AHA Guide for Improving Cardiovascular Health at
the Community Level, 2013 Update: A Statement for
Public Health Practitioners, Healthcare Providers,
and Health Policy Makers
Pearson TA, Palaniappan LP, Artinian NT, Carnethon MR,
Criqui MH, Daniels SR, Fonarow GC, Fortmann SP, Franklin
BA, Galloway JM, Goff DC Jr, Heath GW, Holland Frank AT,
Kris-Etherton PM, Labarthe DR, Murabito JM, Sacco RL,
Sasson C, Turner MB; on behalf of the American Heart
Association Council on Epidemiology and Prevention.
0
The AHA Community Guide
• Conceptual Framework for Heart Disease and
Stroke Prevention
• Optimal Behaviors Targeted for Population-Wide
Change
• Intervention Goals, Recommendations, and Current
Programs
© 2013, American Heart Association, Inc. All rights reserved.
Pearson, TA et al. Circulation. 2013: published online before print March 21, 2013, 10.1161/CIR.0b013e31828f8a94
2020 Impact Goal
‘By 2020, to improve the cardiovascular health
of all Americans by 20% while reducing deaths
from cardiovascular diseases and stroke by
20%.’
(Circulation. 2010;121:586-613.)
© 2013, American Heart Association, Inc. All rights reserved.
Pearson, TA et al. Circulation. 2013: published online before print March 21, 2013, 10.1161/CIR.0b013e31828f8a94
Goals and Objectives
• Provide a comprehensive inventory of evidencebased goals, strategies, and recommendations for
cardiovascular disease (CVD) and stroke prevention
that can be implemented on a community level.
© 2013, American Heart Association, Inc. All rights reserved.
Pearson, TA et al. Circulation. 2013: published online before print March 21, 2013, 10.1161/CIR.0b013e31828f8a94
Improves Upon the 2003 AHA
Community Guide
1) Incorporates new evidence for community
interventions gained over the last decade.
2) Expands the target audience to include a broader
range of community advocates.
3) Aligns with the concepts and terminology of the
AHA 2020 Impact Goals.
4) Recognizes the contributions of new public and
private sector programs involving community
interventions.
© 2013, American Heart Association, Inc. All rights reserved.
Pearson, TA et al. Circulation. 2013: published online before print March 21, 2013, 10.1161/CIR.0b013e31828f8a94
Complements Existing
CVD and Community Guidelines
• Public health strategies can preserve optimal levels of
cardiovascular health factors from childhood throughout the
life course or shift the entire population distribution of
cardiovascular risk to lower levels.
• This public health approach yields lifelong benefits in terms
of good health and reduced healthcare costs.
• The AHA Community Guide complements existing guidelines
that target individuals, healthcare providers, and
communities.
• The AHA Community Guide provides a comprehensive and
up-to-date review of community approaches for CVD
prevention.
© 2013, American Heart Association, Inc. All rights reserved.
Pearson, TA et al. Circulation. 2013: published online before print March 21, 2013, 10.1161/CIR.0b013e31828f8a94
Interventions for Population-Wide Health
Promotion: Health Impact Pyramid
(Frieden TR. Am J Public Health. 2010;100:590-595.)
© 2013, American Heart Association, Inc. All rights reserved.
Pearson, TA et al. Circulation. 2013: published online before print March 21, 2013, 10.1161/CIR.0b013e31828f8a94
Conceptual Framework at a Community Level
Community
setting
(Pearson et al. Circulation. 2003;107: 645-651)
© 2013, American Heart Association, Inc. All rights reserved.
Optimal behaviors
Pearson, TA et al. Circulation. 2013: published online before print March 21, 2013, 10.1161/CIR.0b013e31828f8a94
Table 1. Behaviors Targeted to Improve Cardiovascular Health at
the Community Level and the Prevalence of Optimal Levels in the
U.S. Adult Population.
Example:
Prevalence in U.S. Adults with
Optimal Behaviors
Optimal Behaviors*
No Tobacco
Reduce Tobacco Use
Reduce Exposure to Environmental
Tobacco Smoke
Healthy Dietary Practices
BMI <25kg/m2
(Appropriate caloric balance for age,
gender, height and physical activity)
73% are nonsmokers
-Approximately 1% meet 4-5 of 7
healthy dietary recommendations
33% have a BMI less than 25 kg/m2
* Optimal refers to levels associated with lower risk for developing cardiovascular disease.
© 2013, American Heart Association, Inc. All rights reserved.
Pearson, TA et al. Circulation. 2013: published online before print March 21, 2013, 10.1161/CIR.0b013e31828f8a94
Table 2. Systematic Reviews/ Evidence Summaries with
Recommendations for Optimal Behaviors at the Community Level
Example:
Optimal Behaviors
No Tobacco
Reduce Tobacco Use
Reduce Exposure to
Environmental Tobacco
Smoke
Healthy Dietary Practices
Calories
Review/Summary
Recommendation
Surgeons General Reports
USPSTF
Institute of Medicine (IOM)
Report on Tobacco
Complete cessation for individuals
Surgeon General Reports
IOM Report on Tobacco
Reductions in prevalence of smoking
to level where public health impact is
minimal
Curtail all sources of involuntary
exposure to environmental tobacco
smoke
AHA 2020 Impact Goals
• Women: 1,600 to 2,400 calories
AHA Diet and Lifestyle
per day
Recommendations
• Men: 2,000 to 3,000 calories per
AHA Obesity Guidelines
day
2010 U.S. Dietary Guidelines • Calorie ranges depend on age and
physical activity level. Balance
calorie intake and physical activity
to achieve or maintain a healthy
body weight.
