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What Are the 7 Steps to A Heart Healthy Lifestyle

The key ‘take home’ points for patients based on the latest 2019 American College of Cardiology (ACC)/American Heart Association (AHA) Guidelines on Primary Prevention of Cardiovascular disease.

Introduction

Following the theme of Preventive Lifestyle from the 2018 American Heart Association meeting, EPI | Lifestyle 19,  the Cardiology community eagerly awaited the release of the highly anticipated 2019 American College of Cardiology (ACC)/American Heart Association (AHA) Guidelines on Primary Prevention of Cardiovascular disease1. These guidelines were released at the recent ACC annual scientific meeting in New Orleans, Louisiana March 16-18, 2019. There is an increased focus on the importance of lifelong adherence to a heart healthy lifestyle of eating heart healthily and maintaining a physically active lifestyle. There were also new recommendations with regards to use of aspirin for primary prevention. These recommendations have caused some anxiety with regards to use of aspirin, a common drug used by many persons over the last several decades hoping to prevent heart disease. Cardiologists have already received questions from their patients regarding aspirin use and the recently release prevention guidelines. In this blog I will focus on the key take home messages for patients from these prevention guidelines and the seven steps to heart healthy living outlined in the guidelines.

 

Where should I begin?

A heart healthy lifestyle is one that is important to start at any age, and the earlier this is started in life, the better the degree of prevention. Living a heart healthy lifestyle should first begin with an assessment of your cardiovascular (CV) risk which is defined as the probability/chance of an individual having a cardiovascular event, such as a heart attack or stroke, over the next 10 years. CV risk is based on family history of premature heart disease, age, gender, ethnicity, history of tobacco smoking, level of physical activity, diet, the presence of diabetes, hypertension and/or hyperlipidemia.

Your CV risk should be assessed by your physician. Based on your history, physical exam and blood testing, a CV risk profile can be assessed and calculated based on the ACC AHA CV risk calculator. After your risk is calculated, your physician can customize their recommendations based on your CV risk profile. Most times further testing may not be necessary. However, for individuals with an elevated CV risk score further testing may be recommended. These tests may include a Cardiac CT scan without contrast to assess for the presence and degree of calcification of the blood vessels of the heart, which suggests the presence of hardening of the blood vessels known as atherosclerosis. This atherosclerosis indicates a high CV risk as it is a usual precursor for heart attacks and strokes and for patients with this finding further treatment and/or testing may be recommended by your physician.

 

Next steps

There are 7 main take home messages for healthy individuals preventing heart disease, the first three steps are focused on living a healthy lifestyle. The last 4 steps focuses on recommendations related to medical therapy and should be actively discussed with your provider to customize recommendations based on your CV risk profile.

 

Step 1 – Heart Healthy Diet 

A diet that is focused on eating fresh fruits, vegetables, legumes, nuts and whole grains is recommended. Sweetened drinks, processed foods, foods with a high content of sodium, and foods containing trans fats and saturated fats should be avoided.

 

Step 2 – Physically Active Lifestyle 

Maintaining a physically active lifestyle is also recommended with at least 150 minutes a week of moderate intensity exercise such as a brisk walk or 75 minutes a week of high intensity exercise such as playing basketball, rowing, et cetera. Generally, maintaining physical activity should be a daily regimen rather than focused on 1 or 2 days a week which was emphasized in the 2018 updated second edition of the Physical Activity guidelines that were released by the Department of Health and Human services2.

 

Step 3 – Cessation of Tobacco Smoking 

Tobacco smoking is the single most potent reversible risk factor for cardiovascular disease. It is recommended that tobacco smoking is avoided to prevent the development of cardiovascular disease. This recommendation is relevant for all age groups.

