Primordial CVD Prevention, Maternal Health, and Advocacy to Improve Outcomes Now & Into the Future

Take two minutes to let us know what you think of the Heart to Heart Nurses Podcast. Share your thoughts by March 26, 2026 to be entered into a drawing for a $25 gift card. Visit PCNA.net/podcast Welcome to Heart to Heart Nurses. Brought to you by the Preventive Cardiovascular Nurses Association. PCNA's mission is to promote nurses as leaders in Cardiovascular Disease Prevention and Management. Well, welcome back to our audience and we are very honored to be here with Don Lloyd-Jones and he is going to introduce himself and we're going to get into several different topics today. You are not going to want to miss. So Dr. Lloyd-Jones, please introduce yourself, please. Thank you, Journalist. Great to be with you. So I am Don Lloyd-Jones. I'm a cardiologist and cardiovascular epidemiologist. I'm the chair of the Department of Preventive Medicine at Northwestern University in Chicago and have the real honor of being the president of the American Heart Association this year. So as again, I've said before we are so honored to have you here and you have such a breadth of information for us to try and take advantage of while we have you here in the podcasting studio. But let's go ahead and get started about primordial prevention of cardiovascular disease. Can you talk a little bit more about that and what that might look like maybe in clinical settings? Sure. So I think many people have not maybe heard this term before so it might be worth defining it. And the way I think about prevention is in buckets. So tertiary prevention is really what we refer to when a patient is in the emergency department in the midst of an acute stroke or an acute heart attack. What do we need to do to keep them alive? Secondary prevention, people will be familiar with, right? Once they've had that heart attack or stroke, how do we prevent the next episode? Primary prevention where we spend a lot of our time, people have risk factors and we want to prevent that first heart attack or stroke. But primordial prevention is really the new kid on the black. Actually first defined in 1978, but if you look at across the literature at the citations, there's this huge uptick that happens in 2010. From essentially three citations a year referring to primordial prevention now in the several hundreds per year and growing. And the reason that changed happened is because in 2010 the American Heart Association really put a premium on defining primordial prevention, defining something that we want to strive for which is positive cardiovascular health. And the way to achieve that is through primordial prevention. So what does it mean? What primordial prevention means is we're not going to let people develop risk factors in the first place. Because once they've developed hypertension or diabetes or cholesterol, we can treat those things very effectively in primary prevention, but we can't put the horse all the way back in the barn. Too many of those people will have a sudden cardiac death event as their first event or will go on still to have a heart attack or stroke because we can't completely restore the lowest risk. So in primordial prevention, we're really taking a life course approach to try to start early in life, continue through a young adult to middle age to make sure we keep that blood pressure as low as possible, as long as possible. So as you can imagine what we're talking about here is both population level interventions, but especially individual interventions to make sure we're optimizing lifestyle so that the blood pressure doesn't start to go up in our 20s and 30s and 40s. That's a really not very novel based on the years that you were talking about that this has been in literature, but for most of us that is a really novel consideration. So how would that look in clinical practice? Let's say you are a primary care provider. What would that look like? I heard you talk about the hypertension and controlling that, but what would the conversation maybe be to try and make that really approachable to a patient? Yeah, well I think it is always really important to frame this in a positive framework, meaning you know if we can keep your really excellent blood pressure where it is today for the next 20 years, you won't need to take medication. In fact, you know when that time comes like your parents are. And in fact, you know we can actually avoid you having a stroke or a heart attack in your 50s and 60s. We'll actually help you avoid cancer if we follow these lifestyle approaches as well. We'll help you actually live longer and healthier longer without many of these chronic diseases of aging. So the time to start my pediatric patient or my young adult patient is now and the way we're going to achieve this is through keeping you active. Every single day trying to move a little bit more. Keeping your weight healthy at a minimum, let's not let you gain any more weight. Let's hold the line where you are and if we need to, let's figure out strategies that work for you to reduce some weight if you need to. And critically important, the thing that's upstream from all of this of course is our eating pattern. So getting people focused on a more plant forward eating pattern, helping them understand how to avoid sodium that's in the processed food supply, how to eat food that looks like food and really enjoy that because it can actually help all the other things that happen downstream. So I suspect you probably have some resources that you could point to so that our providers could have some additional information. Yeah. So a great place to start is with the Life's Simple 7 website of the American Heart Association where a patient or a provider can go and enter very simple information about a patient's eating pattern, their physical activity pattern, what their weight is, do they smoke and their current levels of cholesterol, blood pressure and blood sugar. And they'll get their cardiovascular health score and they'll also get a lot of great tips about how to improve those things that might get a red light or a yellow light instead of a green light so that they can improve their cardiovascular health through primordial prevention strategies, again mostly focused on lifestyle and then achieve, again, that longer healthier lifespan which is I think really the goal of primordial prevention. I really like that idea. I kind of wish I was not at this point in my life and could go back a little bit further and be part of that trajectory towards better health throughout life. What's really important to know though is it is