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ACC-New York, Dec. 11, 2015 No Disclosures
PROMOTING HEALTH
CHILDREN, FAMILY & COMMUNITY
Leadership & Motivation
Documents on Global CV Health – Follow-up ?
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.
Institute of Medicine Experience
“A Critical Challenge to Achieve Global Health”
2011 June 27 2014
Circ. 2011;123:1671 12 RECOMMEDATIONS
“FUNDING THE FIGHT AGAINST CHRONIC NCD”
Sense of Need - Local, National and International
Government, Non-Profit Private, For-Profit Private, Partnerships
“EDUCATION & LOCAL DATA”
Census-Based, Survey-Based, Study-Based - Great Impact
ACC-New York, Dec. 11, 2015 No Disclosures
PROMOTING HEALTH
CHILDREN, FAMILY & COMMUNITY
Leadership & Motivation
Health & Quality of Life (QoL) – Aging (A) to Birth (B)
B
B
B
Prom.
Health
Subcl.
Disease
Stable-Unst.
Disease
Window
Young
Future
Behav.
Change
Adherence
Simplicity
25 50 75 100
25 50 75 100
A
Present
Late
Expensive
Early
Economic
Health (QoL)
A
A 0
Science
Education
V Fuster, JACC 2015 (October)
Environment
Policy Mandatory (?)
Air Pollution & Noise
Education
0
JN Giedd. Scientific American 2015;312:32
Child’s Brain Development
Less Networking Brings Atention
1B
GENERAL
PUBLIC
3-5 CHILDREN 6-8 9-14
EDUCATIVE GOAL: HEALTHY HABITS FOR CHILDREN BETWEEN 3 & 5 YRS
COLOMBIA – CHILDREN’S PROGRAM
1. In Children’s KAH Mean Scores*
40.0
50.0
60.0
70.0
80.0
90.0
100.0
0 18 36
Sco
re (
me
an)
Knowledge Attitudes Habits (physical activity)
p< 0.001
p< 0.001
p< 0.001
p< 0.001
p< 0.001
The Amer J of Med 2012; 126, 27 The Amer J of Med 2013;126:1122 Bogota – 25,000
JL Peñalvo, V Fuster et. al. JACC 2015 (In Press). - 75,000,
2. Changes In Anthropometric Variables
At Each FU In Overweight Children
Body Mass Index (BMI)
Waist Circumference (WC)
ACC-New York, Dec. 11, 2015 No Disclosures
PROMOTING HEALTH
CHILDREN, FAMILY & COMMUNITY
Leadership & Motivation
Health & Quality of Life (QoL) – Aging (A) to Birth (B)
B
B
B
Prom.
Health
Subcl.
Disease
Stable-Unst.
Disease
Window
Young
Future
Behav.
Change
Adherence
Simplicity
25 50 75 100
25 50 75 100
A
Present
Late
Expensive
Early
Economic
Health (QoL)
A
A 0
Science
Education
V Fuster, JACC 2015 (October)
Environment
Policy Mandatory (?)
Air Pollution & Noise
Education
0
Subclinical Disease (N=10,000)
Carotid 3D-US, Coronary Calcification
U Baber, R Mehran, V Fuster, et al. J. Am. Coll. Card. 2015; 65: 1065 L Fernandez-Friera, A Fernandez-Ortiz, V Fuster et.al Circ 2015, 4/20
c
?
A Health Center
In The Adult Brain (?)
To Stimulate / Motivate
2B
1. AMPATH Centers In Kenya
BP Control / Non MD / High Technology
R Vedanthan, V Fuster, NHLBI / Kenya Model (2012-2016)
2a. CARDONA INTEGRAL – “FIFTY-FIFTY”
SMOKING 0 11 2 -- -- 2
OVERWEIGHT 0 12 2 -- -- 2
SEDENTARISM 0 13 2 -- -- 2
HYPERTENSION 0 14 2† -- -- 2
TOTAL HABIT SCORE 8
95% of the people have improved in one or more of the habits or RF.
SIX MONTHS
86
69
96
104
127
70
86
N=552
2b.The Seven Community Study
E. Gomez, V Fuster et al 2015 (Subm)
Approach 3: PESA Program, Madrid – AHA 2015, Orlando
2c. Global Demonstration Project - GHP
1975
2000
2000
High Risk Factor Profile
2c. GHP-CHANGE
Grenada Heart Project –Community Health ActioN to
EncouraGe Healthy BEhaviors.
Planning
• August/Sept
2014
Baseline
Assessment
• Completed
March
2015
Group
Meetings
• Ongoing
currently
Midpoint
Assessment
• August/Sept
2015
Post-Interv.
Assessment
• March/April
2016
>1 CV Risk Frs
N=402
Monthly Group
Meetings
12 month GHP
Outcomes Score
Self-
Management
12 month GHP
Outcomes Score
R
Health & Quality of Life (QoL) – Aging (A) to Birth (B)
B
B
B
Prom.