© 2013, American Heart Association, Inc. All rights reserved.
Pearson, TA et al. Circulation. 2013: published online before print March 21, 2013, 10.1161/CIR.0b013e31828f8a94
Goals, Recommendations,
and Current Programs
• The intervention goals and recommendations promote
lifestyle and behavior change at both the individual and
community levels and policy change at the community
level.
• Goals added based on recent evidence that demonstrates
the substantial impact of obesity, sodium consumption,
and air pollution on cardiovascular health.
• A major addition has been the listing of current programs
which illustrate best practices at national, regional, or
local levels
© 2013, American Heart Association, Inc. All rights reserved.
Pearson, TA et al. Circulation. 2013: published online before print March 21, 2013, 10.1161/CIR.0b013e31828f8a94
Table 3. Intervention Goals and Recommended Actions for Public
Health Programs
Example:
Intervention Goals
Surveillance:
Goal: All communities should
have access to data that CVD
and stroke are leading causes
of death and disability for
everyone in their community.
Recommended Actions
•
•
•
© 2013, American Heart Association, Inc. All rights reserved.
Determine and make available data on the burden of CVD and
stroke morbidity and mortality at the local level (city or
county).
Identify groups defined by gender, race/ethnicity,
socioeconomic status, or geographic location that are at
especially high risk of CVD and stroke within each community.
Assess the levels of major preventable causes of CVD and
stroke in the community including social and environmental
factors (e.g., safety, air pollution), lifestyle behaviors (e.g.,
unhealthy diet, tobacco use, sedentary lifestyle) and risk
factors (hypertension, atrial fibrillation, diabetes, elevated
blood cholesterol, and obesity).
Pearson, TA et al. Circulation. 2013: published online before print March 21, 2013, 10.1161/CIR.0b013e31828f8a94
Table 4. Intervention Goals and Current Public Health Programs
Example:
Intervention Goals and Current Programs
Surveillance:
Goal: All communities
should have access to
data that CVD and stroke
are leading causes of
death and disability in
men and women in their
community.
American Heart Association (AHA) Heart and Stroke Facts
The American Heart Association, in conjunction with the Centers for
Disease Control and Prevention, National Institutes of Health and
other government agencies, compiles up-to-date statistics on heart
disease, stroke and other vascular diseases in the Heart Disease and
Stroke Statistical Update. This is a valuable resource for researchers,
clinicians, healthcare policy makers, media professionals, the public
and others who seek the best national data available on disease
morbidity, mortality and risks; quality of care; medical procedures
and operations; and costs associated with the management of these
diseases.
www.heart.org/statistics
CDC State Tobacco Activities Tracking and Evaluation (STATE) System
The State Tobacco Activities Tracking and Evaluation (STATE) System
is an electronic data warehouse containing up-to-date and historical
state-level data on tobacco use prevention and control.
http://apps.nccd.cdc.gov/statesystem/Default/Default.aspx
© 2013, American Heart Association, Inc. All rights reserved.
Pearson, TA et al. Circulation. 2013: published online before print March 21, 2013, 10.1161/CIR.0b013e31828f8a94
The future burden of CVD is projected
to increase and have an
enormous economic impact
• Enhanced population-based prevention programs could lead
to a large decline in CVD morbidity and mortality.
• The AHA Community Guide serves to aggregate and integrate
the evidence available to date to provide clinical and public
health practitioners, community leaders, and policy makers
with an overview of the many opportunities to improve their
communities’ cardiovascular health.
© 2013, American Heart Association, Inc. All rights reserved.
Pearson, TA et al. Circulation. 2013: published online before print March 21, 2013, 10.1161/CIR.0b013e31828f8a94
American Heart Association Guide for Improving
Cardiovascular Health at the Community Level, 2013 Update
Citation:
Pearson TA, Palaniappan LP, Artinian NT, Carnethon MR, Criqui MH, Daniels SR,
Fonarow GC, Fortmann SP, Franklin BA, Galloway JM, Goff DC Jr, Heath GW, Holland
Frank AT, Kris-Etherton PM, Labarthe DR, Murabito JM, Sacco RL, Sasson C, Turner
MB; on behalf of the American Heart Association Council on Epidemiology and
Prevention. American Heart Association guide for improving cardiovascular health at
the community level, 2013 update: a scientific statement for public health
practitioners, healthcare providers,
and health policy makers. Circulation. 2013: published online before print March 21,
2013, 10.1161/CIR.0b013e31828f8a94.
Link:
http://circ.ahajournals.org/lookup/doi/10.1161/CIR.0b013e31828f8a94
© 2013, American Heart Association, Inc. All rights reserved.
Pearson, TA et al. Circulation. 2013: published online before print March 21, 2013, 10.1161/CIR.0b013e31828f8a94