Edisto Fork United Methodist Church Orangeburg, South Carolina - PowerPoint PPT Presentation

Edisto Fork United Methodist Church Orangeburg, South Carolina February 11, 2016

Brent Egan, MD ISHIB 14

Tri-County Health Network & ISHIB Present: Cardiometabolic Health Equity: Improving Outcomes through Patient-Centered Best Practices Brent M. Egan, MD President, International Society on Hypertension in Blacks (ISHIB) Professor of Medicine, USCSOM – Greenville Chief Science Officer, Care Coordination Institute

Cardiometabolic (CM) Health Equity: Improving Outcomes through Patient-Centered Best Practices Symposium Objectives – Bi(Multi)-directional learning: • Identify and discuss medical and social factors contributing to cardiometabolic (CM) health disparities • Identify and discuss Patient-Centered Outcomes Research (PCOR) opportunities to improve CM health equity • Apply lessons learned from this Symposium & focus groups to develop and fund an intervention that can be sustained locally and replicated in other communities with CM disparities

(Cardio)Metabolic Syndrome 3 or more of : 1. Waist 35 + ” women, 40 + ” men) 2. High fasting blood sugar (≥100) 3. High fasting triglycerides (≥150) 4. Low HDL-cholesterol (<50 women, <40 men) 5. Hypertension or BP 130+/85+ Ford, et al: JAMA. 2002;287:356.

Complications of Cardiometabolic Syndrome 1. Heart Attack 2. Heart Failure 3. Stroke 4. Kidney Disease and Failure (dialysis) 5. Peripheral Vascular Disease (Amputation) 6. Memory Loss (Dementia) 7. Blindness (especially from diabetes) 8. Poor Quality of Life 9. Early Death

Population Health Perspective Variance in Health; Spending 20%; ~90% 80%; ~10% Kindig, DA. Improving population health. http://www.improvingpopulation health.org/blog/what-is-population-health.html

Modern Life Has Its Conveniences and Costs “ ACCESS TO EXCESS ” calories, sugar, fat, salt, labor saving devices and passive entertainment . . . A KEY DRIVER OF CHRONIC DISEASE Lambert, Craig And Bing, Christopher. The Way We Eat Now. Harvard Magazine ; May-June, 2004; Page 50.

Tri-County Health Network Strategic Plan – Three Year Goals Tri-County Health Network will use a collective approach to support systems change to: • Increase the percentage of adults and children participating in physical activity. • Increase the percentage of adults and children who eat more fruits and vegetables daily. • Sustain a community-wide partnership that focuses on healthy lifestyles

Healthy People in Healthy Communities . . .

Potential Benefit of Combined Blood Pressure and Lipid Control in Men Effect of optimal control of BP and LDL-C in men Currently: 1,500,000 CHD Events Optimal BP control: 1,078,500 CHD Events Optimal BP and LDL-C 385,500 CHD Events control Wong ND, et al. Am J Cardiol . 2003;91:1421-1426. 23

Cardiometabolic (CM) Health Equity: Improving Outcomes through Patient-Centered Best Practices Symposium Objectives – Bi(Multi)-directional learning: • Identify and discuss medical and social factors contributing to cardiometabolic (CM) health disparities • Identify and discuss Patient-Centered Outcomes Research (PCOR) opportunities to improve CM health equity • Apply lessons learned form this Symposium & focus groups to develop and fund an intervention that can be sustained locally and replicated in other communities with CM disparities

Cardiometabolic Health Interactive Workshop: Good Health Made Simple[r] Brent M. Egan, MD President, International Society on Hypertension in Blacks (ISHIB) Professor of Medicine, USCSOM – Greenville Chief Science Officer, Care Coordination Institute

Cardiometabolic (CM) Health Interactive Workshop: Good Health Made Simple[r] Outline: 1. Working definition 2. Key factors determining good CM health a. Non- modifiable (can’t change) b. Modifiable (can change) 3. What you can do to enhance your CM health without losing sleep or breaking the bank

Good (Cardio)Metabolic Syndrome Absence or control of: : 1. Waist 35 + ” women, 40 + ” men) 2. High fasting blood sugar (≥100) 3. High fasting triglycerides (≥150) 4. HDL-Chol <50 women or <40 men 5. Hypertension or BP 130+/85+ And: Good physical and mental endurance which allow you to participate fully in life-stage appropriate activities Ford, et al: JAMA. 2002;287:356.