Health
Subcl.
Disease
Stable-Unst.
Disease
Window
Young
Future
Behav.
Change
Adherence
Simplicity
25 50 75 100
25 50 75 100
A
Present
Late
Expensive
Early
Economic
Health (QoL)
A
A 0
Science
Education
V Fuster, JACC 2015 (October)
Environment
Policy Mandatory (7)
Air Pollution & Noise
Education
0
1. DBD/AD - CVRFs, Lacunar Les., < Cognitive
MRI – Perfusion
Ischemia affects 60 to 90% of patients with Alzheimer’s
1.V Novak, I Hajjar. Nat. Rev. Cardiol. 2010; 7:686(HMS)
2. HW Querfurth, FM LaFerla. NEJM 2010; 362:329
Autopsy (n=6000)
3. JB Toledo et al. Brain July 10, 2013
CV Risk Factors, Cognitive Function, Imaging
4. CARDIA (K Yaffe et al) Circ. 2015 (In Press)
5.JI Friedman, V Fuster et. al– JACC CV Imag. 2015 (In Press)
Intervention
6. FINGER (T Ngandu et al)., The Lancet 2015; 385:2255
3B
2. Aging / Frailty
Oxidative Stress on Telomere
B Niemann et. al. JACC 2011; 57: 577.
R Madonna, R De Caterina et. al EHJ 2011;32:1190 (Houston &Chieti, Italy)
JC Kovacic, EG Nabel, V Fuster – Circ. 2011;123:1650
1
2
4
3
3. CV Drugs Underuse - Polypill, 2ary Prevention.
Am. H J 2011;162:811 Semin.Thor.Cardiov.Surg 2011;23:24 JACC, 2014; 64:2071 Approved in 26 Countries
* Valentín Fuster (inventor)
FOOD INTERACTION
PHARMACOKINETIC INTERACTION WITH ASPIRIN
PHARMACOKINETIC INTERACTION WITH
SYMVASTATIN
PHARMACOKINETIC INTERACTION WITH RAMIPRIL
PHARMACODYNAMIC INTERACTION WITH ASPIRIN
PHARMACODYNAMIC INTERACTION WITH
SYMVASTATIN
PHARMACODINAMIC INTERACTION WITH RAMIPRIL
BIO-EQUIVALENCE
ASA, Statin, ACE-Inhibitor
Argentina Brazil Paraguay Italy Spain
FOCUS 1 & 2
FREEDOM
AETNA-DIABETES
SECURE-EC 2015
Colombia / Spain
Behavior
Science, Health, Education(SHE)
2 . Five Countries
Kenya/Spain/Grenada
IIIP / PPPI
“Extended healthy lives” in part due to medical research
generates dramatic returns - Albert & Mary Lasker Found.- 2002
Polypill
American Heart Association,
Focused Prevention Research Center
Family-Based Approach
Prevention of CVD in a Minority Community
Integrating Systems-Biology
Icahn School of Medicine at Mount Sinai
Head Start Organization
O
Start
Start
Children
3 Groups
Caregivers
3 Groups
P
P
P
P
P
P
Teachers
O
I
I
I
O
O
O
O O
O
O
O
O
O
KAH-BEA
Mol. Genomics KAH-BEA S-KAH-BEA
BEWAT
Point of Care.
3D-US
Mol. Genomics
O
IP
II II
O
IP
Contr./Interv.
S-BEWAT
Point of Care
BEWAT
Point of Care
3D-US
Mol. Genomics
1st
Yr 2nd
Yr 3rd
Yr 4th
Yr
Intervention.
Intervention
Control
IIIP
PPPI
KAH-BEA = Knowledge, Attitude, Habit -BMI, Exercise, Alimentation
PPPI = Peer-to-Peer Program Interv;
IIIP = Intensive Individual Intervention Program
BEWAT = BP, Exercise, Weight, Alimentation, Tobacco
(1)
(2)
(3)
(3)
(1)
(2)
Wearable Tech
Lanzamiento de la versión internacional THE CIRCLE OF HEALTH
Actividades previstas
Interactive “Circle of Health” - App
FC Barcelona
Evolving Partners
Engaging Partners
Mount Sinaí
Heart
ACC-New York, Dec. 11, 2015 No Disclosures
PROMOTING HEALTH
CHILDREN, FAMILY & COMMUNITY
Leadership & Motivation
HEALTH
ENVIRONMENT
SCIENCE
EDUCATION
EDUCATION
CARDONA
HARLEM
GRENADA
KENYA
MADRID
BOGOTA
Co
ntin
uity
Community
Family
Adults
Children
ACC-New York, Dec. 11, 2015 No Disclosures
PROMOTING HEALTH
A CHALLENGE FOR SCIENCE & EDUCATION
Leadership & Motivation