 

Step 4 – Maintaining Healthy Cholesterol Levels 

Your cholesterol levels should be checked by your physician on a regular basis as determined by your provider and latest guidelines. Based on your individual CV risk, your physician may opt to start medical therapy to manage your cholesterol or may opt to perform further testing such as a non-contrast Cardiac CT to determine calcifications in the blood vessels of the heart reported as a “CAC score.” This CAC score will assist your physician to determine the need for medical therapy and/or further testing.

 

Step 5 – Maintaining a Healthy Blood Pressure 

Achieving and maintaining a healthy blood pressure of <130/80 is recommended. This may or may not require medical therapy as determined by your physician. A physically active lifestyle, low sodium diet and a diet rich in fruits and vegetables are helpful in maintaining a healthy blood pressure.

 

Step 6 – Maintaining a Healthy Glucose level and Adequate Control of Type 2 Diabetes Mellitus (DM)  

Adequate control of type 2 DM is important to prevent cardiovascular disease. A heart healthy diet as outlined previously in this blog along with one that is low in sugar and processed foods, as well as maintaining a physically active lifestyle, are vital in controlling DM. Additionally for diabetic patients on medications, Metformin is a primary line of treatment while newer drugs such as SGLT-2 inhibitor and GLP-1 receptor agonist are secondary line of treatment options for these patients to prevent the development of CV disease.

 

Step 7 – Aspirin Use

For decades aspirin has been useful in individuals with established CV disease to decrease risk of future cardiac events such as a heart attack. However, there is an increased risk of bleeding associated with aspirin use. For healthy individuals without established CV disease who have a low CV risk profile the increased risk of bleeding with aspirin use outweighs the benefit of cardiovascular disease prevention. For this reason it is recommended that use of aspirin for primary prevention of CV disease should be reserved only for selected patients with a high CV risk profile. Use of aspirin should therefore be discussed with your physician prior to considering starting or stopping an aspirin regimen.

 

Conclusion – Putting it all together!

The 2019 ACC AHA Primary Prevention guideline1 focuses on a heart healthy lifestyle and focuses on a patient centered approach that emphasizes active engagement and discussion between patient and physician to determine the best customized approach and recommendations based on an individual’s CV risk profile.

There are several patient related resources such as:

References:

  1. WRITING COMMITTEE MEMBERS, Arnett DK, Blumenthal RS, Albert MA, Michos ED, Buroker AB, Miedema MD, Goldberger ZD, Muñoz D, Hahn EJ, Smith Jr SC, Himmelfarb CD, Virani SS, Khera A, Williams Sr KA, Lloyd-Jones D, Yeboah J, McEvoy JW, Ziaeian B, ACC/ AHA TASK FORCE MEMBERS, O’Gara PT, Beckman JA, Levine GN, Chair IP, Al-Khatib SM, Hlatky MA, Birtcher KK, Ikonomidis J, Cigarroa JE, Joglar JA, Deswal A, Mauri L, Fleisher LA, Piano MR, Gentile F, Riegel B, Goldberger ZD, Wijeysundera DN, 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease, Journal of the American College of Cardiology (2019), doi: https://doi.org/10.1016/j.jacc.2019.03.010.
  2. The Physical Activity Guidelines for Americans: THe HHS Roadmap for an Active Healthy Nation. Second Edition. ADM Brett P. Giroir, MD

 

 

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Putting Together The Pieces of Genes, Behavior, and Environment

The theme of this year’s #EPILifestyle19 conference was “Genes, Behavior, Environment: Putting the Pieces Together.” The three speakers in the first session, Dr Eric Boerwinkle, Dr Leslie Lytle, and Dr Michael Jerrett presented a cohesive program truly reflecting putting the pieces together.

