Chapter 6

Cardiovasc ular Disease

From rhe lllOlllellt of birth until dealh,
the human heart pumps continuously,
Normally the size of a fist, this incred-
ibly powe rful muscle literally is lift:
itself. The heart's form and funC[iOIl
have been stl1died for centu ries, lead ing
to inc redible advances in knowledge
and interventions. However, cardiovas-
cular disease (eV D) rem:llns the leading
killer for both men and women among
all racia l and ethnic groups in rhe
United States. Indeed. cardiovascular
disease was t he greatest epidemic of
the 20th centu ry, outstripping lllfcc-
tiolls diseases suc h as polio and AIDS.
The epidemic peaked around 1968 in
the United States, with :\11 impressive
2.6 perce nt decline in eV D mortality
per yeJr from 1968 to 1990. TheSe
declines have been recognized as olle
of the greatest health achievementS in
the 20th century.
TIll' /rlw"m /rcllrf.
Despite these declines, Olle person dies every 30 seconds
from e vo, mo re t han 2,600 people eve ry day. Almost one
million Americans die of eVD each year, representing 42
percent of :til dCJths. Of these. 160,000 arc indiv iduJls
betwcen the ages of 35 and 64 years, an indi cation of how
w idespread eVD is in the popubtion, not just among ol der
Amcri c:tlls. Heart disease and strokt' account for nearly six
Illillton hospitalizations each year and cause disability for
almost 10 million Americans aged 65 years and older. The
COStS of treJtment approach 5329 billion each year when
lost productivity from disability is factored in, encompass-
ing physic ians, profc ss ional~ , hospiral Jnd nursi ng home
services, mcdi c:t tions and home healrh ca re. There is evi-
dence that, despite the declines in dCJth rates, the rate of
new cases of ev o has not declined. A large proportion
of eVD patients are hving wi th their disease. l3 y 2050, In
estimated 25 million Americans will ca rry the diJgnosis
of coronary heart diSCJse.
Looking Back
A Brief History of Cardiology
One of the earliest physicians, Imh otep (circa 2725 13C),
was rC!:,'<l.rded in ancient Egypt as the god of medicine. I-Ie
is said to have been the first to connect the pulse rate with
the resulting action of the heart . It was not until the tillle of
H ippoc[:l CCS (460-377 DC), in ancient Greece, that the heart
was mentioned again in medical rather than spiritual or
mysterious terms. Hippocrates believed that the heart was a
strong muscle and unde rstood e nough of its structure t hat
he provided theories on the function of the heart's valves.

R.oughly another SOD years passed before Cla udIUS Galen

(AD 130-20 I). co nsidered the father of cardiology, studied N /I 0 T I:
th e heart in detaiL An authority on anJ.tOI1lY in a n cient llllholep (fi rea 2725 BC).
R ome, Galen was not allowed to dissect human bodies,
R ather, his knowledge of the heart cam e from dissecting
Barbary apes. It was no surprise, therefore, that much of
Galen 's work proved later to be !l1 correct. Nonetheless, his
imerest in the anatomy of the heart laid the foundation of
ca rdiac study in futu re ce nturi es.

In the 16th century, more progress in undcrstanding the

truc function of the heart was made. The work o f Miguel
Sc rvcrus (1511-1553), a Span iard, preceded the discoveries
ofWiIliarn Hlrvey on blood circulatioll . Unfortunately, his
work went unrecognized as he linked his medical views
with theological writings thlt were deemed heretical.
Fortunately, Amireas Vesalius (1514-1564), a graduate
of Padua U niversi ty in Italy, enjoyed greatet intellectull
freedom, leading to the publication in the mid- I 500s of
his studics on the hea rt.

