Transcript: How Many Meet the Simple Seven?
In public health school, we learn there are three levels of preventive medicine. Primary prevention would be like trying to prevent someone at risk for heart disease from getting their first heart attack. Secondary prevention is when you already have the disease and are trying to prevent your second heart attack, and tertiary prevention is like cardiac rehab, where we’re just trying to reduce the complication rate. A fourth level was suggested in 2000, quaternary prevention, trying to reduce the damage from all the drugs and surgery from the first three levels. But people seem to forget about a fifth concept, introduced by the World Health Organization back in 1978, termed primordial prevention. But it is now being embraced by the American Heart Association’s 2020 strategic impact goals.
Primordial prevention was conceived as a strategy to prevent whole societies from experiencing epidemics of the risk factors. The corresponding strategy at the individual level is to prevent the development of risk factors. Instead of trying to prevent someone with high cholesterol from getting a heart attack, why not prevent them from getting high cholesterol in the first place.
So the American Heart Association came up with the "Simple 7", seven simple health behaviors or factors. Not smoking, not being overweight, being “very active”–defined as walking at least 22 minutes a day–a few fruits and veggies, below average cholesterol, normal blood pressure and normal blood sugars.
Their goal was to reduce heart disease deaths by 20% by 2020. Why so modest an aim? An improvement of 25% was deemed unrealistic; 15% was considered insufficient; so, they decided on 20%. But if 90% of risk can be thrown out the window by engaging in simple lifestyle modifications, why is a 25% drop in death considered so unrealistic? To understand, one must realize just how bad our diets have gotten.
The most common reason patients give for not complying with a cholesterol-lowering diet is the presumption that they’re already eating healthy, and so don't need to change. But if you look at the status of cardiovascular health in U.S. adults, only about 1% have a bare minimum of healthy eating behaviors, such as five-a-day fruits and veggies, eating beans, whole grains, and drinking less than three cans of soda a week. What percentage of Americans hit all seven of the simple 7? 14,000 men and women were surveyed, and most had two or three, but hardly any had all seven simple health components. Just how low a prevalence was having seven out of seven? Only about 1 out of 2,000 Americans had all seven factors intact. And the one they were missing the most? Diet. That should give us pause.
Unfortunately unhealthy behaviors extend into the medical profession. Just like smoking doctors are less likely to tell their patients to stop smoking, and couch potato docs are less likely to push exercise, or things like more fruits and vegetables, doctors need to role model healthy behavior. This greatly enhances our credibility and effectiveness. Gone are the days of traditional authority when the fat physician, dropping cigarette ash down his gravy-stained vest, could credibly prescribe a change in behavior.
To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.
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