Dr Eric Boerwinkle genetic researcher, dean, and chair of public health at the UTHealth School of Public Health, kicked things off with a hearty welcome to Houston, and applauding the audience for braving the city during the annual Houston Rodeo. Dr. Boerwinkle’s talk was marked by sincerity and focused passion for precision health and precision prevention – terms to replace “precision medicine” – that mirrors the AHA’s focus on cardiovascular health over cardiovascular disease.

https://en.wikipedia.org/wiki/DNA_methylation

He highlighted that genetics, environment, and lifestyle behaviors can be envisioned in several ways, depending on perspective and discipline. A key challenge in producing science focused on fitting these pieces together is measurement. Variables are often measured separately and differently across disciplines, and no matter the metaphor, Boerwinkle encouraged the audience to step out of their silos and begin measuring key variables together. Dr Leslie Lytle of UNC Chapel Hill Gillings School of Public Health provided a concrete example with the ADOPT project for obesity treatment, which identified high-priority measures to measure across biology, behavior, psychosocial, and environmental processes.

Transitioning from genetics to lifestyle behaviors, Boerwinkle highlighted research finding that even in genetically high-risk patients, modifying environmental factors and lifestyle behaviors can lower risk.

Dr. Leslie Lytle, professor in the department of Health Behavior at UNC Chapel Hill, situated her talk in the puzzle piece landscape by contrasting the NIH’s position on the importance of intervention research with the dismal percent of funding dollars that actually go towards intervention research.

unsplash by yusuf evli

After emphasizing the importance of intervention research to address the lifestyle and behavioral challenges of poor cardiovascular health, particularly obesity, Dr. Lytle showed us what intervention research should look like and what it can accomplish. Combining environment-level interventions based on socioecological models with individual level education can effect change, like in in the CATCH intervention, which involved child-level education, positive social modeling, and healthy changes in physical activity and school meals.

Over the past few years, the “exposome” concept has only gained popularity, along with the “-omics” trend. Wrapping up the themed session with environmental factors, Dr Michael Jerrett of UCLA School of Public Health taught us about characterizing the exposome by incorporating hyper-spatiotemporal components into research to assign exposure. What are hyper-spatiotemporal components? These components measure where people go during the day, what the pollution level is there, what they are doing and how it affects their exposure (walking in a park, biking behind a diesel truck, sitting in a car).

unsplash by adrian williams

Jerrett highlighted several studies examining these concepts, comparing the inhaled pollutants when biking, walking, or commuting by car to work in various areas of a city. How can we measure these spatiotemporal components in a “ubicomp” (ubiquitous computing) environment? Jerrett broke down the inside of our smart phones, calling attention to the numerous sensors present in nearly every smart phone and the research possibilities to harness these.

 

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Highlights of AHA18 – Bridging Lifestyle Medicine with Contemporary Medicine through Science

This year’s annual scientific meeting of the American Heart Association (AHA) held in Chicago, Illinois November 10-12, 2018 was excellent. The abbreviated 3-day meeting received positive feedback as this allowed practicing physicians to attend the meeting over the weekend and be able to return to their practice early in the work week rather than having to spend an extended time away from the office. It was great being a part of the AHA Early Career Blogger group as this allowed access to many of the embargoed sessions. At these sessions I was able to listen to the AHA 2018 updated Lipid Management Guidelines1 as well as The Physical Activity Guidelines for Americans, Second Edition2 prior to their release at the meeting. This gave me a chance to ask the guideline committee several questions related to patient management.

 

Opening Session:

The opening session by Dr. Ivor Benjamin, the President of the American Heart Association, delivered very powerful messages throughout his speech. He highlighted the track of his career and the important role of strong mentors throughout his career and the impact it had on his advancement throughout the field of cardiology. He also discussed both the importance of mentoring and diversity in the cardiology profession highlighting the fact that African American men account for only 3% of Cardiologists in the United States and the need to bridge this gap. I found this session very inspiring and encouraging especially with regards to mentoring and supporting junior colleagues and being grateful for the mentors I have had thus far in my career. I also welcomed the message of the importance of diversity and inclusion as this leads to a healthier work and training environment.

