Author Archives: Webmaster

About Webmaster

"My characteristics are:A foundation, order, service, struggle against limits, steady growth. My destiny is to express wonderful organization skills with my ever practical, down-to-earth approach. I’m the kind of person who is always willing to work those long, hard hours to push a project through to completion. My abilities to write and teach may lean toward the more technical and detailed. The positive attitudes; I am one who no doubt, fulfills obligations, and is highly systematic and orderly. I am serious and sincere, honest and faithful. It is my role to help and I am required to do a good job at everything undertake. I may express some of the negative attitudes. The obligations that my face may tend to create frustration and feelings of limitation or restriction. I may sometimes find myself nursing negative attitudes in this regard and these can keep me in a rather low mood. Avoid becoming too rigid, stubborn, dogmatic, and fixed in my opinions. I may have a tendency to develop and hold very strong likes and dislikes, and some of these may border on the classification of prejudice. The negative often produces dominant and bossy individuals who use disciplinarian to an excess. These tendencies must be avoided, hufz..I wish . Finally, I must keep my eye on the big picture and not get overly wrapped up in detail and routine. My desire in life is personal expression, and generally enjoying life to its fullest. I want to participate in an active social life and enjoy a large circle of friends. I want to be in the limelight, expressing my artistic or intellectual talents. Word skills may be my thing; speaking, writing, acting. In a positive sense is friendly, outgoing and always very social. I have a decidedly upbeat attitude that is rarely discouraged; a good mental and emotional balance. My Soul Urge gives intuitive insight, thus, very high creative and inspirational tendencies. The truly outstanding trait shown is that of self-expression, regardless of the field of endeavor. On the negative side, I may at times become too easygoing and too optimistic, tending to scatter forces and accomplish very little. Often, the excessive 3 energy produces non-stop talkers. Everyone has faults, but my urge doesn't appreciate having these pointed out. I dream of being a leader and one who is in charge. I want to be known for my courage, daring, and original ideas. I seek unconquered heights. People may get a first impression that I am very aggressive and sure of myself.

Rempah-rempah Penurun Trigliserida

KOMPAS.com – Rempah-rempah tidak hanya bermanfaat untuk membuat makanan menjadi lebih enak untuk disantap, tetapi juga berkhasiat mengikis lemak jahat di dalam tubuh.

Menurut riset terbaru yang dipublikasikan dalam The Journal of Nutrition, menambahkan beberapa jenis rempah ke dalam makanan dapat membantu mengurangi  efek buruk makanan berlemak, terutama menurunkan kadar trigliserida.

“Antioksidan dalam bumbu rempah berperan penting mengurangi stres oksidatif sekaligus menekan risiko penyakit kronis. Biasanya, ketika Continue reading

Rabies Bisa di Cegah


Tanggal 28 September diperingati dunia sebagai Hari Rabies Dunia. Indonesia pertama kali memperingati tahun 2009 di Bali. Saat itu, Bali tengah dilanda peningkatan kasus rabies.

Kematian karena rabies pertama kali dilaporkan di Kabupaten Badung pada November 2008. Tahun 2010 dan tahun 2011, peringatan juga dipusatkan di Bali. Hal itu untuk mendukung Pemerintah Provinsi Bali mewujudkan Bali bebas rabies di tahun 2012.

Rabies adalah suatu penyakit menular akut yang Continue reading

Virus Rekayasa Pelawan Sel Kanker Diteliti

SEBUAH virus rekayasa, yang disuntikkan ke dalam darah, secara selektif dapat menargetkan sel-sel kanker di seluruh tubuh, seperti dikutip dari jurnal Nature, Kamis (1/9).

