Benjamin Franklin Had the Right Idea

Here is a sobering fact to start your morning: Nothing kills more Americans than heart disease and stroke, and nothing costs the health care system more financially.

In 2023 nearly 920,000 Americans died from cardiovascular disease (about 1 in 3 deaths) while between 2019 and 2020 health care costs related to cardiovascular disease were over $250 billion in direct costs and $165 billion in indirect costs (costs related to lost employment, etc.). These staggering numbers are projected to reach nearly $2 trillion by 2050.

Despite these daunting statistics, all is not “doom and gloom.” I have had the privilege of practicing cardiology for nearly 40 years and have witnessed many astounding advances in the management of cardiovascular disease over that time. From innovative and powerful new medications to the development of sophisticated, minimally invasive, catheter based and surgical techniques, our ability to improve both the quality and quantity of life for people with cardiovascular disease has never been greater.

However, despite these impressive advancements, when it comes to cardiovascular disease, I often fall back on an old maxim attributed to Benjamin Franklin: “An ounce of prevention is worth a pound of cure.”

Several years ago, American Heart Association developed “Life’s Simple 7”: seven metrics that people could modify to lower their risk of developing heart disease and stroke. These included smoking, diet, physical activity, weight, blood pressure, cholesterol, and blood sugar.

Studies have shown that optimization of these risk factors results in lowering the risks of developing heart attack and stroke and a reduction in health care costs. For example, optimization of 5 of these 7 parameters can cut the risk of cardiovascular disease by 50%, as well as lowering the risks of other diseases, such as diabetes, dementia, and some cancers.

That said, I personally never liked the term Life’s Simple 7 because, as someone who has spent a career trying to educate and encourage patients about the importance of lifestyle changes in cardiovascular disease prevention, I realize that making these changes is never simple. Therefore, I was pleased when the American Heart Association recently added sleep health to the list and changed the name to “Life’s Essential 8.”

Although there is no doubt that heritability plays a role in the risk of development of cardiovascular disease, evidence suggests that personal behavior and environmental factors are of greater importance. I always tell patients that you cannot change your “genes” (at least not yet) but that many other factors are modifiable through lifestyle changes and, if necessary, medical therapy.

Although space does not allow for an extensive discussion regarding ways to achieve optimal cardiovascular health, here is a brief synopsis of each component of Life’s Essential 8.

Although the earlier one can focus on the optimization of cardiovascular health the better the outcomes will be, it is never too late to realize favorable health outcomes by doing so. So, as we begin a new year, let’s all try to get moving, eat healthier, stop smoking, get adequate sleep, stay on top of our weight, blood pressure, cholesterol and blood sugar, and follow Ben Franklin’s sage advice. Doing so will greatly enhance our chances of a longer, happier, and healthier life.