 

Bridging Lifestyle Medicine with Contemporary Medicine through Science:

This year’s meeting highlighted the value of integrating lifestyle medicine with contemporary medicine to achieve the best outcomes for patients with regards to the prevention of cardiovascular disease. This was supported by the release of the updated 2018 American College of Cardiology (ACC)/American Heart Association (AHA) Guidelines on Lipid Management on the first day of this meeting1. This updated guideline emphasized the importance of the cholesterol management at all stages of adulthood along with the importance of therapeutic lifestyle changes1. The utility of coronary artery calcium (CAC) scoring with cardiac CT was also emphasized as a useful tool to further refine patients’ risk to determine the best management for patients who are at intermediate risk for atherosclerotic cardiovascular disease (ASCVD)1. This guideline also had included ezetimibe and PCSK9 inhibitors as having a complementary role when used with statin therapy in selected patients at high risk for ASCVD1. The release of this updated guidelines will be a useful in my management of patients with regards to primary and secondary prevention of ASCVD. I appreciated the role of CAC scoring which will be very helpful for the management of the intermediate risk patients.

The release of the U.S. Department of Health and Human Services’ second edition of the Physical Activity Guidelines for Americans on the last day of the meeting was also well received2. This second edition emphasized the importance of increasing physical activity for all age ranges throughout the population including women in pregnancy and the postpartum period, as well as adults with chronic diseases or disabilities2. This guideline update will assist me with counseling patients with regards to increasing their physical activity to improve their overall cardiovascular health.

 

Networking Opportunities:

There were many networking opportunities during the meeting. These included the Council on Clinical Cardiology dinner on the first night of the meeting which honored Dr. Judith Hochman the recipient of the James B. Herrick Award for Outstanding Achievement in Clinical Cardiology. Dr. Stacy Rosen was also the recipient of the Women in Cardiology Mentoring Award. This dinner was attended by many leaders in the field of Cardiology and was a great opportunity for me to meet these leaders. The Women in Cardiology Committee also hosted a networking luncheon on the first day of the meeting during which Dr. Sharonne Hayes from the Mayo Clinic was the keynote speaker. Dr. Hayes gave a very riveting interactive talk on leadership for women in cardiology, she was also the recipient of last year’s Women in Cardiology Mentoring Award. Her talk was useful with very powerful messages on navigating your professional and personal life to achieve overall job satisfaction, career success and personal happiness. I learned several tips that I will apply to my own career as well. Dr. Annabelle Volgman and the faculty at Rush University was gracious to host a wonderful networking dinner for Women in Cardiology (WIC) on the second night of the meeting. This dinner provided a great opportunity for me to meet fellow WIC colleagues and to discuss several relevant issues related to our practice in the Cardiology field.

Social Media Coverage:

There was also a broad social media coverage of the meeting on Twitter and this was assisted by the AHA Early Bloggers writing group. I was able to share live tweets during several sessions and this generated a lot of discussion amongst members on Twitter. This also allowed many colleagues who were unable to attend the meeting to be able to follow and comment on several meeting highlights.

 

Looking Forward to AHA 2019:

This year’s AHA Scientific Sessions embrace of lifestyle medicine and the value of preventive cardiology was refreshing and empowering. This meeting highlighted the importance of not only treating ASCVD but also the importance of preventing disease and empowering our patients to take responsibility for their health as well. In the words of Goethe as mentioned in Dr. Ivor Benjamin’s opening session “Choose well….your choice is brief, and yet endless.” We look forward to next year’s AHA 2019 meeting in the beautiful city of Philadelphia.

 

References:

1. Grundy SM, Stone NJ, Bailey AL, Beam LT, Birtcher KK, et al. 2018AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol. JACC Nov 2018, 25709; DOI: 10.1016/j.jacc.2018.11.003

2. The Physical Activity Guidelines for Americans: THe HHS Roadmap for an Active Healthy Nation. Second Edition. ADM Brett P. Giroir, MD.