Virus ini bisa menyerang tumor saja dan melewatkan jaringan sehat. Hal itu setidaknya telah terbukti dalam uji coba terhadap 23 pasien. “Kami sangat gembira karena ini adalah pertama kalinya dalam sejarah medis bahwa terapi virus telah terbukti secara konsisten dan selektif mereplikasi jaringan kanker setelah infus intravena pada manusia,” kata John Bell, seorang peneliti utama dan dari Continue reading

Mana yang lebih menguntungkan Rivaroxaban atau Warfarin pada Nonvalvular Atrial Fibrillation

Non valvular atrial fibrilasis merupakan salah satu faktor risiko stroke iskemia dan embolisme pada pembuluh darah. Selama ini warfarin merupakan salah satu obat pilihan untuk pencegahan strok iskemia maupun pembentukan emboli pada pasien dengan fibrilasis termasuk pasien dengan nonvalvular atrial fibrilasis. Hasil Uji klinis untuk membandingkan kemanjuran rivaroxaban dengan warfarin pada nonvalvular atrial fibrilasis telah dilaporkan oleh NEJM.

rivaroxaban

faktior risiko cvd

Original Article

Rivaroxaban versus Warfarin in Nonvalvular Atrial Fibrillation

Manesh R. Patel, M.D., Kenneth W. Mahaffey, M.D., Jyotsna Garg, M.S., Guohua Pan, Ph.D., Daniel E. Singer, M.D., Werner Hacke, M.D., Ph.D., Günter Breithardt, M.D., Jonathan L. Halperin, M.D., Graeme J. Hankey, M.D., Jonathan P. Piccini, M.D., Richard C. Becker, M.D., Christopher C. Nessel, M.D., John F. Paolini, M.D., Ph.D., Scott D. Berkowitz, M.D., Keith A.A. Fox, M.B., Ch.B., Robert M. Califf, M.D., and the ROCKET AF Steering Committee for the ROCKET AF Investigators

N Engl J Med 2011; 365:883-891September 8, 2011

Comments open through September 14, 2011

Abstract
Article
References
Citing Articles (1)
Comments (3)

Background

The use of warfarin reduces the rate of ischemic stroke in patients with atrial fibrillation but requires frequent monitoring and dose adjustment. Rivaroxaban, an oral factor Xa inhibitor, may provide more consistent and predictable anticoagulation than warfarin.

Full Text of Background…

Methods

In a double-blind trial, we randomly assigned 14,264 patients with nonvalvular atrial fibrillation who were at increased risk for stroke to receive either rivaroxaban (at a daily dose of 20 mg) or dose-adjusted warfarin. The per-protocol, as-treated primary analysis was designed to determine whether rivaroxaban was noninferior to warfarin for the primary end point of stroke or systemic embolism.

Full Text of Methods…

Results

In the primary analysis, the primary end point occurred in 188 patients in the rivaroxaban group (1.7% per year) and in 241 in the warfarin group (2.2% per year) (hazard ratio in the rivaroxaban group, 0.79; 95% confidence interval [CI], 0.66 to 0.96; P<0.001 for noninferiority). In the intention-to-treat analysis, the primary end point occurred in 269 patients in the rivaroxaban group (2.1% per year) and in 306 patients in the warfarin group (2.4% per year) (hazard ratio, 0.88; 95% CI, 0.74 to 1.03; P<0.001 for noninferiority; P=0.12 for superiority). Major and nonmajor clinically relevant bleeding occurred in 1475 patients in the rivaroxaban group (14.9% per year) and in 1449 in the warfarin group (14.5% per year) (hazard ratio, 1.03; 95% CI, 0.96 to 1.11; P=0.44), with significant reductions in intracranial hemorrhage (0.5% vs. 0.7%, P=0.02) and fatal bleeding (0.2% vs. 0.5%, P=0.003) in the rivaroxaban group.

Full Text of Results…

Conclusions

In patients with atrial fibrillation, rivaroxaban was noninferior to warfarin for the prevention of stroke or systemic embolism. There was no significant between-group difference in the risk of major bleeding, although intracranial and fatal bleeding occurred less frequently in the rivaroxaban group. (Funded by Johnson & Johnson and Bayer; ROCKET AF ClinicalTrials.gov number, NCT00403767.)

 

Pharmacogenomic : Future to individualized medication . ARE YOU READY???

