Transcript for CDC Telebriefing: Most Americans’ hearts are older than their age

Higher heart age means higher risk of heart attacks and stroke

OPERATOR: At this time, all parties are on listen-only mode through the question and answer session. At that time, you’ll be able to press star one. Today’s conference is being recorded and if for any reason you object to that, you may disconnect at this time. I’ll hand the conference over to Mr. Tom Skinner. You may begin.

TOM SKINNER: Thank you Sidney and Thank you all for joining us today for the release of another CDC Vital Signs, this one on predicted heart age and racial disparities heart age among U.S. adults. We’re joined today by the director of the Centers for Disease Control and Prevention, Dr. Tom Frieden who will provide opening remarks and he’ll be joined by Dr. Matthew Ritchey, our Division of Heart Disease and Stroke Prevention to help with your questions.  Dr. Frieden.

TOM FRIEDEN: Thank you for joining us, everyone.  CDC works 24/7 to protect Americans and to keep us healthy, safe and secure. While we respond to external threats like Ebola, one of our biggest threats is within us, our heart. Heart disease, stroke, and other cardiovascular disease killed nearly 800,000 Americans each year and in each Vital Signs we focus on a disease from the front lines of CDC science to tell you what can be done to protect and save lives.  Saving lives is our bottom line and the bottom line for this month’s report is that your heart may be older than you are. For most adults in the U.S., it probably is. In fact, half of U.S. men and nearly half of U.S. women have a heart age that’s five or more years older than their chronological age; but there’s also good news. It’s easier to understand heart age than some other ways of measuring risk. To hear it or know that your heart is de-facto older than the rest of you is scary and it should be because it means that you’re at higher risk of a heart attack or a stroke. But it’s also empowering because there are a few simple steps that you can take to reduce your heart age. You can’t turn back the clock, in general, but you can turn back the clock on your heart age. The facts of this report come from heart health risks from every U.S. state and facts on heart disease risk compiled over many years of the Framingham heart study. It’s given us much of our knowledge about cardiovascular risks and other important findings. It’s interesting to note — and I have to confess, I didn’t know this until a couple of years ago — but the founder of CDC, Dr. Joseph Mountin, was also the individual who conceived of and initiated the Framingham heart study. It’s appropriate that we have this collaboration here. This Vital Signs report boils down to a huge amount of information into a simple health tool that any American can use. So what exactly is heart age?  It’s the age of a person’s heart and blood vessels based on their personal risk of cardiovascular disease and it’s important because it gives a stark, simple picture of your future risk of having or dying from a heart attack or a stroke.  Take, for example, a 53-year-old woman who finds out that her heart age is 22 years older than her chronological age, 75; and that’s because she smokes or has uncontrolled and has uncontrolled high blood pressure or a 45-year-old man who finds out that his heart is 30 years older than he is, despite the fact that his weight is healthy, because he has untreated high blood pressure, smoking and diabetes. For that woman or that man, for every American, learning your heart age can be a clear call to take charge of your health. This is good advice for both younger and older Americans. It is never too late to turn back the clock on your heart age. We found that heart age varies by race and ethnicity, gender and where you live. This is actually the first study of its kind to give population-level estimates of heart age as well as differences or disparities in heart age nationally. We found that nearly 69 million adults ages 30 to 74 have a heart age that’s five or more years older than their actual age. That’s as many people as there are living in the 130 largest cities of the U.S. combined. These are people at much higher risk of a heart attack and stroke. Now, I know many of us have lost family members or friends too young to heart attack or stroke and it’s particularly tragic because in so many cases, these deaths are preventable. A previous CDC study indicates that, at a minimum, at least 200,000 cardiovascular death as year could be avoided through better management of our risks and management of our health conditions. The fact that so many adults have a heart age above their actual age really bothers me, both as a doctor and as a CDC director. We have a tool on our website that can help people take action and learn their heart age. CDC.gov/vitalsigns/heartage. There are facts on this report that are particularly important. The first relates to gender. Both men and women have an average heart age older than their average age, but a man’s heart age is eight years older than he is and for women, five years older. Until age 60, when women surpass men.  Second, excess heart age increases with age but even younger adults can have an average heart age that’s much higher than their actual age. For example, people that are aged 44 to 49, men have an excess heart age of six years and women of three years. People at any age should address their cardiovascular risk factors sooner rather than later, but it’s never too late. Third, race and ethnicity. African-Americans have a significantly higher predicted heart age compared to other groups with both men and women averaging really a very distressing and truly shocking 11 years older than their actual age. There are many persistent racial disparities in cardiovascular disease, such as a much higher rate of heart disease among African-Americans.  There are differences in average heart age. Heart age is typically higher or older in the southern part of the U.S.  Mississippi, West Virginia, Louisiana, Kentucky and Alabama; all have the the highest percentage of adults with heart age five years or more over their actual age, with Utah, California, Colorado, Massachusetts and Hawaii having the lowest percentage.  And for both men and women, excess heart age decreases with more education and household income. So, it’s possible to use this information to improve heart age. We can target efforts for individuals, doctors and nurses can provide this to individuals to help them make informed choices and take action. For most Americans, it’s important to remember that starting at any age can make a difference.  If you choose one or two risk factors that you’re ready to change, such as smoking or high blood pressure and focus on them, you can make a big difference. Here’s an example. If you take a 50-year-old who smokes, if that individual quits, they’ll gain 14 years of heart life. State and local health departments can help by promoting safe walking areas and access to healthy food and promoting smoking cessation, increasing the price of tobacco products and doctors and nurses and physician assistants can use heart age calculators to inform treatment decisions. The federal government is doing our part by requiring most health plans to cover recommended preventive services at no out-of-pocket costs, blood pressure screening, help to quit smoking, resources in all 50 states to address and prevent chronic disease. We’re also running national campaigns, such as the tips from former smokers’ campaign, which is proven to save lives and save money. Included in these efforts and really an over-arching framework for them is million hearts. That’s an initiative to prevent 1 million heart attacks and strokes in five years. We can get there by prevention strategies that work, smoke-free policies, reducing sodium in our foods. Million hearts focuses where the clinical providers for doctors and nurses, pharmacists, nurse practitioners on the ABC’s of heart health, aspirin for people at risk, blood pressure control, cholesterol management and smoking cessation. The heart age tool gives away to understand clearly and simply what might be a ticking time bomb inside of you but not only that but how you can diffuse it.  Thank you very much.

