Things change… and hopefully for the better! A lot of progress was made over the last decades in our understanding of the pathophysiology of chronic diseases such as type 2 diabetes and cardiovascular disease. Nowadays, patients who have access to medical procedures and treatments in the field of cardiology can enjoy a much longer life expectancy than patients of the mid-20th century.
However, during the same period, because of our comfortable sedentary lifestyle and our ultra-processed, energy-dense diet, we have nevertheless experienced a rapid progression in the prevalence of obesity and of related chronic diseases. Thus, the World Health Organization has stated that more than 70% of deaths are now due to chronic conditions (cardiovascular and respiratory diseases, type 2 diabetes, some forms of cancers) that are largely explained by four behaviors (smoking, too much alcohol drinking, lack of physical activity and a diet of overall poor quality) [1]. This is why the American Heart Association (AHA) had identified, more than 10 years ago, the promotion of cardiovascular health as its next priority [2].
Indeed, if behaviors are important for the improvement and maintenance of cardiovascular health, they should be assessed in clinical practice. Unfortunately, due to lack of time and resources, a minority of physicians assess nutritional quality and level of physical activity in their patients [3].
This is why several committees from various councils of the AHA have joined forces to produce two advisory papers [4, 5] and one scientific statement [6]. The purpose of these three papers was to provide clinicians and primary care health professionals with practical tools based on the 5A model (Assess, Advise, Agree, Assist and Arrange) so that lifestyle vital signs are assessed and targeted in clinical practice.
It is hoped that these papers will help health professionals reshape the lifestyle habits of their patients and thus contribute to the improvement of their cardiovascular health.
References
1. World Health Organization. Noncommunicable diseases. https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases. Accessed December 16, 2021.
2. Lloyd-Jones DM, Hong Y, Labarthe D, et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic Impact Goal through 2020 and beyond. Circulation 2010; 121: 586-613
PubMed ID: 20089546
3. Teoh H, Després JP, Dufour R, et al. A comparison of the assessment and management of cardiometabolic risk in patients with and without type 2 diabetes mellitus in Canadian primary care. Diabetes Obes Metab 2013; 15: 1093-100
PubMed ID: 23683111
4. Kris-Etherton PM, Petersen KS, Després JP, et al. Strategies for promotion of a healthy lifestyle in clinical settings: pillars of ideal cardiovascular health: a science advisory from the American Heart Association. Circulation 2021; 144: e495-e514
PubMed ID: 34689589
5. Kris-Etherton PM, Petersen KS, Després JP, et al. Special considerations for healthy lifestyle promotion across the life span in clinical settings: a science advisory from the American Heart Association. Circulation 2021; 144: e515-e32
PubMed ID: 34689570
6. Laddu D, Ma J, Kaar J, et al. Health behavior change programs in primary care and 6. community practices for cardiovascular disease prevention and risk factor management among midlife and older adults: a scientific statement from the American Heart Association. Circulation 2021; 144: e533-e49
PubMed ID: 34732063