Healthy heart is a startling rarity among us

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Ideal heart health apparently is a rarer occurrence among middle-aged and elderly adults than might be expected in Allegheny County.

A University of Pittsburgh School of Medicine study published online in Circulation says only one person of 1,933, aged 45 to 75, had heart health that met all seven factors the American Heart Association lists for "ideal cardiovascular health."

Those factors include four behaviors -- nonsmoking, a body-mass index below 25, goal-level physical activity and a healthy diet -- and three other health factors including cholesterol levels below 200 mg/dL, blood pressure below 120/80 and a fasting blood-sugar level below 100 mg/dL, said the study's senior investigator, Dr. Steven Reis, a cardiologist who serves as associate vice chancellor for clinical research at Pitt.

Only one person of the nearly 2,000 achieved these results without medication, as the definition for ideal heart health requires. The group contained a larger proportion of African Americans and women than the county population.

"It's a very sobering result," Dr. Reis said, noting "the current prevalence of heart health is extremely low" among study participants. "I think we need to focus on the importance of improving heart-healthy behavior to reach these factors for ideal health."

The study, known as Heart SCORE (Heart Strategies Concentrating on Risk Evaluation), evaluated 1,933 Allegheny County residents through surveys, physical exams and blood tests. Other local researchers in the study included Dr. Suresh R. Mulukutla, Dr. Aryan N. Aiyer, also of the Pitt School of Medicine, and dietitian Andrea Dinga.

Lead author Dr. Claudia Bambs, a visiting researcher from Chile, did the research in Pittsburgh.

Launched in 2003, the study included 855 African Americans or 44 percent of the total, and 1,268 women. While it didn't represent a cross-section of the county population, it did focus attention on underrepresented groups in cardiovascular research.

Dr. Reis said a large portion of participants, all of whom volunteered for the study, with some recruited through the Urban League and Pittsburgh Theological Seminary, proved to be overweight or obese. The older age range also worsened results, especially considering that many national studies evaluating cardiac risk include adults 18 and over.

Still, the results remain troubling.

Fewer than 10 percent of participants met five of seven criteria, with only 2 percent meeting all four heart-healthy behaviors, and only 1.4 percent meeting all three heart-healthy factors (cholesterol, blood sugar and blood pressure). After adjusting for age, sex and income level, African Americans had 82 percent lower odds than whites of meeting five or more criteria for an ideal healthy heart.

Male participants more often were smokers, overweight or obese with high blood pressure and elevated blood-sugar levels. Women were less likely to exercise regularly and had a greater prevalence of high cholesterol.

Caucasians averaged 2.6 of the seven factors, while African Americans averaged two, Dr. Reis said.

As a result, Allegheny County faces "a great challenge ahead" to attain the AHA's aim of a 20 percent improvement in cardiovascular health rates by 2020, he said.

But he said he's reluctant to write off the results to generally poor health in the county. Instead, he said, the study provides impetus to improve cardiovascular health communitywide, including reducing disparities in health care through policy, awareness and affordable, accessible care.

"We have to look at the built environment," he said, noting one example. "Do we have neighborhoods where people can exercise and have access to affordable care?

"We shouldn't aim all the efforts on the individual and need to focus on public health policy."

In the next three to five years, the study will continue working with participants to improve cardiovascular health through better diet, exercise and other health behaviors. In addition to treating people with risk factors, he said, the community also should shift its focus to preventing risk factors from occurring in the first place.

"If you get enough physical activity, eat a heart-healthy diet, maintain the ideal weight and not smoke, you are less likely to have high cholesterol, glucose levels and blood pressure," Dr. Reis said. "This demonstrates to us that we really need to re-evaluate how we are advising patients and evaluate our focus on adopting healthy behaviors and lifestyles."


David Templeton: dtempleton@post-gazette.com or 412-263-1578.


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