 

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Shift Your Perspective To Get The Most Out Of Mentoring

The AHA Epidemiology and Prevention and Lifestyle and Cardiometabolic Health Scientific Sessions is quite different from AHA Scientific Sessions. Smaller in size and more focused, with few concurrent sessions and ample coffee breaks, I enjoyed attending the numerous Early Career sessions. They varied in topic and format: “Connection Corners” were short round-table discussions twice a day with focused conversations on ‘beefing up your CV’, the grant writing process, developing a catchy elevator speech, and leveraging non-NIH funding. Both the EPI-Prevention and Lifestyle councils had lunchtime panels at the end of their annual business lunches, and had the audience asking questions about avoiding burnout in academia and global collaboration in cardiovascular research.

To end the week, the Early Career Council outdid themselves with the early morning ‘fire-side’ chat with Drs. Emelia Benjamin, MD ScM from Boston University School of Medicine, Norrina Allen, PhD from Northwestern Medicine, Jean-Pierre Després, PhD from Laval University in Quebec, Chiadi Ndumele, MD MHS from Johns Hopkins Medicine, and Lenny Lopez, MD MDiv MPH from UC San Francisco.

 Drs. Emelia Benjamin, Jean-Pierre Depres, Chiadi Ndumele, Lenny Lopez, and Norrina Allen (left to right) provide eye-opening mentoring advice to early career investigators at the EPI Lifestyles Scientific Sessions 2018 in New Orleans, LA
Drs. Emelia Benjamin, Jean-Pierre Depres, Chiadi Ndumele, Lenny Lopez, and Norrina Allen (left to right) provide eye-opening mentoring advice to early career investigators at the EPI Lifestyles Scientific Sessions 2018 in New Orleans, LA.

If you missed this morning session, no worries! I have you covered. The panel conversation, led by Dr. Emelia Benjamin, started with finding your niche as an early career investigator, and developed into a great discussion on building a mentoring team and planning your own path.

Using Sli.do to anonymously ask questions allowed for an unbiased view of what the audience was thinking. And overwhelmingly were questions along the lines of:

  • What do you do if your mentor selects a niche for you that doesn’t excite you?
  • How do you separate your niche from your mentor?
  • What can you do to fix a fall-out with your mentor?

I found these questions concerning! To me, they reflect a mentee perspective that 1) once you’re assigned a mentor, you’re stuck with them; 2) your mentor is the be-all-end-all guide in your career path; and 3) you must do everything your mentor tells you.

My first response to this perspective is: we’ve got to shift this mindset! If your relationship with your mentor is that of a duckling and mother goose, something has got to change. A mentor that “assigns” a research niche to you is either a Tormentor or is responding to your lack of initiative. If the former, you should find a new mentor. Your institution will have a number of resources including a faculty affairs office or an ombudsman and possibly a mentoring program that will help you find a mentor that best fits with your needs.

If the latter, you’ve got some work to do! But the career panel provided some great advice on how to get started. (So do Vineet Chopra, MD MSc, Vineet M. Arora, MD MAPP, and Sanjay Saint, MD MPH in an article titled “Will you be my mentor?” published in JAMA last year).

Make the most of your time

Mentors have a number of responsibilities and how they have made their own career path and achieve work life balance is a great indicator if you will be a good fit. Do you aspire to a career like theirs? Do you admire their work-life balance? They might make a great life or career mentor for you.

Just as you expect your mentor to give you their full attention when discussing your goals, you must respect their time as well! That means giving thought to your research goals, planning the steps to get there, and using their expertise and experience to provide direction and improve your process.

Set up a meeting with your mentor and prepare an agenda beforehand. Know the topics you’d like to cover, whether their input on goals and milestones, plans for research projects, or ideas to brainstorm on. Preparing an agenda shows respect for both of your times and keeps you on track for a productive meeting. Jot down action items and follow-up after the meeting.

Judy T. Zerzan, MD MPH and coauthors discuss “managing up” and how to take responsibility for your half of the mentor-mentee relationship in “Making the Most of Mentors: A Guide for Mentees.”

Earlier this year, Dr. David Werho wrote about sponsorship versus mentoring in his 2-part article “When Mentoring Isn’t Enough”. Read Part 1 and Part 2 to learn about why dependability pays off, how to diversify and be the protégé you want, and why it’s worth it to do your homework.’

One is the Loneliest Number

Another solution to mentor woes is creating a mentor network. Over and over, the panel expounded on the advantages of having both a primary mentor and a mentoring group. This structure is explicit in career development grants, where the primary mentor supports your career development initiatives, and the content and methods experts support your training goals. Content and methods mentors in your network can also help you explore different areas in your field as you work to identify your research niche.

A mentor network means different researchers with different backgrounds and different perspectives. Bouncing your research ideas off them results in contrasting views, some that will jive more with you, and some that will make you think. Instead of being molded into a “mini”-me mentee, a mentor network helps you build the scaffolding upon which you’ll grow into your own independent researcher.

I’ll touch more on this idea later, but here’s a great read from Yan Shen, Richard D. Cotton, and Kathy Kram for the MIT Sloan Management Review. Even if you are post-tenure, you still benefit from a strong mentoring network! Read more from Kerry Ann Rockquemore in “Posttenure Mentoring Networks.”

Identifying a Niche

The pre-established theme of the Friday morning early career session was how to “Identify Your Niche”. While much of the discussion centered around mentoring and its supportive role in finding your niche, there was also focused advice on how to find your way.

The panel emphasized that as an early career investigator, it’s imperative to utilize this time to identify and achieve the additional training you see as important to your overall career goals. While this may be in the form of a post-doctoral position or a K-award, it can also be informal in the research projects you pursue and the skills you acquire.

Dr. Emelia Benjamin, who provides mentoring support to early career faculty at Boston University, gave us 2 homework assignments to help us plan our way.

First, reflect on where you’ve been and where you’re going. A 1-page personal statement makes a powerful addition to your CV, and the journey to this final product will help you learn to tell your story as a connected arc, rather than a zig-zag path jumping from topic to topic. The evolution of your research niche from project to project is hardly evident in your publication list, but through narration and self-reflection you can illustrate your approach to the scientific process and summarize where you might go next. Not only will you provide a picture of your research goals and personality to anyone reading your CV, but you will likely have a few “Aha!” moments discovering connections between projects you hadn’t seen before.

Second, diagram your mentoring network. It’s important to visualize this – are all of your mentors above you? Below you? Horizontal to you? Peers? Are they in the same division, institution, or all distance? A mixture is key, but the components of that mixture depends on your research and career goals. Dr. Chiadi Ndumele from Johns Hopkins Medicine shared his take on 5 valuable types of mentors to have:

  1. Methodological mentors are those you go to for questions and feedback about approach.
  2. Content or clinical mentors are those you go to about patient care of content expertise.
  3. Life mentors are those whose work-life balance is one you admire.
  4. Career mentors help you step back and see the big picture, particularly the asks you should say no to.
  5. A brainstorm mentor plays devils advocate and is a great sounding board to bounce ideas off of that also bounces back.

5 Valuable MentorsDr. Emelia Benjamin utilizes the theories from Kathy Kram, Monica Higgins, and David Thomas on “Creating Developmental Networks” and “Reconceptualizing Mentoring” with her early career faculty at BU. Take a cue from her, and use this worksheet, Define your Developmental Network, to identify the gaps in your mentoring network, and take the first step to filling them.

Bailey DeBarmore Headshot
Bailey DeBarmore is a cardiovascular epidemiology PhD student at the University of North Carolina at Chapel Hill. Her research focuses on diabetes, stroke, and heart failure. She tweets @BaileyDeBarmore and blogs at baileydebarmore.com. Find her on LinkedIn and Facebook.

