Researchers at the Population Health Research Institute (PHRI) want to prevent cardiovascular disease. That is the driving force behind the Heart Outcomes Prevention and Evaluation (HOPE) studies. HOPE-4 is the fourth in the series, and occupational therapist Jackie Bosch has been there since the start with HOPE-1.
“We started out looking at those people who had cardiovascular disease: had events, needed additional treatment, because they continued to have events,” says Bosch.
“We’ve now moved into a realm of primary prevention. Primary prevention is interesting because it’s people who don’t think they’re at risk for cardiovascular disease, but they are.”
At these early stages, there are many proven treatments that can effectively prevent cardiovascular disease. But the truth is that even though we have these tools, they aren’t being used adequately. This is a global problem, no matter how rich a country is, says cardiologist and PHRI’s Executive Director Salim Yusuf.
“Let’s take hypertension, for example,” says Yusuf. “Detecting hypertension isn’t difficult. You don’t need highly trained people to detect it. Yet only 50 percent of people who have hypertension have been diagnosed to have hypertension.”
Hypertension is a leading cause of cardiovascular disease, and beyond the diagnosis gap, there’s also a treatment gap. Once diagnosed, 80 to 90 percent of hypertension patients are treated, usually with medication to lower their blood pressure.
Treatment effectiveness goes up when blood pressure medication is combined by controlling LDL cholesterol with statins, but the combination is only used 5 percent of the time in clinical practice.
HOPE-4 strives to bridge both these gaps, and not just with drugs but with an entire support network. It starts with door-to-door screening of an entire community. When cases are found, the team gives lifestyle advice and recruits family members and friends to help them support the necessary lifestyle changes. At the same time, the combination of blood pressure drugs and statins are used for treatment.
The combination of all these interventions has a large benefit, and all of it can be delivered by non-physicians.
HOPE-4 is an early intervention plan that can be implemented now. With widespread use, it gives patients the best known drug treatment and helps them stay on course to make enduring lifestyle changes to prevent cardiovascular disease.