Another graduate of Padua University was WIlliam H arvey,

an En glishm an. Harvey was f:1scinated by th e w ay blood
flowed throllgh the human body. [n [628, he published All
AI/afomicnl SlIIdy oj l/1e M Oliol/ oj liI(' H eMI alld oj Ihe Blood ill
AI/imnls, which explained how blood is pumped frolll rhe
heart throughout rhe body, then returning to the heart and
reci rculated. Ha rvey's views, controversial at the time, con-
WilIiallJ Harv<'I'
rr:l.dicted the belief of many people that the liver and not explail1cd IroUI ,ire //('I/r/
the heart ca used blood to flow. Ha rvey's work became the pumps al1d rrcircu/irl('S
blsis for modern research on the heart and blood vessels. blood,

, taken from a corpse with liquid wax.
DraWIII,!! <~r III(' 111"11(111
IlFllrl 111111 b/<'<J(I IIrss('/s
by UOlI(lrilu till Villd.
• version of a stethoscope. l3 y the end of the 19th century,
• scope offered an immediate diagnOS IS at a minimal cost.
A II early l'l'rsi,,,, oj II
SletIrM(Ope.
It IS likely that both Vesalius and Harvey
wcre greatly innuenced by the anatomi-
cal drawings of Leonardo da Vinci
(1452- 1519) showing thc structure of
the heart. After injecting a hUlllan heart
da Vinci more clearly illustrated the
different components of the organ.
Nearly tWO centuries later, the invell-
tioll of the microscope by Anton van
Leellwenhock (1632-1723) opened
new doors to an understanding of
capilla ries, small veins and arte ries.
In 1714, the English physIOlogist,
chemist and inventor Stephen Hales
(1677-1761) conducted the first experi-
ments with blood pressure whcn he
opened an artery of a horse, IJ1serted a
brass tube, determined the existence of
something called blood pressure and
dev ised a mechan ism for measuring it.
Hales published his experimcntal findings under the title
/-laClllaSlati(ks. He :lisa discovered that blood pressu re v:lried
between veins and ;lrteries and between the contractions
:lnd dilations of the heart. S:lfcr methOds for measuring
blood pressun;' :lppe;lred more th:m a cemury later with
M arey 's wrist sphygl1logr:lph, designed in 1857, followed
by Dudgeon's, des igned in 1882. Both we rt~ gre:lt steps
forward in the search for cOllwnie nt , simplified ways to
rlle:lsure blood pressure. At the tillie, Dudgcon's device
W:lS so successful rh:lt it beC:lllle st:lndard equipment for
till: U. S. N:lvy.
R.T H . Lacnnec, a French physici:lll. first began using a
hollow wooden cylinder in the early 1800s, the earliest
nexible, binaural stethoscopes were COllllllon. Although
some physicians fdt the invemion of the stethoscope we;lk-
eneel the physiCian's own powers of diagnosis, tht' stetho-
Tire invention of the electrocardiograph by Wille!n
Eimhovell of the Netherlands enabled physicians to
become diffe rentiated as speci:ilists in heart disease.
Einthoven received the Nobel Prize for hi s invention in
1924, the same ye:lr the Allleric:11l Hear t Associa tion was
founded. Through the remaining decades of the 20th cen-
tury, tbe fi eld of ca rdiology became further specialized.
Numerous professio nal organizations and associations were
created to accomtllodate the amazing pace of scien tific and
clinical discovery rd ated to the heart. c
 Case Study
Risk Assessment
Risk f.1ctor screening, accompanied by lifestyle modifica-
tions - stich as a healthy diet :md regular exerc ise - call
lead [0 early detection of fisk and prevention of cardio-
vascular disease. Cardiovascular disc3se l1 SlI:J.lly presents as
three distinct types: coronary artery disc:l~e (CA D), stroke

