We unveiled our association-wide 2020 Impact Goal last week. Now, let's get to specifics! What exactly does the 2020 Impact Goal mean for our work in policy? Here's a handy reference of the American Heart Association's new measurements for ideal cardiovascular health and the corresponding advocacy/policy solutions that can help us reach that ideal mark!
Smoking Status
  Ideal for cardiovascular health
     Adults: Never smoked or quit more than a year ago
     Children: Never tried or never smoked a whole cigarette
  Advocacy/Policy Solutions

• Comprehensive clean indoor air laws
• Excise taxes on tobacco products
• Increase/sustain funding for state smoking cessation/prevention programs
• Comprehensive implementation of FDA regulation of tobacco
• Implement clinical guidance and monitor health claims around smokeless tobacco and other "harm reduction" products
• Comprehensive smoking cessation benefits in Medicaid, Medicare and other health plans
• Eliminate tobacco sales in pharmacies and other health-related institutions

Additional policy resources available at http://www.americanheart.org/tobaccocontrol

Physical Activity
  Ideal for cardiovascular health
     Adults: At least 150 minutes of moderate of 75 minutes of vigorous physical activity each week      Children: More than 60 minutes of moderate-vigorous physical activity per day
  Advocacy/Policy Solutions

• Address the built environment and support efforts to design workplaces, communities and schools around active living; integrate physical activity opportunities throughout the day
• Fund and develop walking/biking trails that connect key aspects of the community, increase Safe Routes to School, implement zoning/building ordinances that encourage walking/stair use, wider streets to allow for biking and walking, pedestrian-friendly streets and roadways with appropriate cross-walks, sidewalks, traffic lights, etc., and slower speed limits in walking/biking areas
• Implement shared use of school facilites within the community and support the construction of school fitness facilities
• Increase sports, recreational opportunities, parks and green spaces in the community
• Increase the quantity and improve the quality of physical education in schools. Also support 60 minutes per day of supervised, moderate-vigorous physical activity integrated through the school day.
• Help implement the national physical activity plan

Additional policy resources available at http://www.americanheart.org/obesitypolicy, http://www.fitkidsact.org/, and http://www.americanheart.org/workplacewellness

Body Mass Index (BMI)
  Ideal for cardiovascular health
     Adults: BMI between 18.5 and 25 kg/m
     Children: BMI between the 15th & 85th percentile
  Advocacy/Policy Solutions

• Adequate prevention, diagnosis and treatment of obesity in the healthcare environment
• Robust surveillance and monitoring
• Comprehensive worksite wellness programs
• Implement and monitor strong local wellness policies in all schools
• Adequate funding and implementation of coordinated school health programs
• Comprehensive obesity prevention strategies in early childhood and day care programs

Additional policy resources available at http://www.americanheart.org/obesitypolicy

Healthy Diet
  Ideal for cardiovascular health
     Adults and children should achive four of the five following key components of a healthy diet:

1. Fruits & Vegetables: More than 4.5 cups a day
2. Fish: More than two 3.5 oz. servings per week (preferably oily fish)
3. Fiber-rich whole grains (more than 1.1g of fiber per 10g of carbohydrates): Three 1 oz. equivalent servings per day
4. Sodium: Less than 1500mg per day
5. Sugar-sweetened beverages: Less than 450kcal (36 oz.) per week

  Advocacy/Policy Solutions

• Work to eliminate food deserts and improve access to and affordability of healthy foods
• Strengthen nutrition standards in schools for meals and competitive foods and in all government nutrition assistance or feeding programs
• Improve food labeling
• Menu labeling in restaurants
• Continue to monitor the removal of industrially-produced trans fats from the food supply and assure the use of healthy replacement oils
• Address food marketing and advertising to children
• Nutrition education/promotion in schools
• Limit added sugar and sodium in the food supply

Additional policy resources available at http://www.americanheart.org/obesitypolicy

Total Cholesterol
  Ideal for cardiovascular health
     Adults: Total cholesterol less than 200 mg/dL
     Children: Total cholesterol less than 170 mg/dL
  Advocacy/Policy Solutions

• Assure adequate healthcare coverage for prevention and treatment of dyslipidemia
• Increase funding for programs that eliminate health disparities

Blood Pressure
  Ideal for cardiovascular health
     Adults: Below 120/80 mm
     Children: Lower than 90th percentile
  Advocacy/Policy Solutions

• Reduce sodium in the food supply
• Increase funding for state heart disease and stroke prevention programs
• Ensure the availability of essential cardiovascular disease preventive benefits in private insurance and public health programs

Fasting Plasma Glucose
  Ideal for cardiovascular health
     Adults & Children: Less than 100 mg/dL
  Advocacy/Policy Solutions

• Assure adequate healthcare coverage for early treatment and prevention of diabetes

The association created the definition as part of its effort to achieve its new national goal: By 2020, improve the cardiovascular health of all Americans by 20 percent while reducing deaths from cardiovascular diseases and stroke by 20 percent. The novel focus of the new goal will be preventing heart disease and stroke, most notably by helping people identify and adopt healthier lifestyle choices. This will be the first time the American Heart Association has adopted better health as a principal goal.