Good Cardiometabolic Health Prevents Complications or Delays Them to Late in Life 1. Heart Attack 2. Heart Failure 3. Stroke 4. Kidney Disease and Failure (dialysis) 5. Peripheral Vascular Disease (Amputation) 6. Memory Loss (Dementia) 7. Blindness (especially from diabetes) 8. Poor Quality of Life 9. Early Death

Keys to Good Cardiometabolic Health 1. Healthy lifestyles a. Balanced nutrition b. Minimize Sedentary Activity c. Low and Moderate Intensity Physical Activity 2. Good Medical Care – Access to, use of, and adherence with evidence-based guidelines for: a. Risk factor screening b. Risk factor treatment and control 3. HOPE ; I’m connected to caring people and believe my life has purpose (makes a difference)

Healthy Food Doesn’t Taste Good & Costs More – Myth Buster!

It Costs Too Much To Eat Healthy: The Revis Family of North Carolina Spends $342 Weekly on Food.

The Aboubakar Family in Breidjing Camp (Chad; refugees from Darfur, Sudan). Food costs for 1 Week $1.23. 145

Cost of Basic Healthy Food in the U.S. A year supply of wheat, rice, oats, and beans weighs 400 pounds (ten 6-gallon pails) and provides ~1800 Calories / day for 1 person for 1 yr. If these items provided half of daily calories or $490 + $12 shipping ($502) ~900 Calories/day, then from Emergency Essentials http://beprepared.com the cost is $0.69 / day.

Walking is a Great Exercise with Major Health Benefits

Many Americans Spend Most Waking Hours Sitting: It’s Killing Us: Stand, Stretch and Bend.

Consider a Standing Desk at Work, Home & School!

Have ‘Standing’ Conversations !!!

The Sedentary Life is Killing US !! “ ACCESS TO EXCESS ” calories, sugar, fat, salt, labor saving devices and passive entertainment . . . A KEY DRIVER OF CHRONIC DISEASE Lambert, Craig And Bing, Christopher. The Way We Eat Now. Harvard Magazine ; May-June, 2004; Page 50.

Do you know your BMI? Weight (lbs) 120 130 260 270 280 290 300 140 150 160 170 180 190 200 210 220 230 240 250 5'0 " 5'2" 5'4" 5'6" 5'8" Height 5'10" 6'0" 6'2" 6'4"

Control Blood Pressure and Treat Cholesterol to Reduce Heart Disease and Stroke by More than Half !!! Effect of optimal control of BP and LDL-C in men Currently: 1,500,000 CHD Events Optimal BP 1,078,500 CHD Events control: Optimal BP & 385,500 CHD Events LDL-C control: Wong ND, et al. Am J Cardiol. 2003; 91:1421-1426.

Screening of Risk Factors for Heart Disease & Stroke • Have your BP checked 1. at least every two years if <120/<80 2. At least every year if 120 – 139/80 – 89 (pre-hypertension) 3. At least every month if more than 140/90 • Have your cholesterol checked at least every 5 years know your risk for heart disease and stroke and whether you are a candidate for statin treatment – your risk for heart disease and stroke fall at least 20% for every 40 point fall in bad (LDL) cholesterol • Screen every 3 years for diabetes if last test is normal (fasting glucose <100, HbA1c less than 5.7% • Check BMI at least yearly and take action to reduce weight by 5% or more if overweight or obese

Hypertension Treatment Algorithm: Based on ISHIB Guideline and Discount Medications Regimen-1 Regimen- 2 Regimen- 3 Regimen- 4 (3 pills; 3 meds) (2 pills; 3 meds) (3 pills; 3 meds) (2 pills; 3 meds) Benazepril / Valsartan / HCT Losartan 100 320/25 Lisinopril 40 (Free) Amlodipine 40/10 ($4/mo) ($10/mo) ($4/Mo) Amlodipine 10 Amlodipine 10 Amlodipine 10 Indapamide ($4/mo) ($4/mo) ($4/mo) ($4/mo) HCTZ 25 ($4/mo) HCTZ 25 ($4/mo) Total Cost: Total Cost: Total Cost: Total Cost: $12/month $14/month $8/month $8/month Pharmacological Treatment algorithm (should control 80% – 90% of hypertensives to <140/<90). Note: If patients have compelling indications for specific medication classes, then begin with those. For information on inexpensive medications for use in delivery of the CCI Treatment Algorithms, visit CCIHealth.org.

20% fewer heart problems ACEI / HCTZ Cumulative event rate and strokes with the CCE / ACEI than diuretic / ACEI 650 events CCB / ACEI 679 events 552 events HR: 0.80 (0.72, 0.90) P <0.001 Time to Primary Outcome(days) Jamerson K, et al. NEJM . 2008;359:2417 – 2428.

ASCOT: Low dose statin reduces heart disease in hypertensive patients 4 Cumulative Incidence (%) Atorvastatin 10 mg Number of events 100 Placebo Number of events 154 3 36% reductio n 2 1 HR = 0.64 (0.50 – 0.83); p = 0.0005 0 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 Years Sever PS et al. Lancet 2003;361:1149 – 1158. Slide Source: Lipids Online Slide Library Reprinted with permission from Elsevier Science. www.lipidsonline.org