, and periphera l arterial disease. Atypical presentations also

abound. ... Itisk f.1ctors include nonlllodifiable risks -
:lgt::, gl'IHier, race and f.111lily history - and behaviorally
Risk faccors
modifiable risks, such as obesity, high-f.lt :lnd high-
include 110n-
cholesterol diet, a sedentary lifestyle and smoking. CVD is
modifiable risks -
also caused by physiologic risk factors, such as hyperten-
age, gender, race
sion. hyperlipidemia and diabetes mellitus (types land 2),
and family history
which often require pharmacologic treatments in addition
- and behaviorally
to lifestyle modific:ltions.
modifiable risks,
such as obesity, V:lriOllS tests lIsed to screen for CV]) provide a hopeful
high-f.1t and path to uncoverlllg and tre:lting C:lrly cardiov:lscubr disease
high-cholesterol before it develops into a marc serious condition. Physici:llls
dict, a sedentary can lise simple, noninvasive tests, sLlch as risk-f.1ctor assess-
lifestyle and ments bcfore Illoving to Illore complic:lted - and usually
smoking. more expensive and invasive - tests bter. Risk f.1Ctors for
he:lrt disease to be assessed in patients over age 20 include:

• Family history of CVD

• Smoking status

• Dlct. cholesterol ami physical activity

• l3lood pressure

• l30dy weight and body mass index

• Waist circumference

• Fasting blood lipid profile

• Fasting blood glucose

These risk factors can be llsed to calculate :l global risk

score ill people 40 years and oldn, providing an estimate
of the 10-year risk of heart attaCks and death frolll cardiac
d;~ease.
Advances in (he tests currently available fo r hean disease
continue to evolve. At present, available noninvasive tests
include:

• Resting electrocardiogram (ECG o r EKG)

• Signal - averaged electrocardiogram (SAECG)

• Chest X-ray
• Holter monitor (ambulato ry electrocardiogram)

• Echocardiogram

• Exercise stress [cst

• ComplUcd tomography (CT) scan

• Magnetic reson:l.Ilce imaging (MR I)

• Magnetic resonance angiog raphy (MRA)

Nuclear imaging tests, which are noninvasive , include: Ec/romrdiogmlll

• MUGA scan
• Thallium stress test

• Technicium stress test

• PET test
• Stress echocardiography

Other invasive imaging tests include:

• Transesoph ageal echoca rdiogram (T EE)

• Cardiac cathete ri zation ("cath") - also known as

corona ry angiography

• Intravascular ultrasound (IVUS)

Recent developments indiC:1te th:lt high levels of tll:1rkers

of infhmmation, such :1S C-re:1ctivc protein (CRY), Ill:ly
:lIsa be markers for incre:lsed ri sk of CVD. As :l screening
tool. blood levels of infbmrnatory markers may one day
become as familiar as cholesterol and blood pressure
numbers, but tests with greater specificity need to be
developed . In patients presenting with chest pain of
unknown cause, measurement of c:lrdiac troponin T can
reliably detect damage to the heart frOI1l a myocardial
 IIlfarctioll within one day after the onset of chest pain, all
indi ca tion of how colltinuing improvemcms in diagnostic
tests help identify pati ents at high risk. Yet another risk fac -
tor, fibrinogen , a protein that forms blood elms, is now also
thought to be a Illarker for cardiac risk. Finally, a simple
measurement of blood pressure in the arms and ankles
provide the ankle- bra chial blood pressure ratio. This has
bee n found to be a reliable predictor of CVD in peopl e
older than SO years of age. IJ

Cbssification 3nd M3!1 3gcmcm of Blood i'resmre for Adults Aged I XYe3r~ or Older

Illitial Drug
HP Systolic Bp· D iastolic Hp· Lifestyle
(Without Compelling
Classification I (Illlll!-lg) (mill !-Ig) Modification
Indications)

Norm.1 <t211 <80 Encnn"'!;'"

No ~""hypc"~"""~ dn'!;
I )~-hypcncm!o" 120-139 "< 80-89
uuh rOled

~t.Olle , TI"az"Ic-,ypc dll''''uc, for mo.l,;

may com;da ACE ",h,bllor.AItB.
hYI'"ne,,,,<>,.
140-159 "< 911-99
Ik,a blochr. COl.
o r (0",b".3UOII.

