns have been associated with lower blood pressure, lipid profile, risk of CVD1 Smoking cessation reduces risk of CVD to half in 1 year; risk of stroke to never-smoker in 5-10 yr and lung cancer in 5 yr2 Recommended PA helps reduce blood pressure, increase HDL cholesterol, reduce triglycerides, support weight loss, may decrease insulin resistance3 Losing 5 – 10% of body weight (as little as 10 lbs) can improve blood pressure, blood cholesterol and blood sugar.4 Sources: 1) DGAC 2010 report 2)CDC “Benefits of Quitting” 3)Am Heart Assn “Physical Activity” Position Statement 4)CDC Healthy Weight: It’s not a diet, it’s a lifestyle http://www.cdc.gov/healthyweight/losing_weight/index.html Strategies – From What to How Evidence suggests that addressing patterns of behavior(s)not just one element or behavioris key DGA 2010 emphasizes patterns of eating and importance of physical activity in addition to healthful nutrition Prevention and treatment guidelines for chronic diseases typically recommend a cluster of interrelated behaviors including diet, activity, weight management, smoking cessation, stress management Source: DGA 2010 Chap 5, Building Healthy Eating Patterns Strategy: Be Aware. Be Intentional. Dietary Guidelines for Americans 2010 strategies Weigh regularly. Know your healthful weight range. Know your appropriate energy intake levels. Learn and observe portion sizes that meet your energy needs. Source: DGA 2010, www.dietaryguidelines.gov Strategy: Track efforts to measure progress Using personal tracking or self-monitoring programs has been shown effective for reaching diet and activity goals Tracking encourages adherence Tip: MyPyramid.gov offers a free, individualized online tracking program for diet and PA Sources: Greaves et al. BMC Public Health. 2011; Chambliss et al. Patient Educ Couns 2011 Feb epub; Hartwell et al. Primary Care Diabetes 2011 Jan epub; Conroy et al, Med Sci Sports Exerc 2010 epub; Yon et al; J BehavMed 2007; Cushing et al; J Ped Psych 2010 epub; Masoudi et al. J Biomed Inform 2010 Strategy: Model Healthful Behaviors Health care professionals who adopt healthful lifestyles are more likely to counsel and encourage patients Parents are effective models for children of nutrition and activity behaviors Workplace, school and community environments may encourage or discourage behaviors Sources: Howe et al. Prev Cardiol 2010; Abramson et al. Clin J Sport Med 2000; Frank et al. J Am Women’s Med Assn 2003; Frank et al. AJCN 2002; Pearson, Pub Health Nutr 2009; Johannsen et al. Obesity 2006; Gidding et al. Circulation 2009; Story et al. JADA 2002 Strategy: Provide Counseling Motivational, behavioral counseling is typically more effective than just providing information. Clients and patients trust health care professionals as source. Why not begin with this strategy? Counseling without the other strategies may not be as effective. Sources: Berben et al, Eur J Cardio Nurs 2010; Clune et al. Prev Med 2010; Greaves et al. BMC Pub Health 2011; Jackson et al. Clin Cardiol 2010; Jansink et al. BMC Health Serv Res 2009; McIvor et al. Can Respir J 2009; Patrick et al. J Phys Act Health 2009; Persson et al. BMC Res Notes 2010; Prokhorov et al. Arch Intern Med 2010l; Whittemore et al. J Am Acad Nurse Pract 2010 Realizing strategies through specific action goals Encourage eating more fruits and vegetables Select sensible portions Encourage regular physical activity Facilitate weight loss and weight management Encourage smoking cessation Cardiovascular Health and Lifestyle Medicine— the Future is Now Discussion of how to improve our health care system in ability to delivery better outcomes at better cost has centered on two strategies: the “patient centered medical home” (PCMH) and the “accountable care organization” (ACO) PCMH model focuses on a strong primary care foundation for health care. ACO model focus on provider-led integrated delivery across the whole continuum of care with accountability for quality of care and cost. Lifestyle Medicine with its emphasis on the integrated and inter-dependent nature of the importance of lifestyle behaviors to health or risk of disease is the optimum foundation for delivery of such health care.