Heart Disease and Stroke Prevention Connection -  newsletter December 9, 2013

The Connection Newsletter is “Connecting!”Stanton Shanedling

Stanton Shanedling, PhD, MPH
Supervisor, Heart Disease & Stroke Prevention Unit

Public health certainly is embracing a lot of “C’s” lately. We collaborate, cooperate, and coordinate.  Since the inception of our Connection Newsletter, the Heart Disease and Stroke Prevention Unit at MDH has made an effort to “connect” to our partners through our newsletter with information on creative initiatives, programs, policies, and updates on the burden of disease and our Statewide Strategic Plan.  Since there are common threads in the definitions of all the “C’s”, I thought it would be a useful idea to look up the word connection. To my surprise there was a reference to public health!

Connection: a relationship in which a person, thing, or idea is linked or associated with something else - "the connections between social attitudes and productivity.” The point at which two or more things are connected as in:
the connection between overeating and obesity.         
                                                                              - Wictionary

Henceforth and starting with this issue of the Connection Newsletter, Diabetes will be our “connected partner” providing expanded information exchange for you, our readers. We of course have known for a long time of the elevated risk of heart disease mortality and stroke among persons with diabetes and that diabetes is considered a cardiovascular risk equivalent. Our coordinated work with our grant recently awarded from the Centers for Disease Control will focus on a wide array of initiatives to prevent and control heart disease and diabetes over the next five years. These include innovative approaches to primary prevention, acute treatment and disease management. The emphasis will be on addressing obesity (physical activity and nutrition), hypertension, team based care, use of diabetes self-management education programs, medication management and adherence, the national Diabetes Prevention Program, and finally continued measurement.

Renée Kidney, PhD, MPH, our Epidemiologist from MDHs Diabetes Unit, pulled together some very convincing information that underscores our connection:

Did you know?

  • National data show that the CVD death rate among persons with diabetes declined 40% between 1997 and 2004. (Reference Gregg et al. 2012)
  • Data from US adults with diabetes collected between 1999 and 2010, showed that the probability of coronary heart disease decreased between 2.8 and 3.7 percentage points using the UKPDS or Framingham risk scores respectively.  Between one third and one half of all adults did not meet targets for blood pressure, LDL cholesterol or blood glucose controls. (Reference Ali et al. 2013)
  • The American Heart Association promotes the link between CVD and Diabetes on their website and provides individuals with diabetes the ability to assess their 10 year cardiovascular disease risk?  Click here for pages on diabetes and CVD and here to check your CVD risk.
  • People with prediabetes have increased risk of micro-vascular disease, kidney disease and stroke.  (Reference: MDH Diabetes and Prediabetes in Minnesota 2012) A recent meta-analysis Increased risk for stroke may be entirely explained by cardiovascular risk factors in some but not all patients.  (Reference: Lee et al. 2012)
  • The Diabetes Prevention Program may affect not only diabetes risk, but may improve cardiovascular risk profiles as well.  For more on the National Diabetes Prevention Program in Minnesota, visit the I CAN Prevent Diabetes Website.  Also, if you are a provider and want to learn about screening for prediabetes and referrals to National Diabetes Prevention Program sites, watch the recent prediabetes webinar held for Minnesota providers.
  • Prevention efforts need to focus on Minnesotan children and youth.  National data between 1999 and 2008 show that, the overall prevalence of prehypertension/hypertension was 14% and prediabetes/diabetes was 15% among adolescents 12-19 years of age.  Prediabetes/diabetes rates had increased between 9-23% over the interval. (Reference: May et al. 2012)

In this issue of the Connection Newsletter articles focus on the impact of the SagePlus program, diabetes prevention programs, new CVD and diabetes fact sheets and a recently awarded MillionHearts™ Grant.

I hope you enjoy the new focus going forward and welcome your comments and input.


Diabetes Prevention Programs in Minnesota

I Can Prevent Diabetes logoI CAN Prevent Diabetes (I CAN PD) is a collaborative, community-based, lifestyle change program designed for people with pre-diabetes. The Minnesota Individuals and Communities Acting Now (I CAN) Prevent Diabetes offers diabetes prevention education and support for people with pre-diabetes.