Two-dril l: CO lllb"I>UOII for mOS,

S,ag'" 2 ("'''J ll y tI" JZ ,d~~lyI'C """ ...;e and
hype",·",;""
2:160 "< >HXJ AC E ,,,l,,lm<)r or AIUI or li eu
blocker or Cell).

hu,,, 'he .s.,...",h ~..,...,.., ".i,h, }»~, ,\'""""~/ G,," ,,,,,,,.,. ,m 1_.. ,,,,,,. /,,"'1"(1,"" . I ;",/"~,,,,~ ""J·Ii..~",,,,,, of //,.~h /11",.1 I",,,",,
aSCI'III.ZOO}.
Abbr<v.,,,',,,,AC~. >"I\''''e'''''' ....·o,,'''''''''~ .... ~",,·:A IUJ .• "~,,..<CO"'''_r<"<"~I''''' bl<.><kt·r: UP. blood 1'='''''': (;(:11. <>1;""" ,·h.",,,.1
bl .... k,. Tn·>tmcn, dctCfO"",,,1 by h'l\l".,., Ill' <><c!:'''r
- Tn·>tmc,n d<tcrm",cd by ,h,' h,gIo .... IJI> <>'(!S"'r

I
I'
114

Vignette
Statins
High blood cholesterol is a well-accepted risk factor for CVD.
Most cholesterol is carri ed in th e blood in two forms, high-density
lipoprotein (HDL) and low-density lipoprotein (LOL), with only
HDl considered advantageous for fighting the acculllulation of
plaque in the blood vessels that leads to CVD. A high LDL level , all
the other hand , usually signi fi es that a patient is at risk for eVD.
Federal guidelines on cholesterol have changed in the last ten years,
with stronger recommendations for lowering total c holesterol while
maintaining appropriate HDL levels. The cu rrent guidelines are:
• Patients should consume 110 more than seven percent o f calor ies
from s:tturated fa t (the previous recommendation was ten percent).
• Adults are advised to consume no more than 35 percent of
calories from total fat (the previous recommendation had been
30 percent), prov ided that the main source is unsaturated fats,
which do not raise cholesterol levels.

• Ideal body weight should be attain ed and maintained.

• T he new target for dietary cholesterol is less than 200 mg pe r day
(the previolls target had been under 300 mg per day).

• An optimal LDL-C level is 100mg/dL or less per day for all adults.
The recommendations ca n be difficult for the average healthy con-
sumer [Q follow, and ideal LDL-cholesterollevels may be especi:llly
difficult for so m e CVD patients to achieve through diet alone. The
development of the class of dtugs known as statins has changed the
way many physicians manage patients with high cholesterol.
Clinical knowledge of how [Q counteract elevated blood c holesterol
dates back only three decades. Rese:lrch mto inhibitors of H MG-
CoA reductase, part of the body's metabolic pathway fot the synthesis
of c hol esterol, began in Tokyo,Japan, in 1971 in the laboratory of
Drs. Endo and Kuroda. This team reasoned that certain mic roorga n-
isms may produce inhibitors of this particular enzyme to defend
themselves against othe r organisms. Th e first agent to be isolated was
m evastatin, a molecule produced by Penicillium citr;IIUIII. Th e pharma-
ceutical company M e rc k showed an interest in the research in 1976
and isolated lovastatin from the mold A spergillus terrel/s. Lovastatin
would become the first statin to be cOllllnerci:llly marketed and
would have a dramatic effect on the way high choleste rol is treated.
 liS

As of 2005, six statin drugs are on the market in t he United States.