In a recent survey of adult Americans, the association found 39 percent said they thought they had ideal heart health; however, 54 percent of those (and 70 percent of all respondents) said a health professional had told them they had a risk factor for heart disease and/or needed to make a lifestyle change to improve their heart health. These findings indicate most people don't associate important risk factors, such as poor diet and physical inactivity, with cardiovascular disease.

"To date, there has been great success in reducing disability and death from heart disease and stroke in part through aggressive improvements in the diagnosis and treatment of these diseases and in limited uptake of measures to prevent heart disease and stroke," said Clyde W. Yancy, M.D., American Heart Association president. "We achieved our 2010 goal of reducing death by heart disease and stroke by 25 percent — earlier and by a wider margin than we had targeted. However, too many people continue to have unrelenting exposure to known important risk factors for heart disease and stroke to the point that we are likely to begin seeing an increase in these diseases — and at an earlier age. That is a cause for alarm and a trend we need to stop now."

In a scientific statement published in Circulation: Journal of the American Heart Association, the association described seven health factors and lifestyle behaviors that can affect optimal cardiovascular health. Improvements in these areas can greatly impact quality of life and life span, as well as dramatically reduce the financial burden of the Medicare-eligible population, said Donald M. Lloyd-Jones, M.D., Sc.M., lead author of the statement.


"If we reach people in middle age and even younger with this message, we could change American health for the better for decades to come," said Lloyd-Jones, chair of the Department of PreventiveMedicine and associate professor of Preventive Medicine and Medicine at Northwestern University Feinberg School of Medicine in Chicago.

For the 2020 impact goal, the association categorizes cardiovascular health as poor, intermediate or ideal — depending on where people are in each of the seven areas. While the metrics for children vary based on pediatric recommendations and guidelines, ideal cardiovascular health for adults is defined by the presence of these seven health measures, known as Life's Simple 7:

1. Never smoked or quit more than one year ago;
2. Body mass index less than 25 kg/m2;
3. Physical activity of at least 150 minutes (moderate intensity) or 75 minutes (vigorous intensity) each week;
4. Four to five of the key components of a healthy diet consistent with current American Heart Association guideline recommendations;
5. Total cholesterol of less than 200 mg/dL;
6. Blood pressure below 120/80 mm Hg;
7. Fasting blood glucose less than 100 mg/dL.

"Ideal" health can be difficult to achieve, in part because genetics can play an important role in several of the health factors, Lloyd-Jones said. But he said everyone should strive to reach his or her optimal level of heart health. He said the first step is to know your heart health numbers — cholesterol, blood pressure, glucose — and what they mean. The next step is to try to reach as close to "ideal" as you can.

"Essentially, everyone is a candidate to take at least one step forward in these metrics, from poor to intermediate or intermediate to ideal, to move a substantial portion of the population and have a real impact on cardiovascular health," he said.

To help people improve their heart health, the American Heart Association has developed a new online resource – My Life Check. The short assessment easily identifies the seven goals for ideal health and notes where a person is on the spectrum, while additional tools and information offer specific action steps to improve the measurements and track personal progress toward better health.

"A simple step-by-step approach has now been developed that delivers on the hope we all have – to live a long, productive, healthy life. We call it Life's Simple 7," said Yancy, medical director of the Baylor Heart and Vascular Institute at Baylor University Medical Center in Dallas. "Any favorable movement on these proven measures will lead to better outcomes. The payoff here is that with even modest improvements in health, the benefit of a longer, healthier life free of disease is real."

Noting the goals are aggressive, Yancy said the association will partner with healthcare and government agencies and those in other arenas to make policy and environmental changes to help move Americans toward ideal cardiovascular health.

"It's simple. Of all the treatment strategies that work for heart disease and stroke, the best treatment is to avoid disease altogether," he said. "Prevention should be a cornerstone of healthcare reform, a priority of our state and local legislatures, incorporated into our workplace policies, in our schools and our community environments, and a big part of our everyday lives. The American Heart Association is clearly focusing not only on reducing the burden of disease but, importantly, on prevention of disease. That should matter to everyone."