never ever too late. Yes, the earlier you start the bigger the impact will be but it is never too late and we can show from a lot of population level data that people who make changes in their 50s, 60s and 70s can actually extend their health span even by doing it then. Now, yes, we'd love to have them do it in their 20s, 30s and 40s because it will have a bigger longer impact but it is never too late and it's important to emphasize that as we empower our patients at every stage of the life course. Well speaking, having a long-term impact, we've had a situation around the globe in the last couple of years and I think we're all very familiar with what's happened but if you could talk a little bit about how COVID and CBD, those interrelationships and what we might be looking at both short, medium and long-term. Yeah, this is really important and I think we know the devastating impact that COVID has had around the globe with millions and millions of deaths coming up on a million deaths here in the spring of 2022 in the United States all too quickly. But I think it's important to remember what put us at risk for this virus to have such a devastating impact. It was obesity, it was hypertension, it was diabetes. The same things that made our population unhealthy and gave us such high levels of cardiovascular disease and cardiovascular deaths were actually the very same things that put us at risk for the virus. That sort of low-level inflammation and the unhealthiness of our immune systems related to obesity, diabetes and hypertension are the very things that made it more likely that those patients would also have complications from the virus. I think when we've learned we really need to get back to thinking about these chronic conditions and how they make the whole population unhealthy, not just around cardiovascular disease and stroke, but for these other reasons as well. It was the fertile soil that I think the virus found. But what's really important to know also is that as we've gone through this pandemic, we've seen a number of problems that have increased cardiovascular disease death rates, both directly and indirectly related to the virus. The stresses of an infection certainly increase the risk of heart attack and stroke for maybe as long as six to 12 months after the acute infection. Interesting data about that. Unfortunately, we've seen as the different waves have gone through, patients voting with their feet, staying at home when they're having severe symptoms that might be a heart attack or stroke, not going to the emergency room because they're worried about the virus and then presenting either too late for us to be able to intervene or sometimes presenting dead unfortunately. And so we've seen marked increases, maybe 50,000 more deaths in the last two years each due to cardiovascular disease because of these kinds of acute problems that aren't being addressed. And that's the pandemic sort of getting in the way of our usual systems of care. But then also we've seen patients deferring or avoiding care for those chronic conditions. In the summer of 2020 the American Heart Association did a national survey and 41% of patients were saying they were deferring or avoiding their routine clinic visits to manage obesity, hypertension, diabetes, cholesterol. And then even by the next summer of 2021 it was still 20% of patients. So those patients had disconnected from their usual sources of care. And we know and I'm seeing these patients back now and we desperately want them back because blood pressure has gone far out of control and it takes time to get those things back under control. So particularly marginalized populations underrepresented, under-resourced communities, we've seen devastating impacts there and we're going to see ripple effects for probably years to become because we've lost control of some of those really critically important cardiovascular risk factors. And I'm worried. I'm hopeful because we have new ways maybe to reach patients through telehealth, through home blood pressure monitoring. We can empower people, but we need to get them back in first to be able to activate that. Such great information that you're sharing with us. We're going to take a quick break and then we'll be right back with Don Lloyd Jones. Until recently when a patient was diagnosed with HCM, symptom management was the only therapy available. Now, with two approved treatments, Mavicampton and AphaCampton, shared decision-making is more important than ever to ensure that patients, family members and caregivers understand available treatment options. Join us April 9th through 11th in Scottsdale, Arizona for PCNA's cardiovascular nursing symposia. And colleagues from across the country and even the globe to learn from subject matter experts, share best practices and network. If you can't attend a person, join us virtually from your workplace or home. Find more details at PCNA.net/ symposium. And we're back with Don Lloyd Jones. We are so thrilled to be able to have this conversation with him. I know that there's a number of things that you wanted to discuss in our time today. And one of those had to do with gestational and maternal risks of cardiovascular disease. So I'm wondering if you could launch into that topic for us. Certainly. And it's going to be along the lines of some of the things we've already talked about in terms of primordial prevention. Maybe the first thing I'll say is that healthy moms have healthier babies. And those healthier babies in turn launch into healthier trajectories across their life course. It's really important that we think about having healthier moms preconception because we know that moms that go in already having weight problems or blood pressure problems more likely to have adverse pregnancy outcomes. That affects mom's health, also affects the baby's health. But we've done some interesting research. If we know what the cardiovascular health status of a woman in second trimester, we can actually predict what the cardiovascular health status of her child will be 10 to 14 years later. Oh my gosh. So, really interesting. So, the sort of priming that happens within the uterine environment for that child is incredibly important to understand how they're going to handle stresses, how they're going to handle calories later downstream. This sort of imprinting that happens through epigenetic mechanisms in utero can actually decide whether the child's going to launch to a higher trajectory or maybe not be able to achieve that higher trajectory. So, got to get our moms healthier for so many different reasons. But maybe the most stark and important