1) A Transition From Disease to Health 2) Heart Brain ... · 3) Imaging / Genetics / Tissue Regeneration ... Imaging / Genetics / Tissue Regeneration Complex ... SYLVIE STACHENKO,

1) A Transition From Disease to Health 2) Heart – Brain Integration 3) Imaging / Genetics / Tissue Regeneration

Complex – CAD to CVD

Subclinical -- HRP to DBD

Health -- IOM / COE to SHE

1) Translational 2) Quality/Effective 3) Social Responsibility

2

HEART

MI

1) Emboli

2)Thrombi

3)Hemorrh

BRAIN -

STROKE Thrombi

1. Cardiovascular Disease AHA

Macrovascular & Microvascular

2. UN Targets Top Killers

D Butler. Nature. 2011;477:261. At Present, 2011

R. Beaglehole et. al. Lancet 2008;372:1988 - > 30% Across, 2030

3. Prevalence of CVD is Increasing Treatment (Live Longer) and Technology - $

V Fuster et. al. Nat Rev. Cardiol. 2009;6:669.

EG Nabel, E Braunwald. NEJM 2012;366:54 – Age Adjusted

Rx, H-I $368 Bill, X3 10y

Rx, L-I MI, Pocket 80%

Rx, H-I $ 95% - Prev $ 5%

3a). Number and % of U.S. Population with Diabetes,

1958 - 2009

CDC’s Division of Diabetes Translation.

National Diabetes Surveillance System available at

http://www.cdc.gov/diabetes/statistics - 2011

http://www.cdc.gov/diabetes/statistics

3b). Health Care Expenditures and Life Expectancy in

the US and Ten Other Developed Countries, 2005

VR Fuchs et. al. N Engl J Med. 2011;364:1985

4. Progression of Cardiovascular Disease

R Corti, V Fuster EHJ. 2011 (April 19)

A Arbab-Zadeh, M Nakano, R Virmani, V Fuster, Circ.2012;125:1147

5. CARDIOVSCULAR RISK FACTORS (7) & LIFE STYLE

>2 Risk Factors

1. MI & 2. Stroke

25% in 10 Yrs

75% in 30 Yrs

3. DBD & 4. AD

Quality

Framingham (2010) 5, Interheart (2004)2: Obesity, (Diet), Sedentary

c

c






COMMITTEE INSTITUTE OF MEDICINE

VALENTÍN FUSTER (Chair), Mount Sinai Heart, New York

CIRO A. DE QUADROS Albert B. Sabin Vaccine Institute

JOHN W. FARQUHAR, Stanford Prevention Research Center,

ROBERT C. HORNIK, Annenberg School for Communic, U Penn

FRANK B. HU, Harvard School of Public Health

PETER R. LAMPTEY, Family Health International

JEAN CLAUDE MBANYA, Faculty of Medicine, University of Yaoundé

ANNE MILLS, London Sc.h of Hygiene & Tropical Med.

JAGAT NARULA, Division of Cardiology, Univ. Calif, Irvine

RACHEL A. NUGENT, Center for Global Development

JOHN W. PEABODY, Institute for Global Health, UCSF

K. SRINATH REDDY, Public Health Foundation of India

SYLVIE STACHENKO, The Sch. of Public Health, Univ. of Alberta

DEREK YACH, PepsiCo

B.B. KELLY, - Instute of Medicine

1. Behavior Risk, 2. Lack of Policy NCD,

3. Lack Intersectorial , 4. Mixt Health Delivery

12 RECOMMENDATIONS

( Research, Children )

National Heart, Lung, and Blood Institute

Institute of Medicine,

of The National Academy of Sciences

IOM – V Fuster, BB Kelly, eds Washington DC: Nat.Acad. Press: 2010

V Fuster, BB Kelly, R Vedanthan , Circulation. 2011;123:1671

Untreated BP<120/<80 mm Hg

Body mass index <25 kg/m2

Recommended dietary pattern

Untreated cholesterol <200 mg/dl

Untreated glucose <100 mg/dl

Absence of smoking

Recommended physical activity

1. Relation Between Biological / Behavior Components

of CV Health and Outcome (N=12744)

ARIC ((AR Folsom et. al.) JACC. 2011;57:1690. <1% Had Ideal / CV Health

NHANES (CM Shay et. Al) Circ. 2012;125:45. <1% Had Ideal / CV Health

CARDIA (K Liu et. al.) Circ. 2012;125:996 (Northw. Univ., NHLBI). 6% Behavior

2. Timeline of Major Documents on Global CVD

Promoting Cardiovascular Health in the Developing World; A Critical Challenge to Achieve Global Health.

Ed. V Fuster and B Kelly. IOM of the Natl. Academies. Natl . Academies Press. Washington DC.2010.

Promoting Cardiovascular Health in the Developing World; A Critical Challenge to Achieve Global Health.

Ed. V Fuster and B Kelly. IOM of the Natl. Academies. Natl . Academies Press. Washington DC.2010.

3. Recommendations By Targeted Actor

Workshop Summary. Washington, DC:

The National Academies Press. 2012

4

16

Centers of Excellence Program

Centers of Excellence Program

Goal: To establish Centers of Excellence to combat non- communicable chronic cardiovascular and pulmonary diseases (CVPD) in developing countries

Centers of Excellence:

–Enable capacity building

–Train future chronic CVPD investigators

–Conduct research on new or improved approaches,

programs, and measures to prevent or treat chronic

CVPD

17

NHLBI and UnitedHealth Group Collaborating

Centers of Excellence-Established on June 8th, 2009

New partnership between NHLBI & UnitedHealth Group

Network of 10 Collaborating Centers

–Six centers funded by UnitedHealth Group & NHLBI

–Three centers funded by NHLBI

–One center funded by UnitedHealth Group

18

1. Behavior Risk, 2. Lack of Policy NCD,

3. Lack Intersectorial , 4. Mixt Health Delivery

12 RECOMMENDATIONS

( Research, Children )

National Heart, Lung, and Blood Institute

Institute of Medicine,

of The National Academy of Sciences








C.H.S.