PERNAHKAN Anda membayangkan, ketika memasuki ruangan dokter sambil membawa kartu cerdas berisi seluruh informasi genetik tubuh Anda yang telah dikode dan diamankan dengan nomor PIN layaknya anda membuka ATM. Dengan melihat data-data informasi genetik yang unik, dokter Anda dapat menentukan obat yang tepat dalam dosis yang akurat secara efisien sesuai dengan kondisi Anda tanpa khawatir ketidaktepatan pemilihan obat.

Keadaan tersebut merupakan impian para ilmuwan yang menginginkan pengobatan yang bersifat individual. Impian tersebut bukanlah hal yang mengada-ada tetapi didasarkan pada bidang ilmu yang saat ini berkembang yaitu farmakogenomik, yang menganalisis fungsi gen. Analisis ini dapat diarahkan untuk mengenali keadaan penyakit seseorang serta dapat memperkirakan proses tanggapannya terhadap obat. Sehingga setiap orang nanti akan mempunyai kartu identitas genomik yang dapat menentukan jenis pengobatan yang sesuai untuk dirinya.Farmakogenomik adalah bidang ilmu yang berkembang dari gabungan ilmu farmasi, genetik, ilmu kedokteran, bioinformatik, biologi molekuler, dan biologi medikal. Farmakogenomik bukanlah ilmu yang baru. Ilmu ini telah dikenal sekitar lima puluh tahun lalu, saat para peneliti memulai pencarian kerusakan gen tunggal yang bertanggungjawab terhadap kegagalan metabolisme suatu obat.

Farmakogenomik ini mulai populer pada tahun 1980-an. Dengan berhasilnya pemetaan genom manusia, yang diumumkan pada tanggal 16 Juni 2000 di Gedung Putih (Washington) oleh Human Genome Project (HGP), yang berhasil memetakansekitar 100.000 gen, telaah farmakogenomik pun semakin melebar. Kajiannya tidak hanya terbatas pada satu gen , tetapi lebih kepada multigen yang produknya berperan dalam metabolisme suatu obat.Selain itu, mengikuti keberhasilan program sekuensing genom ini, juga dilakukan program analisis keragaman genetik individu yang dinamakan single nucleotide polymorphism (SNP), program inilah yang nantinya menjadi bahan dalam pembuatan kartu identitas genomik yang dapat digunakan untuk pengobatan individual. Hasil SNP dapat dijadikan kartu identitas genomik karena sebagian besar perbedaan manusia dipengaruhi oleh adanya perbedaan SNP yang terjadi pada genom-nya, dan sering kali dihubungkan dengan adanya perbedaan dalam predis-posisinya dalam penyakit tertentu ataupun respons tubuhnya terhadap penggunaan obat.

Sebagai contoh, secara fisik, setiap orang diciptakan berbeda satu dengan yang lainnya. Perbedaan warna rambut, warna kulit, warna mata dan sebagainya terjadi karena adanya variasi genetik pada manusia. Demikian pula respons individu terhadap suatu obat dapat berbeda, misalnya dalam hal metabolisme obat dalam tubuh. Golongan obat yang mengandung thiopurine yang digunakan dalam pengobatan leukemia, pada sebagian kecil kelompok Caucasians dapat menjadi sangat toksik. Hal ini terjadi disebabkan kelompok tersebut memiliki genetik varian pada gen pengode TPMT {thiopurine methyltransferase), enzim yang bertanggungjawab terhadap metabolisme thiopurine. Bagi Caucasians thiopurine kurang di metabolisme dalam tubuh, kadar thiopurine akan menumpuk dalam tubuh yang dapat menyebabkan toksik.

Hasil penelitian Lembaga Biologi Molekuler Eijkman menunjukkan respons obat diazepam (obat tidur) berbeda-beda pada setiap orang yaitu dalam hal metabolismenya. Normalnya diazepam akan habis di metabolisme tubuh selama delapan jam. Akan tetapi pada beberapa orang, waktu metabolisme bisa jauh lebih lama, hal ini berakibat menumpuknya kadar diazepam dalam tubuh yang dapat menyebabkan risiko keracunan. Perbedaan waktu metabolisme ini terletak pada keadaan gen pembentuk enzim CYP2C19 yang berfungsi dalam metabolisme diazepam.

Era farmakogenomik

Pada tahun 2005, Food and Drug Administrations (FDA), suatu lembaga di Amerika yang semisal Badan Pengawasan Obat dan Makanan (BPOM) di Indonesia, mengeluarkan buku petunjuk bagi industri farmasi dalam memfasilitasi pengembangan ilmu farmakogenomik dan mengatur penggunaan data farmakogenomik dalam pengembangan obat, baik dalam investigasi obat baru maupun dalam aplikasi baru dalam pengunaan obat.Data farmakogenomik tersebut disimpan dalam suatu cip DNA. Dinamakan cip DNA karena teknologi ini menggunakan lempengan kecil (cip) yang terbuat dari kaca yang di atasnya ditata sejumlah ribuan atau bahkan puluhan ribu jenis gen dalam bentuk fragmen DNA hasil penggandaan dari cDNA. Selanjutnya cip yang memuat fragmen DNA dari ribuan jenis gen tersebut digunakan untuk menganalisis ekspresi gen dari suatu jenis sel dengan metode hibridisasi. Ini merupakan teknologi baru yang dapat mengatasi persoalan dalam analisis pola-pola ekspresi sejumlah besar gen yang dimiliki manusia.

Dalam praktiknya, teknologi ini membutuhkan alat bantu pengolah data berupa seperangkat komputer beserta peranti lunak. Teknologi ini akan membantu manusia dalam melakukan identifikasi seluruh sifat yang melekat pada seseorang. Selain itu teknologi ini juga akan dapat membantu manusia dalam mendiagnosis, memonitor, dan memprediksi suatu penyakit, menemukan dan mengembangkan obat baru, serta menentukan pilihan obat yang paling tepat untuk suatu penyakit dan pasien tertentu.Saat ini masyarakat ilmuwan dunia yang tergabung dalam berbagai grup, baik perusahaan komersial maupun perguruan tinggi, telah berupaya untuk mengembangkan teknologi tersebut. Affymetrix, perusahaan di bidang teknologi cip DNA, telah mampu memproduksi cip yang memuat lebih dari 60.000 jenis gen dalam bentuk fragmen DNA. Dua belas ribu di antaranya adalah gen-gen yang sudah dikenali berpengaruh terhadap kesehatan dan pengobatan.

Pemanfaatan cip DNA untuk analisis ekspresi gen manusia juga telah banyak dilakukan. Sebagai contoh misalnya Stanford University dan National Cancer Institute telah memanfaatkan teknologi ini untuk analisis klasifikasi tumor menggunakan cip DNA yang memuat lebih dari 30.000 jenis gen. Taka-ra, perusahaan bioteknologi di Jepang juga telah mengembangkan teknologi ini melalui pengembangan instrumentasi dan metodologi untuk diagnosis kanker.

Apakah Anda tahu? apa artinya ketonuria?

Pada sebagian masyarakat di dalam urinnya mengandung benda – benda keton, dimana kondisi ini disebut sebagai ketonuria. Pertanda apakah ketonuria itu? kapankah benda-benda keton dalam urin perlu dichek?
Ketonuria menunjukkan bahwa tubuh mengalami perubahan atau gangguan metabolisme. Pada kondisi normal, energi atau kalori dihasilkan dari metabolisme glukosa, namun pada kondisi hipoglikemia, dimana tubuh kekurangan glukosa dari luar atau kondisi starvasi maka energi atau kalori akan diambilkan dari hasil metabolisme nonglukosa misalnya lemak, yang akan menghasilkan metabolit benda-benda keton, seperti aseton, asetoasetat dan asam hidroksibutirat-beta. Pada pasien dengan DM tipe I dimana tubuh tidak mampu menyerap glukosa dari luar juga akan memberikan gambaran positif ketonuria. Kondisi lain yang perlu diwaspadai akan adanya benda keton dalam urin selengkapnya adalah sbb: The testing of urine for the presence of ketonuria is an essential part of diabetes monitoring. Ketone acids include acetoacetic acid anda beta hydroxybutyric acid. Acetoacetic acid spontaneously degrades to form a molecule of acetone and carbon dioxide. The currently available clinical tests only measure acetoacetic acid,yet the levels of beta-hydroxy butyric acid are usually four times that of acetoacetic acid. During hypoxia, severe shock or when there is lactic acidosis, this ratio may be greatly increased and a measure of the acetoacetic acid level may greatly underestimate the actual total level of ketone acids.

Urine should be tested for ketones in the following circumstances:

If vomiting occurs.
Any time the blood glucose is above 15 mmol/L ,especially if the child or adolescent is unwell and especially if the blood glucose has been high for more than 24 hours
If unusually drowsiness is present.
In the presence of high temperature, vomiting or diarrhoea, even when the blood glucose is 15 mmol/L.
In abdominal pain occur.
If breathing is rapid and suggestive of ketoacidosis
If the child or adolescent has flushed checks

Ketonuria is the presence of hyperglycaemia is in indicative of severe insulin deficiency and calls for urgent therapy to prevent progression into ketoacidosis. Ketonuria in the prense of low blood glucose levels is indicative of a starvation state or is the result of a counter-regulatory response to hypoglycaemia.

Awas, Ondansetron dapat menimbulkan gangguan irama jantung

Obat ondansetron, salah satu antiemetik pada kemoterapi, terbukti memiliki risiko untuk gangguan irama jantung. FDA melaporkan bahwa pada kondisi-kondisi tertentu penggunaan ondansetron harus lebih hati-hati dan perlu dilakukan monitoring dengan memantau gambaran EKG. Kondisi-kondisi yang disarankan lebih hati-hati dalam menggunakan ondansetron antara lain pasien dengan bakat gangguan irama jantung yaitu pasien dengan ongenital long QT syndrome, gangguan mineral misalnya hipokalemia, hipomagnesia, gagal jantung, bradikardia dan penggunnaan bersama obat-obatan yang mengakibatkan pemanjangan interval QT. Berita selengkapnya silakan dibaca pada :Zofran (ondansetron): Drug Safety Communication – Risk of Abnormal Heart Rhythms

[Posted 09/15/2011]

AUDIENCE: Oncology, Anesthesiology

ISSUE: FDA notified healthcare professionals and patients of an ongoing safety review and labeling changes for the anti-nausea drug Zofran (ondansetron, ondansetron hydrochloride and generics). Ondansetron may increase the risk of developing prolongation of the QT interval of the electrocardiogram, which can lead to an abnormal and potentially fatal heart rhythm, including Torsade de Pointes. Patients at particular risk for developing Torsade de Pointes include those with underlying heart conditions, such as congenital long QT syndrome, those who are predisposed to low levels of potassium and magnesium in the blood, and those taking other medications that lead to QT prolongation.

BACKGROUND: Zofran (ondansetron) is in a class of medications called 5-HT3 receptor antagonists. It is used to prevent nausea and vomiting caused by cancer chemotherapy, radiation therapy and surgery. FDA is requiring GlaxoSmithKline to conduct a thorough QT study to determine the degree to which Zofran (ondansetron) may cause QT interval prolongation.

RECOMMENDATION: The labels are being revised to include a warning to avoid use in patients with congenital long QT syndrome because these patients are at particular risk for Torsade. Recommendations for ECG monitoring in patients with electrolyte abnormalities (e.g., hypokalemia or hypomagnesemia), congestive heart failure, bradyarrhythmias, or in patients taking other medications that can lead to QT prolongation, are being included in the labels.

Healthcare professionals and patients are encouraged to report adverse events or side effects related to the use of these products to the FDA’s MedWatch Safety Information and Adverse Event Reporting Program:

Complete and submit the report Online: www.fda.gov/MedWatch/report.htm
Download form or call 1-800-332-1088 to request a reporting form, then complete and return to the address on the pre-addressed form, or submit by fax to 1-800-FDA-0178

Kiat mencegah membengkaknya korban gangguan stroke dan jantung

NEJM edisi 13 september 2011 memuat artikel perspektif tentang stroke dan penyakit jantung. Tidak dapat dipungkiri bahwa stroke dan jantung telah menjadi momok yang menakutkan di seantero jagad raya. Stroke dan penyakit jantung telah menjadi penyebab kematian terbesar. Di Amerika, stroke dan penyakit kardiovaskuler diidap lebih dari 2 juta dengan 800.000 atau lebih penderita berakhir dengan kematian. Bagaimana kiat untuk mengerem laju perkembangan kedua penyakit pembunuh ini, baca Berita selengkapnya sebagai berikut:
Perspective
The “Million Hearts” Initiative — Preventing Heart Attacks and Strokes

Thomas R. Frieden, M.D., M.P.H., and Donald M. Berwick, M.D., M.P.P.

September 13, 2011 (10.1056/NEJMp1110421)

Article
References

Each year, more than 2 million Americans have a heart attack or stroke, and more than 800,000 of them die; cardiovascular disease is the leading cause of death in the United States and the largest cause of lower life expectancy among blacks. Related medical costs and productivity losses approach $450 billion annually, and inflation-adjusted direct medical costs are projected to triple over the next two decades if present trends continue.1

To reduce this burden, the Department of Health and Human Services (DHHS), other federal, state, and local government agencies, and a broad range of private-sector partners are today launching a “Million Hearts” initiative to prevent 1 million heart attacks and strokes over the next 5 years by implementing proven, effective, inexpensive interventions (see tableThe Million Hearts Initiative: Principles and Examples of Interventions.).

Cardiovascular prevention works in two realms: the clinic and the community. Clinical and community interventions each contributed about equally to the 50% reduction in U.S. mortality due to heart attacks between 1980 and 2000.2 If used consistently, proven interventions could prevent more than half of heart attacks and strokes. It’s time to take the next big step.

In the clinical realm, Million Hearts will improve management of the “ABCS” — aspirin for high-risk patients, blood-pressure control, cholesterol management, and smoking cessation. As for community-based prevention, the initiative will encourage efforts to reduce smoking, improve nutrition, and reduce blood pressure. It will implement the cardiovascular-disease–prevention priorities of the National Quality and National Prevention Strategies and help in meeting targets set by Healthy People 2020.

Improving management of the ABCS can prevent more deaths than other clinical preventive services.3 Patients reduce their risk of heart attack or stroke by taking aspirin as appropriate. Treating high blood pressure and high cholesterol substantially and quickly reduces mortality among high-risk patients. Even brief smoking-cessation advice from clinicians doubles the likelihood of a successful quit attempt, and the use of medications increases quit rates further.

Currently, less than half of people with ischemic heart disease take daily aspirin or another antiplatelet agent; less than half with hypertension have it adequately controlled; only a third with hyperlipidemia have adequate treatment; and less than a quarter of smokers who try to quit get counseling or medications. As a result, more than 100 million people — half of American adults — smoke or have uncontrolled high blood pressure or cholesterol; many have more than one of these cardiovascular risk factors. Increasing utilization of these simple interventions could save more than 100,000 lives a year.3 Measuring and monitoring can encourage providers to improve preventive care.4

Improving care is particularly critical in light of increases in the prevalence of obesity and diabetes. Obesity and physical activity are currently being addressed by complementary efforts designed to improve understanding, implement pilot or community-based programs, and evaluate outcomes. The First Lady’s “Let’s Move” campaign is a comprehensive initiative with the goal of ending childhood obesity — a precursor to cardiovascular disease — within a generation by fostering environments that support increased physical activity and improved nutrition for children and families. And public and private partners are working to expand the Diabetes Prevention Program, which promotes weight loss, improved nutrition, and increased physical activity among people at highest risk.

The Affordable Care Act (ACA) provides a strong foundation for Million Hearts by increasing coverage and facilitating improved care. It waives patient cost sharing for preventive services, including blood-pressure and cholesterol screening and smoking-cessation counseling and treatment, for enrollees in new private insurance plans. The new annual wellness visit for Medicare beneficiaries will help physicians focus on reducing cardiovascular risk and target interventions appropriately. Eliminating Medicare’s “doughnut hole” in prescription-drug coverage will increase access to blood-pressure, cholesterol-lowering, and smoking-cessation medications. Covering 32 million currently uninsured Americans will reduce financial barriers to preventive care, and expanding community health centers will increase access to care and reduce health disparities. In addition, electronic health records (EHRs) will support improved clinical decision making.

Additional means of increasing control of the ABCS include reducing or eliminating copayments for medications, once-a-day dosing, team-based care approaches, stepwise care management, and new forms of payment and delivery for higher-quality, higher-value, and coordinated care, such as those envisioned for accountable care organizations.

Expanding use of prevention-oriented EHRs will enable providers and health systems to track and improve management of the ABCS. Incorporating core ABCS-related quality measures and decision-support tools into the 2013–2014 criteria for “meaningful use” of information technology and providing technical assistance through quality-improvement organizations in all states, the 62 Health Information Technology Regional Extension Centers (which reach nearly 100,000 primary care doctors), and Beacon Communities will reach more than 100 million patients within the next few years.

Million Hearts will work to standardize core ABCS indicators across medical practices, insurers, institutional providers, and systems in public and nonpublic settings. Standardization will facilitate public reporting and identification and diffusion of best practices and will reduce providers’ burden by streamlining quality measurement and improvement. The initiative will be linked to quality-recognition programs (e.g., the Physician Quality Reporting System and star ratings for Medicare Part D and Medicare Advantage plans) and may eventually support approaches in which providers are paid more for better preventive care.

Community-based prevention works by facilitating healthy choices. Important community-based prevention initiatives include those funded by the American Recovery and Reinvestment Act’s Communities Putting Prevention to Work program and programs supported by the ACA’s Prevention and Public Health Fund, including Community Transformation Grants, initiatives for tobacco control and chronic-disease prevention and control, many National Prevention Strategy initiatives, and state and local actions addressing tobacco use, nutrition, and the linkage between clinical and community-based prevention.

Reductions in smoking, sodium consumption, and trans fat consumption can substantially and rapidly improve cardiovascular health. Warning people about the harms of tobacco use through mass media and other measures, as well as package labeling as enabled by the Family Smoking Prevention and Tobacco Control Act, and creating smoke-free public places and workplaces, as detailed in the National Prevention Strategy and facilitated through ACA-funded community grants, should further reduce smoking rates by discouraging smoking initiation and encouraging cessation.

Reducing sodium intake, another key National Prevention Strategy intervention, reduces risks of hypertension and cardiovascular disease. Because most dietary sodium comes from processed and restaurant foods, it’s difficult for Americans to limit their sodium consumption. Procurement guidelines from the DHHS and the General Services Administration and proposed school-food standards from the Department of Agriculture include a focus on sodium reduction. Menu-labeling requirements in chain restaurants will help people make more informed choices. The Centers for Disease Control and Prevention (CDC) is increasing public and professional education regarding sodium, and the CDC’s National Health and Nutrition Examination Survey (NHANES) will begin collecting information on sodium consumption.

Consumption of artificial trans fat increases the risk of cardiovascular disease by raising low-density lipoprotein (LDL) cholesterol levels and lowering high-density lipoprotein (HDL) cholesterol levels. Replacing artificial trans fat with heart-healthy oils is feasible and does not increase the cost or change the flavor or texture of foods. Since the Food and Drug Administration began requiring listing of trans fat content on food labels, the industry has voluntarily reformulated foods, and according to CDC data, Americans’ trans fat consumption has decreased by at least half. Elimination of such consumption could prevent 50,000 deaths per year.5

Million Hearts will leverage, focus, and align existing investments and generally not require new public spending. Voluntary initiatives will simplify, harmonize, and automate clinicians’ reporting requirements, decrease administrative burden, improve the quality of prevention and care, and inform the public more fully. Improvements in control of the ABCS, nutrition, and smoking are projected to prevent more than a million heart attacks and strokes over the initiative’s first 5 years. By focusing our initial efforts where they will save the most lives, we aim to make progress toward a health system that will serve Americans’ needs in the 21st century.