reason is among all industrialized high income countries, the US is dead last in maternal mortality, a shocking horrible statistic. And we are the only country high income industrialized country in which our rates are getting worse over the last 20 years. Everyone else's rates are getting better. We are getting worse. If we can't protect moms at the time of birth, what are we doing as a society? Because again, it feeds forward into higher risk for their kids as well. And then we have another generation of unhealthy moms and dads who have unhealthier children. We need to arrest this cycle and we need to do it right now. And that again, we must focus earlier in life on healthier lifestyles so that we can arrest this cycle. And it's not evenly distributed. What's tragic here is just like COVID, just like the opportunities to be able to participate in healthy lifestyles. Maternal mortality rates are two times higher in American Indian native indigenous populations, three times higher in black women compared with white or Hispanic women. Unexceptible. And we must, must do better at getting those women access to healthcare, the ability to pay for healthcare and the relationships that are ongoing through the pregnancy and after. Because if a woman has gestational diabetes or a hypertensive disorder of pregnancy, she's at much higher risk to develop those things later after her pregnancy, to have long-term diabetes, to have long-term hypertension. And too many of those women don't get back into care or don't stay connected with the health system after they've had their child. They're just indibult, but there are easy policy ways we can address this, you know, through better Medicaid coverage that will cover mom for a longer period of time after birth so that she gets the care she needs as well. Just such thought-provoking statistics you've provided us and heart-wrenching, literally and figuratively, I, you know, I'm just, like the audience, just amazed at the fact that we're not getting any better and the time is now for us to act. So what are some actions that our listeners can do today to make a difference for all these populations of individuals who are facing struggles that are, if we're not careful, insurmountable? Yeah. So I'm a big believer in advocacy. You know, I think we can do what we can do at our individual level. We can actually affect our families and our near communities, right, with promoting healthier lifestyles. Let's all get up and go for a walk. Let's choose healthier foods to have for dinner. Let's eat them together to have that, you know, enjoyable experience around eating food. So there are many, many things we can do at our individual level, but we need to tilt the playing field so that those default choices that we're forced to make are healthier. And that's where advocacy, I think, is so important. We need to work with our community leaders so that there are safe places for kids to play. You know, after school basketball programs, parks where they can go and play safely, where hopefully, you know, either whether it requires police, you know, patrols or parent patrols or whatever it is so that those kids can be in places where they can run around and play safely, hopefully for 60 minutes every day, which is really how they'll lunch, you know, more healthily. Thinking about the food supply in our schools, getting sugar, sweetened beverages out of our schools, making sure that every single one of our communities and states has tobacco-21 laws, so that no one under 21 can buy combustible tobacco or vaping products. We do not need another generation of individuals hooked on nicotine, and those vaping products are extremely efficient nicotine addiction delivery systems. That's all they're there for. This is Big Tobacco's playbook all over again. We must rise up and fight against this, and we have really powerful ways to do that with our advocacy tools. Thinking even a little bit more broadly, you know, let's talk to our senators and congress people. It's time for the Farm Bill again, rather than subsidizing big ag, corn and soybeans, how about subsidizing fruits and vegetables? That actually would lead to a healthier population with reduced disparities in health, and everybody living longer better. Isn't that what societies are supposed to do for ourselves? So that may seem daunting, but getting involved at the school level, getting involved and getting to know your community and state level representatives, they are so hungry for our knowledge as clinicians, as physicians, as nurses, as parents, about what could be done that they will talk to anybody. And what's really helpful to know is that these strategies are actually cost-saving. So often the bottom line for our policymakers is, well, this is going to cost money, but actually it will be cost-saving because we will have fewer adverse pregnancy outcomes. We will have healthier children with less asthma, with less obesity, with less chronic diseases, even in younger ages, and that will turn into fewer heart attack strokes and cancers down the line as well. So these are cost-saving strategies, and it is maybe it takes a lot of activation energy to be an advocate, but once you do it, you'll be hooked. I promise you. This year as the H.A. President, this has been the most energizing, these have been the most energizing activities that I've done. Testified before Congress for a day. Amazing. I've been working with Senator Durbin's staff on public health funding priorities. Just to see, again, how hungry they are for our knowledge and how you can make a difference, please get out there and do it. It's amazing. I wish you all could see the enormous smile that I'm seeing across the table from me. You can just feel the energy, you can just sense the optimism, and that's really the important part here that we all can make a difference. Dr. Lloyd-Joyce, is there anything else that I neglected to ask that you would like to touch on today? No, I think three incredibly important issues, primordial prevention. Let's start young, but it's never too late. Living lifestyle to improve and enhance our lifespan and our health span. Let's help our moms be healthier. That's policies, yes, but that's also launching our children into healthier trajectories so that they're healthier moms and dads, and their kids are then healthier. Then finally, being an advocate, we can make a difference and actually create a healthier environment for all of us. Dr. Lloyd-Joyce, it's been an honor to have you here speaking with us today. Thank you so very much for your time. This is your host, Gerald and Warfield, and we'll see you soon.