February 19, 2020
The good news about cardiovascular disease in the United States is that it’s becoming less deadly: From 2006 to 2016, the death rate from all cardiovascular diseases decreased by 18.6% and by 31.8% for heart disease related to atherosclerosis.
The bad news is that cardiovascular disease remains the leading cause of death, responsible for 840,768 deaths in 2016.
For nearly 100 years, the American Heart Association has been dedicated to fighting heart disease and stroke.
And starting in July, the organization will be presided over by a neurologist, Mitchell Elkind, MD, professor of neurology at Columbia University Vagelos College of Physicians and Surgeons and an attending at NewYork-Presbyterian Hospital.
We recently spoke with Elkind about heart disease and its relationship to brain health. The following transcript has been edited for brevity and clarity.
Why, as a neurologist, were you interested in becoming president of the AHA?
The AHA is not a professional organization for physicians, it’s really a public health organization. It's geared toward preventing cardiovascular disease, especially heart attacks and strokes. And it does this through a combination of public education campaigns, raising physician awareness of best practices, and research.
So it’s not just an organization of cardiologists; there are neurologists, public health specialists, epidemiologists, nutritionists, physical therapists, occupational therapists, nurses, all kinds of people interested in preventing cardiovascular disease.
Also, over the last 20 to 30 years, stroke has become a really important focus of the AHA, and, more recently, the association has gotten interested in brain health in general.
What’s the connection between the heart and the brain?
I think some of the most exciting research now is at the intersection among heart disease, stroke, and brain health.
We’re learning that sleep, for example, is important for heart health, an area that Columbia researchers are involved in.
We’re also finding that depression and anxiety often take a toll on people’s physical health; people stop exercising, or they smoke to help themselves cope. By the same token, when people have heart disease or a stroke, it's not uncommon that they develop depression or anxiety afterward.
There's a lot of interest now in atrial fibrillation, when the small chambers of the heart don't beat normally and people feel their heart racing. The biggest complication of a-fib though, is a stroke, because blood clots can form in the heart and travel to the brain.
We're learning that atrial fibrillation is much more common than we thought. The condition isn’t always persistent; it can come and go, and some people may have only a few minutes of atrial fibrillation every few weeks. But they still carry a risk of stroke.
These heart problems underlie many of the unexplained strokes that neurologists see. And if we can detect people with these problems, it’s possible that treating them with blood thinners, like atrial fibrillation patients, will reduce the risk to the brain.
In 2010 the AHA set a goal of reducing deaths from cardiovascular diseases by 20% by 2020. Did we make it?
We actually got pretty close; since 2010 we’ve reduced deaths from cardiovascular disease overall by about 10% and from heart disease alone by 28%.
"In some specific areas we have seen tremendous declines in cardiovascular disease over the last couple of decades. But we’re actually starting to see that level off now, and for stroke we’re actually seeing an increase over the past few years."
So in some specific areas we have seen tremendous declines in cardiovascular disease over the last couple of decades. But we're actually starting to see that level off now, and for stroke we’re actually seeing an increase over the past few years.
There are a few things that may be reversing the trend. Substance abuse may be a factor, along with increasing obesity and sedentary lifestyles. And we’re worried that the popularity of vaping among young people could potentially lead to an increase in smoking.
Overall, the picture has been positive, but we don't want to lose the progress that we've made.
How best to keep these trends moving downward?
One step is creating a simple message for the public. The AHA created Life's Simple 7, which are seven things people should do to maintain health: exercise at least five days a week, watch your diet, maintain a healthy weight, do not smoke, reduce blood sugar, control cholesterol, and manage blood pressure.
How do we get people to change behavior? That's been very challenging, but through what we call implementation science, people are coming up with new ideas.
It doesn't all have to happen at the doctor's office, either. We’re using non-traditional approaches to reach people, whether it's through churches, which has been very effective in the African American community, or in hair salons and barbershops, where you can get your blood pressure checked while waiting to get your hair cut.