We're making progress, but our habits are still undermining our health. That's the conclusion of a new report from the American Heart Association (AHA). The AHA wants to reduce heart disease and stroke deaths 20% by 2020. But with current trends, we can expect only a 6% reduction, the report said. Obesity, smoking and lack of exercise are slowing down progress. About 68% of U.S. adults and 32% of children are overweight or obese. Nearly 33% of adults get no exercise at all in a typical week, the report says. Even in high school, 18% of girls and 10% of boys get less than an hour of aerobic exercise each week. Smoking rates are down, but 21% of men, 18% of women and 17% of high school students still smoke. About 8% of adults have been diagnosed with diabetes. The report says broad measures will be needed to encourage change. These could include rewards for doctors who help patients adopt healthier behaviors and school programs to help children do the same. Access to green spaces and healthy foods in all communities also can help. The journal Circulation published the report. HealthDay News wrote about it December 12.

By Robert H. Shmerling, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

Two steps forward and one step back. That's the phrase that came to mind when I read this new report about progress in preventing heart and blood vessel disease in the United States. (But I also wondered if we're actually making one step forward and two steps back!)

The American Heart Association (AHA) says there have been major advances as well as setbacks in the effort to reduce diseases such as heart attack or stroke. The report was just published in the journal Circulation.

The good news is that during the last decade, rates of stroke and heart attack have fallen dramatically. The reasons include:

• A drop in the popularity of smoking
• Improvement in cholesterol levels
• Better control of high blood pressure (hypertension)

But there's also room for improvement. Several factors that increase the risk of heart and blood vessel disease are going in the wrong direction.

Here's the bad news in this report:

• We don't get enough exercise. About one-third of adults say they get no aerobic exercise.
• We weigh too much. About one-third of U.S. adults are obese, with a body mass index (BMI) of at least 30. Another one-third are overweight (BMI of 25 to 29.9). Nearly one-third of children are overweight or obese.
• High cholesterol and high blood pressure are common. About 1 in 8 U.S. adults has a total cholesterol level of more than 240 milligrams per deciliter. About 1 in 3 has high blood pressure.
• Diabetes is on the rise. About 16% of adults have diabetes. Half of them don't know it. Another 38% have pre-diabetes. This means that their blood sugar levels are higher than normal, but not high enough to be diagnosed as diabetic. They are at high risk for developing the disease.
• Smoking is still common. Smoking rates have been dropping for decades. But 21% of men, 17% of women, and 18% of high school students still smoke.

Why does this matter? Heart disease is the No. 1 killer of U.S. adults. It accounts for 1 in 3 deaths. And that's despite a 33% drop in heart disease during the last decade. Despite the toll heart disease takes on our health, we are doing far less than we could to prevent it. And heart disease is among the most preventable of the leading causes of death.

What Changes Can I Make Now?

Much is known about how to prevent heart and blood vessel disease. The challenge is getting people to take the necessary steps.

You can make these changes now to reduce your risk.

• Don't smoke. If you smoke now, see your doctor for advice about quitting. If you don't smoke now, don't start.
• Limit how much alcohol you drink. Current advice suggests no more than two drinks per day for men or one drink per day for women.
• Get your blood sugar checked, and get treatment for diabetes if you have it. Exercising and maintaining a healthy body weight can help.
• Get your blood pressure and cholesterol checked regularly. If either one is high, make the necessary changes in your diet, exercise and weight to improve it. Talk to your doctor about whether medicines are recommended.

These changes are particularly important if you have a strong family history of heart and blood vessel disease.

However, giving advice to each patient in a doctor's office won't be enough. Public health measures are also important. Health insurers, employers and public health officials also can help people lower their risk of heart and blood vessel disease. The AHA report recommends these steps:

• Reward health care practices that help people address the factors that increase the risk of heart and blood vessel disease.
• Encourage health insurers to cover screening, prevention and treatment of conditions linked with heart and blood vessel disease. Examples include smoking cessation programs and home blood pressure monitors.
• Promote workplace health and fitness programs.
• Create safe walking and biking routes.
• Develop education programs to help kids exercise more and improve their diets.

There's a lot of work to do. But at least we know what's needed.

What Can I Expect Looking to the Future?

It's hard to predict where things are going. If current trends continue, we may make modest gains in lowering the rate of heart and blood vessel disease. But if we can reverse certain trends, especially the epidemic of obesity and diabetes, we can expect more improvement.

As we enter 2013, it's worth reflecting on the AHA's goal to lower the rates of death from heart disease and stroke 20% by 2020. Current estimates suggest we won't make it unless we do more to prevent heart and blood vessel disease.