Originally published on LinkedIn
February is American Heart Month. 60 years ago, in February 1964, President Lyndon Johnson established the observance to “give heed to the nationwide problem of the heart and blood-vessel diseases, and to support the programs required to bring about its solution.” Congress supported that proclamation with a joint resolution to make it so.
Attention to coronary heart disease (CHD) was urgent and overdue. At the beginning of the century, few Americans died from CHD, but by mid-century it had become the most common cause of death in the country. By the time Johnson made his proclamation, CHD was responsible for one-third of all American deaths. Then, the tide turned for most but not all.
The overall death rate fell over the next two decades, likely because of more attention paid to heart health and the impact of smoking, diet, and hypertension as well as advances in early detection and bypass surgery.
That decline began to slow starting in the 1980s with the rise in obesity, type-2 diabetes, and hypertension, and in the past 15 years, rates have actually begun to climb again. Between 2010 and 2020, death rates rose 8.5% for adults aged 45-64. From 2020 to 2021, at the peak of the pandemic, heart attack deaths increased 21% for adults 45-64 and 17.5% for adults 65 and older. Stress, sedentary behaviors, weight gain, and the Covid-19 virus itself likely contributed to that spike.
But the story of the past 60 years has been different for Black Americans. Death rates for Black and white Americans were similar in 1968, but they began to diverge in the 1970s when death rates for whites continued to decline while death rates for Blacks plateaued. Between 2005 and 2015, there were small improvements in that disparity. In recent years, 47% of Black American adults have been diagnosed with cardiovascular disease versus 36% of white adults. In 2019, Black Americans were 30% more likely to die from heart disease than white Americans.
Today, despite ongoing clinical and scientific advances, heart disease still claims the lives of more than 650,000 people in America annually, making it the most common cause of death. Congestive heart failure (CHF) affects more than 5 million people across the country and is the most common cause of hospitalizations and readmissions among older adults. And heart-related diseases and deaths continue to affect people unequally along racial, ethnic, socioeconomic, and regional lines.
To continue to heed President Johnson’s 60-year-old call for solutions, we must answer some basic questions: why has the progress in heart health slowed, despite medical advances, and why has heart health not improved as much for Blacks as other racial and ethnic groups?
In addition to access to care and different genetic proclivities to certain illnesses, we now know that diet-related illnesses and conditions like diabetes, hypertension, and high cholesterol significantly contribute to heart health. And we also know that these chronic illnesses are exacerbated by food insecurity.
That understanding should inspire action and change.
Food Insecurity and Heart Health
According to a 2022 JAMA study of National Health and Nutrition Examination data collected between 1999 to 2018, Cardiovascular Disease (CVD) is the top cause of death in the U.S., and diet is the greatest contributor to CVD. The research also showed that the percentage of people in the U.S. with CVD who are also food insecure doubled between 1999 to 2018, from 16% to 38%. And people who are food insecure are twice as likely as non-food insecure people to have CVD.
The higher rates of death from CVD among Black individuals also correspond with higher rates of food insecurity. In 2022, nearly 23% of Black people in the U.S. were food insecure, almost 2.5 times the rate of non-Latino Whites.
This makes food insecurity and CVD bi-directional risks. In other words, food insecurity increases the risk of CVD, and having CVD can exacerbate socioeconomic factors that increase the risk of food insecurity.
A 2022 study of 2018 data collected from 3,000 counties across the country noted that access to quality grocery stores, and other healthy food resources, including SNAP, was significantly associated with lower rates of death from heart failure. And numerous studies show that a healthy diet - particularly Mediterranean, DASH, or plant-based - promote heart health, though there are challenges in adopting and maintaining such a diet.
As Dr. Keerthi Gondi, one of the lead authors of that study, stated: “Heart failure mortality is on the rise in populations that live in socioeconomic deprivation… and food insecurity may be particularly detrimental in this population…. This will have to be addressed in order to make changes to the burden of cardiovascular disease in populations that live in socioeconomic deprivation moving forward.”
The challenge is that food insecurity occurs among populations and communities that are not only marginalized but can be difficult to reach.
Medically tailored diets have shown effectiveness in managing chronic heart failure. Incentives for purchasing healthy food also help, as does nutrition coaching and education. But impact can be amplified and sustained when all of these approaches come together in a personalized solution that takes individual and cultural food preferences into account while also offering coaching, education, and support for adopting healthier behaviors.
That’s how NourishedRx is really making a difference.
A Food Insecurity CHF Study with Humana
In 2021, we partnered with Humana, one of the nation’s largest health plans, to test the impact of our cardiometabolic health program for people living with CHF who were also food insecure. We ran a 12-month personalized nutrition program that incorporated education and coaching. At the end, we examined the results, including satisfaction levels and the impact on physical and mental health.
Participants had on-demand access to us through phone, text, email, or app, and could also access educational content, surveys, and meal ratings. Their food was a mix of customized medically tailored meals, meal kits, grocery boxes, and grocery cards. The food could be modified on an ongoing basis to adapt to any change in the participant’s behavior, circumstances, or preferences.
The program resulted in a significant drop in unhealthy days, a 50% reduction in depression risk, and a 20% reduction in loneliness levels. There was also a positive impact on quality of life, confidence in self-care, blood pressure, and lasting behavior change. Engagement and satisfaction levels were extremely high, indicating enthusiasm for the program and the approach. Participants took ample advantage of the resources available to them and enjoyed the quality and freshness of the food as well as the ease of preparation. Three months post-program completion, 94% of participants contacted answered
affirmatively when asked whether their NourishedRx experience had a positive effect on their ongoing food choices.
We were also able to help Humana address hundreds of member needs around medication adherence, transportation, housing, and home care while also discussing HEDIS care gaps with 25% of program participants. All of which contribute towards whole person health.
A Whole-Person Solution Starting with Healthy Food
CHF is a chronic progressive condition that requires close monitoring, behavior change, and a healthy diet to manage and improve length and quality of life. Our program showed how positively people with CHF and food insecurity responded to engagement through food, nutrition education, and health coaching.
We formed meaningful connections with participants who developed a greater sense of empowerment over their own health, felt less lonely and depressed, and developed healthy behaviors.
Science and medicine continue to make great strides in treating CHF from a clinical angle. But new understanding about the critical role of diet and food security shows the need for more holistic, whole-person solutions in closing gaps and improving heart health for all. The great news is that nutrition-focused programs can be affordable, powerfully effective, and life-changing with a tremendous impact on downstream costs.
On this 60th anniversary of the launch of American Heart Month, it’s time we bring such solutions to everyone in need for the good of all.