TOM SKINNER: Sidney, I believe we’re ready for questions, please.

OPERATOR: At this time, if you do have a question, please press star one and record your name and outlet. If you have a question at this time, press star one. It looks like during the presentation we have one question queued up. That will come from Eben Brown of Fox News Radio. Your line is open.

EBEN BROWN: Thank you and Dr. Frieden, thank you for doing this. A couple questions, sir.  Is this heart age tool, do you think it could possibly become sort of like a pop culture thing to the point where it’s not taken seriously?  Or I guess the inverse of that question is, how serious of a tool is it? I mean, would it be helpful to doctors to communicate with their patients? I understand the purpose behind it and why the CDC is promoting it, but does it run the risk of becoming something that’s not taken seriously because it is so simple?

TOM FRIEDEN: As a science-based organization, we look at the facts and there’s a very interesting study done by some outside researchers  read by Dr. Lopez Gonzalez and what that study found is that they randomized 3,000 people into groups of 1,000 each. One group got routine medical advice, what a doctor tells you, you should do. The second group got a risk calculation, a risk score. It tells you what the risk of a heart attack is in the next ten years. The third group got the heart age and one year later, people who had learned their heart age had gained 2 1/2 more years of healthy heart life than the group with routine medical advice and more than a year more than the group with the risk calculation. So this is a way of communicating a fact that is a life and death fact for many people.

EBEN BROWN: In a follow-up, sir, you’ve given examples of people who have — they are the certain age and because of certain risk factors they have a heart age older than their chronological age. Is it possible, the way the system works that someone would have a younger heart age than what their chronological age is?