Studies using statins have reported 20 percent to 60 percent lower
LDL-cholestcrol levels in patients on these drugs. Statins also reduce
elevated triglyceride levels and produce a modest increase in HDL-
cholesterol. While most patients tolerate statim well, side effects
can include muscle aches and abnormal liver function tests.
Some have questioned the safety of statins, especially given their
widespread use in the U.S. When a statin is given at a high dose,
the risk for developing abnormalities in liver tests is one to two
percent per year. These abnormalities can be reversed, however, by
simply reducing the dose or by stopping t he drug. Another common
side effect, occurring in somewbere between one to two percent of
patients, is muscl e aches or, more rarely, inflammation of the muscles,
called myopathy, in which an enzyme from the muscle leaks into tbe
blood.
Whic h patients are cons idered candidates for statin therapy? The list
is lengthy.
• Those who have had heart attacks or chest pain or those who
have undergone bypass surgery or 3ngioplasty, with :an LDL-
cholesterol g reater than 100 mg/dL.
• T hose with diabetes and those with multiple other risk factors
for heart disease with an LDL-c holesterol greater than 100 mg/dL.
• Those with evidence of blockage in the arteries carrying blood
to the brain (carotid artery disease) or the legs (peripheral vascu-
lar disease).
• Those with LOL-cholesterol grea ter than 160 mg/d L and two
other risk factors after :I t herapeutic lifestyle cha nge or dlOse
with LOL-cholesterol greater than 190 mg/dL with either one
or no risk facto rs. As research progresses, however, new lipid
targets may be recognized.
Statin t reat ment gained unintended public attention with the eme r-
gency heart bypass operation of former pres ident William Cl inton in
2004. Some years earlier, an elevated choleste rol count led the fo rmer
president'S docto r to presc ribe a statin to counte r what was fea red to
be incip ient heart d isease. When the count returned to safe levels rel-
at ively quickly, Preside nt Cl inton chose to d iscontinue usc rather than
follow medical advice :lnd continue to take the statin. As t he world
discovered, that choice may have been a factOr in the fo rmer presi-
dem's development of coronary disease, unde rscoring t he rule that
once a patiem begins a regimen of statins, he should continue that
regi men fo r the rest o f his life. D
Looking Ahead
Obesity in Young Populations

The growin g e pide mic of obesity in young people offers

the public health co mmunity a chall e nge and an opportu-
nity to prevent disease and instill healthy lifestyles. How
to prevent obesity is no secret - a combin:ltion of physical
activity and wise choices in nutrition can have an 11llll1edi-
ate impact on weight and foster long-lasting healthy behav-
ior. R ed uced weight helps prevent diabetes :md cardiovas-
cular disease, among other health threats ca used by being
overweight. Success in this endeavor does not bappen
overnight and req ui res :l long-term commitm ent. An
II1vcstment made today by the public health and medical
COlll tlllllliries, along with schools and governments, will
pay dividends in future healthy adult populations.
The American H eart Association estimates that the preva-
lence of obesity has increased by 75 percent since 1991.
M etabolic syndrome, perhaps the ea rli est wa rnin g sign of
developing health problems, occurs predominantly in peo-
ple who are overweight. As many as 55 million Americans
may meet the diagnostic c rite r ia for metabolic syndrome.
In [988, Dr. Gerald M. R eavan, an e ndocrinologist at
Stanford University, first described somethmg he called
Syndrom e X, noting th at patie nts who presented with a
cluster of low-level risk f.1.ctors had a substantiall y increased
r isk for heart disease. In 1991, the National Cholesterol
Education Program at the National Institutes o f H ea lth
issued a report that renamed Syndrome X as metabolic
sYlld rome. The report em phasized obesity as a ce lHral
componen t of metabo lic syndrome and recommended
other screening tests that would be easy for primary care
doctors to use.