Motivation

Health, Well-being, Society – 2012-2020

Powered by / for Three Ages

2 . P.D.A.

Motivation

G.C.H.P. Motivation

“Extended healthy lives” in part due to medical research

generates dramatic returns - Albert & Mary Lasker Found.- 2002

Growing Toward Heart Health: Influences And Opportunities Into Adulthood.



COLOMBIAN HEALTHY HEART INITIATIVE

• Michael Farkouh

• Marilyn Hunt

• Beatriz Londoño

• Jennifer Chuang

• Jorge Baxter

• Carolina Nieto

• Mark Woodward

• Manuel Urina

• Magola Delgado

• María Lucia Mesa

• Rodolfo Dennis

• German Dario Briceño

• Martha C. Leal

• Zoraida Moreno

• Carmen Lucia Vargas

• Isabel Castaño

• Laura Sofía Céspedes

• Jaime A. Céspedes L.

• Directors, Teachers, staff.

• Parents and Children

• Valentin Fuster

1. PRESCHOOL TRIAL IN BOGOTA (N=6,000 – 25,000)

14 PF Underwent Randomization

C=1216; P/C=928; T=135

7 PF Intervention

C=622; P/C=493; T=64 7 PF Usual Curriculum

C=594; P/C=435; T=71

JA Cespedes, M Farkouh, M Hunn, V Fuster et al., 2012 (In Press)

GENERAL

PUBLIC

3-5 CHILDREN 6-8 9-14

SHE – Progres & Diseminación

HEALTHY FOOD HABITS

PHYSICAL ACTIVITY

HOW YOUR BODY & HEART WORK

EMOTIONAL HABITS TO AVOID

ADDICTIONS

EDUCATIVE GOAL: HEALTHY HABITS FOR CHILDREN BETWEEN 3 & 5 YRS

KNOWLEDGE (70), ATTITUDES (20) & HABITS (10), AT 6 & 18 MONTHS AFTER RECEIVING THE INTERVENTION

90

85

80

75

70

65

60

Sco

re (

mean

)

Baseline 6 months 18 months

Intervention

Period

Follow-up Period

Without Intervention

(p<0.0001)

(p=0.0064)

(p<0.0001)

(p<0.0001)

(p=0.1197) ‡

(p=0.7417)

Teachers Parents Children Control

JA Cespedes, M Farkouh, M Hunn, V Fuster et al., 2012 (In Press)

Intervention

period

Colombia Project Expansion (N=25,000)

September 5, 2011

ProSpain, Multidisciplinary Team

• Valentín Fuster Cardiology - PI

• Ramona Martinez Economics

• Isabel Carvajal Biology/Pedagogy

• Elena Roura Nutrition

• Yolanda Sánchez, Pedagogy

• Domingo Haro Pedagogy

• Xavi Orrit Physical activity

• Carla Rodríguez Psychology

• Gloria Santos, Biology

• Pedro López Biology

• Manuel Franco Epidemiology

COLABORATORS ON THE TEAM

Fundación Alícia, Alimentación y Ciencia.

S

H

E

.

1. Learn To Control Your Emotions

2. Growing Toward Health: Influences And Opportunities Into Adulthood.



. 2. Spain-64 Schools, 2012-2014 (9,500-100,000)

4 T’s – Health - Time, Talent, Transmit, Tutoring

4 A’s - Happy - Attitude, Accept, According, Altruism

3 years old 16 years old

C.H.S.

Motivation



2 . P.D.A.

Motivation

G.C.H.P. Motivation



V Fuster, R Vedanthan, BB Kelly, Circ 2011; 123:1671

1. GROUP INCENTIVE IOM - 12 RECOMMENDATIONS

• Blood Pressure

• Physical Activity

• Weight / Diet

• Smoking

1. CARDONA INTEGRAL – “FIFTY-FIFTY” PROJECT LIFESTYLE CHANGE OUTCOMES

HABIT YES YES/NO NO BASE 3 MO 6 MO

SMOKING 0 11 2 -- -- 2

OVERWEIGHT 0 12 2 -- -- 2

SEDENTARISM 0 13 2 -- -- 2

HYPERTENSION 0 14 2† -- -- 2

TOTAL LIFESTYLE SCORE -- 8

1 Half - 2 Half of Ideal (2 kg. Mo.) - 3 Half of Ideal (30’ 5 Days w.) 4 Still High (Salt Reduction) -- † Still High (Medical Attention)

2.b. PESA & AWHS 2.a. HRP > 55y.

40-54y, n= 8,000 , FU 0,3,6 y N=7000 FU 3y

Predictive ? Economics ?

Life Style & Imaging ?

PI: V. Fuster, Co-PI: E. Falk, P. Muntendam - AHJ 2010;160:49

Natl Lung Screening Trial Research Team (DR Aberle) NEJM 2011;365:395

C.H.S.

Motivation



2 . P.DA.

Motivation

G.C.H.P. Motivation



2007, 2008, 2009, 2010, 2011

CNIC - Discovering / Tutoring

SHE Spain 2011-2014 (2,000-100,000)

Fundacion SHE




