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Framework for Cardiovascular Disease Prevention and Control
CDCs National Leadership
Recognizing the immense burden of cardiovascular disease, in fiscal year 1998 Congress made available funding of $8.1 million to initiate a national, state-based prevention program. This amount, together with CDCís in-house funding of $2.8 million, enabled CDC to assist six states (Alabama, Georgia, Kentucky, Mississippi, Missouri, and South Carolina) in building capacity to target cardiovascular disease and to support two states (New York and North Carolina) for more comprehensive programs. These two states are developing and disseminating policy and environmental interventions with a primary focus on reducing the prevalence of poor nutrition and physical inactivity, leading risk factors for cardiovascular disease.
In FY 1999, CDC will spend more than $15 million for the prevention and control of cardiovascular disease and its disabling conditions. Activities include:
CDC also supports other public health programs that contribute to CVD prevention, including testing a model CVD screening program among at-risk women; supporting university-based Prevention Research Centers to develop effective interventions; and funding state school health education programs and tobacco prevention and control programs.
CDC has provided leadership in developing a plan to ensure that every state is part of a comprehensive, integrated national program to prevent cardiovascular disease and target its major risk factors. Preventing Death and Disability from Cardiovascular Diseases: A State-Based Plan for Action outlines the core functions of state-based cardiovascular disease programs and emphasizes strategies targeting the underserved. CDCís key partners in developing the plan include the American Heart Association; the National Heart, Lung, and Blood Institute; and state health departments.
Establishing a Nationwide Prevention Program
With fiscal year 1999 funding of approximately $16 million, CDC will expand the number of states funded for cardiovascular disease prevention and control programs.
To support state-based programs, CDC is working with key partners (e.g., the American Heart Association) to establish critical national elements, including
Strengthening the Science Base
CDC strengthens and expands the scientific basis for prevention by examining health effects related to major risk factors. The 1996 benchmark report Physical Activity and Health: A Report of the Surgeon General brings together findings from decades of research. A major conclusion is that regular physical activity reduces the risk for cardiovascular disease. Similar groundbreaking Surgeon Generalís reports on smoking and health have documented the relationship between cigarette smoking and cardiovascular disease. Recent reports have addressed tobacco use among adolescents and special populations.
CDCís National Standards Laboratory is a state-of-the-art facility that supports research to better define the relationship of levels of cholesterol and other related lipids to the risk of developing heart disease. This laboratory has established national reference standards for cholesterol measurement that are used by laboratories around the country.
Improving Prevention Strategies
In fiscal year 1999, CDC will support at least 23 Prevention Research Centers (PRCs) at schools of public health and medical schools. The PRCs develop and evaluate promising cost-effective prevention strategies that can be readily applied in community settings. These centers serve as the focal points for targeting such issues as increasing physical activity among the elderly, reducing risk factors for heart disease among urban minority populations, and promoting health in the workplace.
Getting Health Messages Out and Acted On
CDC has collaborated with national partners to develop a health communications campaign promoting heart-healthy behaviors. In doing so, CDC has taken advantage of expertise from the field of social marketing to strengthen and fine-tune health promotion messages.
To strengthen health promotion for children, CDC has consulted with scientific, health, and education
experts to develop guidelines for use by schools and other organizations serving young people. These
guidelines, covering topics such as tobacco use, unhealthy eating, and physical inactivity, provide
specific recommendations for effectively promoting healthy behaviors.
Targeting Risk Factors
Improving Womenís Health
Cardiovascular disease is the leading cause of death among women. Furthermore, women are often diagnosed with cardiovascular disease in its advanced stages, when treatment is less effective. To improve detection, CDC supports three statesóArizona, Massachusetts, and North Carolinaóto screen women for factors that significantly increase their risk for cardiovascular disease, including sedentary lifestyle, obesity, elevated cholesterol, high blood pressure, and smoking. This screening, conducted through CDCís WISEWOMAN program, has been provided to more than 4,000 low-income and uninsured women aged 50 years and older, along with counseling, education, referral, and follow-up services. More than 50% of the women screened have been found to have either elevated cholesterol or high blood pressure, and more than 60% are overweight. Early results suggest that women who received interventions through the WISEWOMAN program significantly lowered their cholesterol level, increased their physical activity level, and raised their fruit and vegetable intake.