Physicians suspect metabolic syndro me when people pres-

ent with at least three of the follOWing five criteria: having
an increased girth arOLind the abdomen, having moderately
high blood pressure, havin g high blood levels of f.1.ts cal!ed
triglycerides, havi ng low levels of HDL ("good") choles-
terol and having above-average blood sugar. It has been
estimated that one million U.S. teenage rs have been di ag-
nosed with the syndrome, rep rese nting fOllr percent of
American adolescents . Th ese yo uths are believed to be at
 sharply increased risk for developing diabetes when they
arc still in their 20s. if nOt before, and hean disease as early
as their 40s.
The American H c;'tr[ Associ:ltion Coullcil on Cardiovascular
Disease in theVollng recommends early detection of blood
pressure elevation. Management for prim:lry hypertension
includes dietary counseling and physical activity prescrip-
tions. Pharm:lCClltic31s :uc reserved only for children whose
blood pressure is consistently very high. Moderation in the
lise of salt is also recommended, since the diet of the aver-
age American child contains Illllch morc sodillm than is
required.
MichJd Weitzman and Steve Cook of the American
Academy of Pediatrics' Center for Child Health Rcsearch
and the De partmellt of Pediatrics at the University of
Roc hester analyzed data on 2,430 adolescents aged 12 to
19 betwee n 1988 and 1994 for the Na tional H ealth :l11d
Nutrition Examination Survey, a nat ionally representative
ongoing federal survey of the U.S. population. The study
showed that 4.2 percellt of adolescc[l[~, or 910,000 teens,
met the criteria for metabol ic syndrome. The syndrome was
found in at least 6. 1 percent of males and 2 . 1 pe rcent of
females. The researchers found that nearly 30 percent of
those who are cither overweight or obese have the syn-
drome. Fortunately, if this population loses weight, the risk
of diabetes and heart disease drops sharply.
, .. One-third to one-half of the population with meta-
bolic syndrome subsequently develops diabetes. Even before
O ne-third to t he onset of diabetes, high blood lipids and other risk fac-
one-ha lf of tors can ca ust:: cardiovascular disease. The earlier mean age
the populat ion of onset for type 2 diabetes of adolescents is startling and
wi th metabolic disturbing, because CVD development that takes place over
syndrome subse- m:l1ly yea rs in adults starts much earlier, potentially leading
quently deve lops to onset of CVD in early and mid adulthood. Oel1lg over-
d iabetes. weight is ne:arly :alw:ays the trigger for type 2 diabetes (ve r-
sus type 1 diabetes, which is triggered by abnormalities in
insulin production and usually diagnosed in childhood).
The onset of di :a bctcs carries with it the distressing proba-
bility of cardiovascular dise:ase within twO decades, greatly
inc reasing the chances for premature de:ath. l3Iac k and
Hispanic Americ:ans have nearly twice tbe inc idence of
type 2 diabetes :as whites and many Native Americ:an tribes
are experiencing epidemic rates.
... The !lumber of overweight children tripled between
1970 and 2000, reaching 15 pcrcellt of those between the
,
ages of six and 19. The highest growth rates have been in The number
African-American and Hispanic youth who live mainly o f overweight
in inn er cities, where access to opportunities for physical chi ldren tripled
activity is often limited. In addition, research has shown between 1970 and
that adolescents who exhibit hi gh levels of hostility are 2000, reaching 15
more prone to becoming obese and developing insulin perce nt of those
resistance, cwo markers of metabolic syndrome that make betwee n th e ages
these youth more likely to develop cardiovascular disease of six and 19.
in adulthood. Current research also links sleep disorders
with metabolic syndrome.
To counter these disturbing trends, the public health com-
munity is seeking new ways to communicate the benefits
of weight control, hcaithier eating and physical activi ty to
reinforce even more effectively that improved lifestyle is a
key to good health for young adu lts and children. Trail1lng
children to live healthy lifestyles can improve cardiovascular
health in adu lt life and is a strategy that must become
widespread in schools, especially inner-city schools that
se rve a high proportion of minority populations.
The health benefi ts associated with a physically active
lifestyle in children include weight control, lower blood
pressure. improved psychological well-being and a predis-
position to increased physical activity in adulthood.
Increased phys ical activity has been associated with an
increased life ex pectancy and dec reased risk of ca rdiovascu-
lar disease. R esearchers have also shown that people who
cat breakfast every day, espec ially whole-grain cereal, are
f:1r less likely to be obese or have diabetes or heart disease.

