BY SHARON H. FITZGERALD

In its first report dedicated solely to heart disease and stroke rates in Tennessee, the state Department of Health (DOH) in December released sobering statistics that confirmed that poor nutrition and inactivity are killing Tennesseans at an alarming pace.

"I think, overall, the document supported what the department felt were some of the key issues in Tennessee. So there was no great surprise," said Donna Henry, director of the department's Division of Health Promotion.

DOH collaborated with the Tennessee State University Center for Health Research and the University of Tennessee Health Science Center to analyze data from a variety of sources dating from 1996 to 2002. Gathering and analyzing the data took more than a year, Henry said. She called this report "baseline information" for a future study to determine whether health-related and fitness programs to battle heart disease and stroke make any difference.

The two most common forms of cardiovascular disease, heart disease and stroke are the first and third leading causes of death and disability respectively in Tennessee. Together they account for one out of every three deaths in the state. In 2002, Tennessee ranked as the sixth highest in the nation in death due to diseases of the heart and the third highest in mortality for stroke. Nine out of 10 adult Tennesseans reported at least one risk factor for cardiovascular disease in 2002, and nearly two-thirds reported two or more risk factors.

"The governor understands the relationship between health and the financial stability of the state, and he has committed resources to address heart disease and stroke," Henry said. "He's done this through some of the initiatives administered through his office — for instance, the Cover Tennessee initiative, Project Diabetes, his call to action with Get Fit Tennessee and his support for coordinated school health programs. We think these efforts will go a long way to support what the Department of Health is currently doing."

DOH's "Better Health: It's About Time" program targets risk factors for the most prominent causes of death and disability and facilitates programs at the local and state level to help Tennesseans improve their health. "What the report showed is that the two primary risk factors for heart disease stroke are really modifiable — a sedentary lifestyle and poor nutrition," Henry said. Asked if she were particularly attacking Southerners' affinity for biscuits 'n' gravy, Henry laughed and responded, "We're suggesting more fruits and vegetables, wise food choices and wise cooking techniques. Those are the strategies that we've advocated so far." No more lard? "No more lard. You can make really wonderful biscuits without the lard — and without the transfats, too. They may not be grandmother's, but they're still good."

Henry said the department looks to physicians and other providers for help to prevent heart disease and stroke. "We encourage physicians to aggressively screen for risk factors and treat those risk factors. If you know that someone is a diabetic or generally physically inactive, treat that as you would treat high blood pressure and also aggressively treat and manage the actual conditions of heart disease and stroke," she said. "Those are the things we're asking providers to do."

Also, through the department's Heart Disease and Stroke Prevention Program, the state has implemented a stroke and heart disease "system-of-care module" in 40 Tennessee hospitals. "The care modules will assist a health system in identifying those patients who have been diagnosed with heart disease or stroke and providing evidence-based treatment and care for them," she explained. The program also is working to improve stroke surveillance in Tennessee and conducting a stroke registry pilot project in East Tennessee in collaboration with East Tennessee State University.

The objectives of the Heart Disease and Stroke Prevention Program are:

1. To increase the number of people with high blood pressure who have it under control.

2. To increase the number of people with total blood cholesterol less than 200 mg/dl.

3. To increase the number of people who know the signs and symptoms of heart attack and stroke and know the importance of calling 911 immediately.

4. To improve emergency response related to heart disease and stroke.

5. To promote quality care through implementation of evidence-based primary and secondary prevention guidelines and policy and system changes.

6. To eliminate health disparities related to heart disease and stroke.

The report specifically addressed disparities, reporting that minority populations generally fared worse in most risk categories than Caucasians. "We had a sense that African-Americans, particularly males, had a disproportionate burden of heart disease in Tennessee, and the report did show that," Henry said.

The report also delineated the costs borne by Tennesseans because of heart disease and stroke. "This report documents that we spent over $3 billion in 2002 on just inpatient and outpatient hospital costs," Henry said. "We also think of cost in terms of lives. Certainly heart disease and stroke can lead to disability, can lead to loss of productivity in the workforce, can lead to loss of life prematurely."


February 2007