TOM FRIEDEN: Not only is it possible but nearly a third of Americans do. About 30% of Americans — and I’m pleased to say I’m one of them, has a heart age younger than their chronological age and that’s a good predictor that they are not early to have a heart attack or a stroke. It’s not a guarantee and it’s not — it’s a way to encourage continuing to not smoke, conditioning to keep your blood pressure under control, being physically active and there are things really within our power. Most persons whoever smoked have already quit and most Americans who still smoke want to quit. So quitting smoking, if you smoke, is the single most important thing you can do to live a longer and healthier life and help the health of the people around you. Controlling your blood pressure doesn’t have to be difficult. Most people with high blood pressure can have it controlled with inexpensive once-a-day medications and that control will dramatically reduce your risk of having a stroke or a heart attack or becoming disabled.  There’s a reason high blood pressure is called the silent killer. We don’t have symptoms of it, but you have to have it under control to have a healthy heart.

EBEN BROWN: One more follow-up, if I can. You keep mentioning smoking and high blood pressure. Obviously these are factors.  But America has been infamous around the world for an obesity epidemic. How does that factor into heart age? I don’t think you’ve spoken about it much today.

TOM FRIEDEN: We have seen an increase in obesity in the U.S. and that has been one thing that’s been driving up the heart age and this is why we encourage everyone to be physically active in ways that you can maintain for a lifetime. One of the things that we emphasize about weight is that both sides of the equation are important. The CDC science suggests that it’s more a matter that we’re eating more and that we’re exercising less, but both of those parts of the equation are important and we encourage people to eat things and do things that they enjoy doing that are healthy. So I think if you want to sustain healthy habits, find food that you love, that is healthy for you with more vegetables than fruits, find activities that you enjoy that you will continue doing, whether that’s walking or dancing or doing whatever it is that you will keep at over the long haul.

TOM SKINNER: Next question, Sidney, please.

OPERATOR: Our next question will come from Mike Stobbe of the Associated Press. Your line is now open.

MIKE STOBBE: Hi. Thank you for taking my question. I have two. One, I just wanted to make sure I had right the percentages of Americans who were younger at heart, those who were — whose heart age was about the same as their actual age and the proportion who have heart ages that are older than their actual. You just said a third were younger at heart. How many were age and heart age were the same and what proportion were older?

TOM FRIEDEN: So 30% are at or below or younger than their heart age and then 70% would be above their chronological age.

MIKE STOBBE: Okay. — Thank you and the other question was, the Million Heart initiative, how is that going?  Or when will there be a report card on what kind of initiative that program is making.

TOM FRIEDEN: I’m glad you asked me that. We’ll have a report on that in the coming months.  I think we’re seeing progress in some areas, not as much as we’d like. But we are seeing some encouraging trends and we’ll have more information on that. It’s going to require that more Americans quit smoking, more Americans get their blood pressures under control.  Those are really two of the main drivers of heart age.  For those who are not familiar, Million Hearts is an initiative from both the CDC and U.S. government and the private sector to prevent a million heart attacks and strokes over a five-year period. We’d like to see more people get into that heart age at or below your chronological age.  30% is 100 million people. So it’s not — I’m sorry.  I’ve got that wrong. Sorry. Let me correct that. That’s incorrect. But the Million Hearts initiative is an effort to focus both our community wide interventions such as smoking cessation and improved nutrition and our clinical interventions, what I call the ABC’s to reduce heart attacks and strokes.

TOM SKINNER: Next question, Sidney?

OPERATOR: Our next question is from Robert Lowes of Medscape Medical News.

ROBERT LOWES: Dr. Frieden, thank you for taking my call. Can you repeat the name of the researcher who did — who compared outcomes for who people got routine advice versus the traditional heart age? I was curious.

TOM FRIEDEN: Reference 22 in the MMWR by Lopez Gonzalez.

ROBERT LOWES: What was that edition?