A healthy level of physical activity requires regular partici-

pation ill activities that generate ene rgy expendi tures sig-
nificantly above the resting level and ideal ly grea ter than
half of maximum exertion . These activities may be accom-
plished through both recreational pastimes and organized
SpO rts. Physical activity in American childre n, however, has
diminished for a variety of reaso ns. Children rely more on
the automobile fo r transportati on, as opposed to walking
or bicycling. Growing numbers of chi ldren also engage in
sede ntary em ertainment, including television, video games
and com puters. Unfortunately, participation in organized
athletics diminishes greatly afte r middle school , a spec ial
problem for girls.
 Although these trends of diminished physical activity

, are nationwide, socioeco llo mic factors place certain sub-

populations of children at greater risk. .. [n large cities,
a lack of safe outdoor play areas limits children's ability
In large cities, to participate in active physical play or recreational sports.
a lack of safe With tightening school budgets and changes in curricldlllll,
outdoor play areas regubr physic;'!] education in sc hools has been de-emphasized.
limits childre n's Th e number of families with two working parents or a
ability to partici- single parent bas increased, with the result chat 111:I11Y more
pate in active parents are limited in theif ability to encourage participation.
physical play or
recreational Federal, state and loca l health departments are working
SpOrts. together [Q counter these alarming trends. CDC. after
much analysis and collaboration , published the following
health promotion and disease-prevention strategies aimed
at obesity:
• Ensure daily quality phys ical education for all school
grades.
• Ensure that more food options that arc low in f:1 t :lT1d
calories, as well as fruits, vegetabl es, whole grains and
low-fat or nonfat dairy products, arc available on
sc hool campuses and at school events.
• Make cOll1ll1llllity r.1cilities available for physical
activity for all people, including on weekends.
• Create more opportunities for physical activity at
work sites.
• Reduce tim e spent watching television and in o th er
sedentary behaviors. In 1999,43 percent of high
school sw dents reported watching two hours of TV
or 1110re a day.
• Educate all expectant paTems about the benefits of
breast- feeding. $mdies indicate that breast-fed infams
may be less likely to become overweight as t hey grow
older.
• Change the pe rception of obesity so that health
becomes th e chief co ncern, not personal appearance.
• In crease research on the behavioral and biological
causes of overweight and obesi ty. Direct research
toward prevention and treatment and toward
ethnic/racial health disparities.
 • Edu cate health ca re providers and health profession
students on the prevention and treatmenr of over-
weight and obesity across the lifespan.
Although it is widely accepted that healthy diets and daily
physical activity together help control we ight and prevent
the onset of CVO, the American population nonethc1e~s
suffers from an epidemIc of overweight and obesity.
Currently 122 million adults are overwt:ight and at risk for
hypertension and related conditions that ca n lead to CVO.
The well - kn own benefits of physical activity and a healthy
diet have not forestalled the epidemic of overweight and
obesity in the United St3tes nor the resulting epidemic
of diabetes and cardiovascular disease. Unless significant
changes arc made, today's overweight and obese children
will be tomorrow's unhealthy adults. Not only will this
affect the health of the U.S. population, it will also become
an economic drain on an already overburdened health care Dr. TJ,omas A.
syStem. All of the diagnostic and treatment advances in Pcarsoll , proJc5Sor (if
CVO should mean that this disease is ab3ting. Unfortunately, Co m,mll/ilyand
the incidence ofCVO is not declining, 3nd the public health PrevwlillC M edi(i,, /,
community ~ in partnership with medical, educational and ar lirl' UuivwilyoJ
legislative en tities - mUSt find innovative solutions to this Rocircsler.
challenge.
Thomas A. Pearson, MD, MP H , PhD, Professor of
Community and Preventive M edicine at rhe University
of R..ochester, suggests, .. "The spectacular reductions
in cardiovascular d isease mortality seen in the 19705 and
,
19805 are in great danger due to th e obesity epidemic. For "The spectacular
the first time in U.S. history, experts are warning that the reductions in
life expectancy of ou r childre n may be less than our own. cardiovascular
These dire predictions ari se from the epidemic of obesity d isease mortality
in our children and the return of the eVD epidemic 3S seen in the 19705
they become adults. A combi ned effort of cl inical alld and 1980s are
publ ic health strategies to reduce obesity will be absol ute- in great danger
ly essential. If we t:1il, the 2010 health goals set for the due to the obesity
United States will prove unattainable." a epidemic."
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