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Back To Reality: Incorporating Scientific Sessions Into Everyday Life

Nearly 2 weeks after AHA Scientific Sessions 2017, I’m back at home, sipping coffee on a chilly Sunday morning and thinking about Anaheim. The larger-than-life convention center, the numerous and packed sessions, and the built-in-a-day pharma fueled exhibit halls.

Working backwards, I remember fitting in a lunch sponsored by Amgen, given by Dr. Alan Brown, Director of Cardiology at Advocate Lutheran General Hospital. It boasted boxed lunches but lacked elbow room, but by the end of the hour, I was impressed.

As a trained dietitian, I’m aware of at least some of the challenges in providing patient care. With new lipid guidelines, new blood pressure guidelines, new everything guidelines, up until now, the ease of popping a pill has seemed to rise above the effectiveness of lifestyle changes.

For the first time, I heard physicians calling on one another to sit face-to-face and eye-to-eye with their patients, and ask them about their physical activity. And their eating habits. In Dr. Brown’s words, by asking about these topics, you communicate to your patients that they are important.

Vegetables on the kitchen counter

(The DASH Diet stands for Dietary Approaches to Stop Hypertension and is rich in fruit, vegetables, low-fat dairy while reduced in saturated fat and cholesterol. Content Provider: CDC/Amanda Mills. 2011)

At this same conference, Dr. Stephen Juraschek presented his results using the DASH diet – “The Effects of Sodium Reduction and the DASH Diet in Relation to Baseline Blood Pressure,” published just a few weeks ago. The investigators randomized adults with pre- or stage 1 hypertension (and not using blood pressure lowering medications) to DASH diet or control diet. Then in random order, over 4 weeks with 5-day breaks, participants were fed at 3 sodium levels: 50, 100, 150 mmol/day at 2,100 kcal. And what did they find? Adopting the DASH diet in combination with reduced sodium intake achieved “progressively greater reductions at higher levels of baseline SBP [≥150 mmHg]”.

So why am I talking about lifestyle modifications in a post about incorporating conference learnings back into your everyday reality at work? Well, a big announcement that came out of AHA17 was the new hypertension guidelines. I noticed recurrent statements and questions about these guidelines, in presentations, on social media, and from my peers when I returned home. 

At our first peer led research meeting back from AHA17, I printed off a few copies of the Top Ten Things To Know (PDF) about the 2017 hypertension guidelines. We touched on the implications of new classification categories – more treatment, higher prevalence, changes in comparisons over time in our epidemiologic studies. 

Connie Alfred (left), of the National Center for Infectious Diseases (NCID), was shown having her blood pressure taken by Robyn Morgan, of the National Center for Chronic Disease Prevention and Health Promotion

(Connie Alfred (left), of the National Center for Infectious Diseases (NCID), was shown having her blood pressure taken by Robyn Morgan, of the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), during a free blood pressure screening event that was held on all CDC campuses in 2005. Content Provider: CDC/CDC Connects. 2005.)

We were happy to see the focus on accurate measurement of BP, ensuring adequate rest time and taking averages of measurements, a technique we use in epidemiologic studies to minimize measurement error. Those of us particularly interested in physical activity and nutrition epidemiology rejoiced at the lifestyle modification efforts. We closed the discussion with an acknowledgement of conflicting and numerous other guidelines, the reality of putting them into practice – from primary care to cardiology clinics – as well as misinformation in the media coverage of the guidelines, such as misquoting the relaxed recommendations for older adults. 

With so much to chew on, I closed the discussion encouraging everyone around the table to think more on the implications of new guidelines, and our role in developing them, implementing them, and evaluating them.

Bailey DeBarmore Headshot

Bailey DeBarmore is a cardiovascular epidemiology PhD student at the University of North Carolina at Chapel Hill. Her research focuses on diabetes, stroke, and heart failure. She tweets @BaileyDeBarmore and blogs at baileydebarmore.com. Find her on LinkedIn and Facebook.