Targeting Tobacco Use in States
To reduce the prevalence of tobacco use, CDC supports and coordinates tobacco use prevention and control programs in all 50 states and the District of Columbia. These programs include strategic activities designed to reach those most at risk, including young people, members of racial and ethnic minority groups, women, and people with low socioeconomic status.
Addressing the Risk for Heart Disease and Stroke Among People With Diabetes
People with diabetes are two to four times more likely to have heart disease or stroke than people without diabetes. As part of its national strategy to address the burden of diabetes, CDC provides resources and technical assistance to state health departments, national organizations, and communities to determine the size and nature of diabetes-related problems and the reasons they exist; to develop and evaluate new strategies for diabetes prevention; to establish partnerships to prevent diabetes problems; and to increase access to quality diabetes care to improve the prevention, detection, and treatment of diabetes complications. Each state and U.S. territory receives at least limited funding for diabetes control activities.
Investing in Our Childrenís Future
Although cardiovascular disease usually becomes evident in middle or older age, progressive harmful conditions (e.g., atherosclerosis) leading to such disease begin in childhood. Reducing the health and economic burden of cardiovascular disease in the United States depends in large measure on reaching our young people early, before unhealthy behaviors are adopted.
CDC provides 15 states with the resources needed to build the state infrastructure to support high-quality,
school-based health education. These programs give young people the information and skills they need to
avoid health risks such as tobacco use, unhealthy dietary patterns, and inadequate physical activity.
Coordinated health education also gives young people the opportunity to practice decision making,
communication, and peer-resistance skills that will enable them to make healthy behavior choices.
Surveillance Provides Vital Information
National and state-based surveillance is essential to support successful cardiovascular disease prevention efforts.
Measuring the Disease Impact
CDC has developed chronic disease surveillance reports that provide extensive state-based information on the burden of cardiovascular disease and the prevalence of associated risk factors. For example, in 1998, CDC released Chronic Diseases and Their Risk Factors: The Nationís Leading Causes of Death with tailored state profiles on the incidence of heart disease and stroke. CDC has also developed more detailed monographs to highlight the health and economic burden of cardiovascular disease in specific regions of the country. Heart Disease in Appalachia: An Atlas of County Economic Conditions, Mortality, and Medical Care Resources was recently developed by a CDC-supported prevention research center in West Virginia. This document analyzes 399 counties in 13 states ranging from New York to Mississippi, and serves as a valuable planning tool for state and local public health professionals in targeting the disproportionate burden of cardiovascular disease in these states.
Essential Information on Risk Factors
In targeting cardiovascular disease, it is crucial to know the extent to which Americans are engaging in behaviors that put them at higher risk. A unique source of such information is CDCís state-based Behavioral Risk Factor Surveillance System (BRFSS). Now active in all 50 states, this system gathers information from adults on knowledge, attitudes, and behaviors related to key health issues, such as tobacco use, dietary patterns, level of leisure-time physical activity, and use of preventive services (e.g., screening for hypertension and elevated cholesterol).
Information from the BRFSS enables CDC and the states to better target scarce health resources by determining the prevalence of risk behaviors and the populations most at risk.
Information to Better Target Prevention Among Young People
Until the 1990s, little was known about the prevalence of behaviors among young people that increase their risk for cardiovascular disease in their middle or later years. The Youth Risk Behavior Surveillance System, developed by CDC in cooperation with federal, state, and private-sector partners, now provides such information.
This surveillance system includes voluntary surveys conducted by CDC among a national sample of
12,000 students as well as surveys conducted among smaller samples by state and local education agencies
every two years. The information collected on the prevalence of key cardiovascular disease risk factorsótobacco use, lack of physical activity, and poor
nutritionóis crucial in targeting health promotion efforts to our nationís young people.
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