TOM FRIEDEN: If you look at the MMWR, it’s reference 22. The first author’s name is Lopez Gonzalez.

ROBERT LOWES: Excellent. Thank you.

TOM SKINNER:  Next question, Sidney?

OPERATOR: Just a reminder, if you have a question, at this time, please press star one.  Our next question is from Lenny Bernstein from the Washington Post. Your line is now open.

LENNY BERNSTEIN: Hi, Dr. Frieden. Thank you for taking my question. I haven’t had a chance to play with the calculator yet but in order to figure out my own personal heart age, do I need to know my own systolic blood pressure? That seemed to be one of the things they used in calculating it.

TOM FRIEDEN: Yes. We think everyone should know their own blood pressure. There are two versions of the calculator.  One, if you know your cholesterol levels, total and good or HDL cholesterol and the other if you don’t. But for both of them you have to know your systolic blood pressure, which I hope everyone will learn.

LENNY BERNSTEIN: Okay. Thanks.

OPERATOR: Our next question will come from Dan Childs of ABC News. Your line is now open.

DAN CHILDS: Thank you so much for taking my question. You know, one of the things that I noticed when we used this calculator was there were a number of factors not accounted for. For example, cholesterol levels, racial and socioeconomic backgrounds and other risk factors. So given that, how accurate that is this tool by not taking account these factors and to what extent is this designed to start a conversation rather than provide an answer?

TOM FRIEDEN: There’s always a balance between something that’s simpler and something that is maybe more detailed. There are two versions of the calculator that you can get to from our website. One of them does require you to have your total and your HDL cholesterol but these are the major cardiovascular disease risk factors that you can change. So there are other risk factors that you can’t change and that is something that is important to study and try to address but you’re not going to change your age. You can change your heart age.

DAN CHILDS: Thank you.

TOM FRIEDEN:  Dr. Ritchey, do you want to say anything more about the accuracy of the calculator?

MATTHEW RITCHEY: As has been looked across populations and if we look at the heart age as calculated using this type of calculation, it has actually been shown to be a very good predictor of future risks for having a heart attack or a stroke. So even though it may not include all of the different variables, risk factors that might impact your heart, ultimately it has been linked to these outcomes. But that still goes back down to the individual level when the clinicians and the doctor and nurse has the conversation with the individual patient and starts to address some of the risk factors that are specifically included within the tool.

DAN CHILDS: And just one follow-up question, is there any particular age that is considered — I know it goes up to age 86. And, for example, if you find that your heart age is 30 years, 40 years older than your chronological age, that that is kind of the top level at which your risks are as high as they can be?

MATTHEW RITCHEY: On the Framingham heart study, the way the calculator works that we provided online, there is a cap of 86 and no matter what your chronological age is, there’s always going to be a cap of 86. Within our study, we’ve modified the cap for that up to 100 years of age. So there is a slight variation there as far as doing our population level assessment for our study.

DAN CHILDS: Thank you.

TOM FRIEDEN: Yep. That was Dr. Ritchey on the answer there.

TOM SKINNER: For those on the call, Dr. Matthew Ritchey’s last name is spelled R-I-T-C-H-E-Y.  Sidney, next question please.

OPERATOR: At this time, I’m showing no more questions in the queue.  If you have a question, please press star one at this time.

TOM FRIEDEN: Okay. We’ll wrap it up here. I’ve just summarized the heart age is an understandable, simple tool to help people take more control over their own health. In particular, their heart health. It’s never too late to turn back the clock on your heart age by doing things like quitting smoking, getting your blood pressure or cholesterol into control, getting regular physical activity and doing — making changes that you can continue with for the long-term so you can be there for the long term. Everyone deserves to have a heart that is — everyone deserves to be young at heart or at least not to be old at heart. Thank you all very much for joining us.

TOM SKINNER: Sidney, this concludes our call. Thank you very much for joining us. We’ll have a transcript of this call available on the CDC media relations website later and reporters who need additional information can call 404-639-3286. Thank you.

OPERATOR: You may disconnect at this time.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES