What is the Million Hearts Program and How Does It Work?
The Million Hearts program is a U.S. initiative aimed at preventing 1 million heart attacks and strokes by 2022 through interventions focused on improving access to proven preventive services and medications. The program seeks to accomplish this lofty goal by focusing on two major areas: optimizing the treatment of high blood pressure and supporting the appropriate use of cholesterol-lowering drugs like statins .
High blood pressure contributes to nearly 1 out of every 3 deaths from heart disease and stroke, making it a major public health challenge. Likewise, elevated cholesterol is a key risk factor for cardiovascular disease, responsible for nearly 50% of all heart attacks. By ensuring that patients with these conditions have access to and properly use effective medications, the million hearts initiative aims to make major strides in reducing preventable heart disease and stroke.
More comprehensive information and care guidelines can be read here.
Understanding the Medications Included in the Million Hearts Program
The Million Hearts initiative focuses on increasing the appropriate use of medications that are proven to prevent cardiovascular diseases, including heart attacks and strokes. This includes several classes of drugs:
Cholesterol-lowering drugs: Drugs like statins and ezetimibe work by lowering LDL (“bad”) cholesterol in the blood, which can significantly reduce the risk of heart attacks and strokes. The risk reduction with statins has been shown to be as high as 30% to 40%.
Blood pressure medications: By lowering high blood pressure, drugs like ACE inhibitors, ARBs, calcium channel blockers and diuretics lessen the strain on the heart and arteries. This reduces cardiovascular events by 20% to 25%.
Blood thinners: Anticoagulants like warfarin and the newer NOACs (non-vitamin K antagonist oral anticoagulants) are used to prevent potentially fatal blood clots that lead to heart attacks and strokes, especially in patients with atrial fibrillation.
Diabetes medications: Drugs that control high blood sugar in diabetes, especially SGLT2 inhibitors and GLP-1 receptor agonists, have been shown to reduce the risk of heart attack, stroke and cardiovascular death beyond that provided by control of glucose alone.
The key is ensuring that patients take these proven medications as directed and at doses that are optimal for their individual health profiles. However, underuse is still common, compromising the effectiveness of the Million Hearts strategy. The program aims to close both prescribing and adherence gaps through targeted interventions.
1. Cholesterol-Lowering Medications: Saving Lives One Heart at a Time
Cholesterol-lowering drugs, particularly statins, are a cornerstone of the Million Hearts strategy due to compelling evidence that they significantly reduce the risk of heart attacks, strokes and even death from cardiovascular causes.
Some key facts about statins and their effectiveness:
Statins lower LDL (“bad”) cholesterol by blocking an enzyme that produces it in the liver. This modestly lowers total cholesterol and significantly reduces LDL cholesterol.
Large clinical trials have shown that statin therapy reduces the risk of major cardiovascular events like heart attack and stroke by 20% to 50%, depending on the intensity of the statin and the patient’s baseline risk factors.
The ** benefits** of statins appear quickly once treatment begins, with risk reduction occurring within 1 to 2 years. However, the benefits continue to accrue the longer statins are taken.
Statins are among the most effective preventive medications available, on par with treatments for conditions like high blood pressure and diabetes.
Despite this, underuse of statins remains common. Only about half of patients who could benefit from a statin actually receive one, due to factors like physician inertia, side effects and patient nonadherence.
The Million Hearts program aims to close this “statin gap” by promoting adherence to clinical guidelines on statin use, streamlining decision support tools, educating physicians and implementing behavioral interventions for patients. These strategies could potentially lead to hundreds of thousands of avoided heart attacks and strokes.
2. Blood Pressure Medications: Protecting Your Heart Health
Medications that lower high blood pressure are a pivotal part of the Million Hearts strategy for preventing heart attacks and strokes. There are several classes of drugs that lower blood pressure by different mechanisms:
ACE inhibitors: These drugs block angiotensin-converting enzyme, thereby relaxing blood vessels and lowering blood pressure. ACE inhibitors have been shown to reduce the risk of major cardiovascular events by 15% to 25%.
ARBs: Angiotensin receptor blockers work similarly by interfering with the renin-angiotensin system. They are effective in reducing blood pressure and cardiovascular risk.
Calcium channel blockers: These drugs block calcium channels, causing blood vessels to relax and widen. They lower blood pressure and have been found to reduce cardiovascular events by around 15% to 20%.
Diuretics: Diuretics, or “water pills,” reduce blood volume by increasing urine output. While older diuretics have fallen out of favor, newer diuretics remain important second-line therapy for controlling high blood pressure.
Studies have consistently found that for every 10 mmHg reduction in systolic blood pressure, the risk of major cardiovascular events falls by 20% to 25%. Thus, a moderate reduction in blood pressure with medications is highly beneficial.
However, only about half of patients with hypertension currently have their blood pressure controlled. The Million Hearts program aims to reduce this treatment gap through initiatives like a national awareness campaign, leveraging health information technology and improving drug adherence. If successful, use of blood pressure medications could contribute meaningfully to the goal of 1 million avoided heart attacks and strokes.
3. Antiplatelet and Anticoagulant Medications: Preventing Heart Attacks and Strokes
Blood thinners play an important role in the Million Hearts program by preventing dangerous blood clots that can lead to heart attack and stroke. Two main types of blood thinners are used:
Antiplatelet drugs like aspirin and clopidogrel (Plavix) work by inhibiting platelets, a type of blood cell that promotes clotting. They are commonly used long-term in patients with conditions like coronary artery disease, stent placement and prior heart attacks.
Anticoagulants like warfarin (Coumadin) and novel oral anticoagulants (NOACs) directly interfere with clotting factors in the blood. They are used long-term in patients with atrial fibrillation to prevent stroke.
Some key facts:
Aspirin reduces the risk of heart attack by 25% and stroke by 17% according to clinical trials. It also lowers the risk of death in those with prior heart disease.
For patients with atrial fibrillation, anticoagulants cut the risk of stroke by 60% to 70% compared to either placebo or aspirin alone.
Properly managed anticoagulation with warfarin reduces stroke risk by 60% to 70%. NOACs have been shown to be as effective as warfarin but with less risk of bleeding.
Despite these benefits, antiplatelet drugs are underused in many patients who could benefit, and international normalized ratios (INRs) for warfarin are often out of target range.
The Million Hearts program aims to close these gaps by developing better decision support tools for clinicians, leveraging health IT and utilizing programs that help patients adhere to medications and monitor INR levels for warfarin. If successful, use of blood thinners could impact 100,000s of lives by reducing preventable heart attacks and strokes.
4. Medications for Managing Diabetes: Safeguarding Your Heart
Certain drugs for managing diabetes also provide significant heart benefits, making them an important part of the Million Hearts program. Two classes in particular have been shown to reduce cardiovascular risk:
SGLT2 inhibitors like empagliflozin (Jardiance) work by blocking reabsorption of glucose in the kidneys, causing it to be excreted in the urine. In clinical trials, SGLT2 inhibitors reduced the risk of cardiovascular death by 20% to 30%.
GLP-1 receptor agonists like liraglutide (Victoza) lower blood sugar by stimulating insulin secretion and inhibiting glucagon release. Some GLP-1 agonists have been found to reduce the risk of major adverse cardiovascular events by 15% to 20%.
The cardiovascular benefits of these diabetes drugs appear to go beyond just lowering blood sugar:
SGLT2 inhibitors cause modest reductions in blood pressure and weight, both of which may contribute to lower cardiovascular risk.
GLP-1 receptor agonists have been shown to reduce inflammation, improve endothelial function and regress left ventricular hypertrophy – all potentially cardio-protective effects.
The Million Hearts program seeks to promote the wider use of these specialty diabetes medications in appropriate patients through strategies like:
Educating physicians about the cardiovascular benefits demonstrated in clinical trials
Improving coverage and access through payers and pharmacy benefit managers
Helping patients better manage side effects that could otherwise limit use
While still investigational, the cardiovascular risk reduction achieved with SGLT2 inhibitors and GLP-1 receptor agonists may be comparable to established therapies like statins. If realized on a broad scale, their impact within the Million Hearts program could be substantial.
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Frequently Asked Question
How can I spread the word about Million Hearts in my community?
I can spread the word about Million Hearts by sharing social media posts, telling family and friends, and encouraging community organizations to get involved.
How can workplaces create a culture of health with Million Hearts?
Workplaces can create a culture of health with Million Hearts by offering insurance coverage for preventive services, implementing smoke-free policies, and providing opportunities for physical activity.
How does Million Hearts aim to reduce sodium consumption?
Million Hearts aims to reduce sodium consumption by working with food manufacturers, restaurants, government feeding programs, and the public.
What are the goals of the Million Hearts initiative?
The goals of Million Hearts are to empower Americans to make healthy lifestyle choices, improve care for people with high blood pressure and high cholesterol, and eliminate health disparities.