Type 2 diabetes can be prevented or delayed in people with pre-diabetes if they make simple changes to increase physical activity and lose weight.  This program provides the tools to prevent or delay adult type 2 diabetes where you live, including the following:

  • Resources on diabetes nutrition and preventative pre-diabetes physical activity
  • Training opportunities for I CAN PD program coaches
  • Instruction and coaching for diabetes prevention focused on nutrition and physical activity
  • An evidence-based 16 week class curriculum
  • Strategies for involving people in community, work or clinic settings
  • Tips for partnering with other organizations in your community to defeat diabetes
  • Resources for promoting your program and tracking your progress
  • A diabetes prevention model that builds partnerships between Minnesota community health care providers, local fitness centers and public health officials

To learn more about the I CAN PD, please go to their website or contact Rita Mays at 651-201-5433 or

We Can Prevent Diabetes logoWe Can Prevent Diabetes MN
We Can Prevent Diabetes Minnesota is a study that tests the effect of incentives on weight loss and attendance in the Diabetes Prevention Program (DPP). This study is for individuals enrolled in Medical Assistance, PMAP or MinnesotaCare who are at risk for developing type 2 diabetes.  DPP sessions are taught by trained YMCA lifestyle coach staff at participating clinics or nearby community locations in separate groups from the YMCA’s other on-going programs.  YMCA coaches work with study participants to maintain their successful participation.  Participating clinics are encouraged to train clinic health navigators to provide additional participant support to address transportation and childcare as needed.

The study’s primary goal is weight loss among participants. Information about enrollees’ participation and other health indicators is being collected at the beginning and end of the study and maintenance of weight loss is being documented, along with cost data. If successful, this project will:

  • Improve weight loss, reduce diabetes incidence, and improve cardiovascular risk among MHCP enrollees who are at risk for developing diabetes and other chronic conditions,
  • Demonstrate that prevention of chronic disease risk factors using patient incentives is cost-effective,
  • Develop infrastructure, systems and partnerships for offering the DPP to patients with pre-diabetes in clinic and community settings, and
  • Provide a patient incentive model that can be widely used among MHCP enrollees at risk for developing diabetes and in the emerging health care home environment.

To learn more about this study, please explore the website to learn more about We Can Prevent Diabetes Minnesota and see how you can get involved or contact the Minnesota Department of Health at 651-201-5158.


SagePlus: Cardiovascular Screening and Service Program – Impact on Minnesota Women

SAGE LogoSagePlus was Minnesota’s implementation of a national program called WISEWOMAN (Well Integrated Screening and Evaluation for Women Across the Nation).  WISEWOMAN was authorized by congress in 1993 to extend services provided to women as part of the National Breast and Cervical Early Detection Program which in Minnesota is the Sage Screening Program. The mission of WISEWOMAN has been to provide low-income, uninsured or underinsured women, age 40-64 with the knowledge, skills and opportunities to improve diet, physical activity, and other lifestyle habits to prevent, delay or control cardiovascular disease.

SagePlus was a heart health add-on to the Sage breast and cervical cancer screening program. SagePlus screened low-income, underinsured or uninsured women for cardiovascular disease risk factors and provided a structured lifestyle intervention using Motivational Interviewing techniques.  The structured intervention empowered women to identify areas for lifestyle change that would reduce their cardiovascular risk by becoming more physically active, making healthier food choices, and stopping tobacco use. To join SagePlus a woman had to be enrolled in the Sage program, be 40 -64 years of age, be uninsured or underinsured, and have a household income at or below program guidelines (250% of FPL). SagePlus began screening in January 2005, and by the end of the program in June, 2013 was available at 19 locations across Minnesota.

SagePlus clinics provided culturally appropriate in-reach and outreach to recruit women into the program, and provided navigation, support, coaching, and community referrals to enrolled women to assist them in accessing heart disease screening, and in making lifestyle changes to eat healthier, increase physical activity, and smoking cessation.

In the first 4 years of the grant, over 2,300 women were screened for cardiovascular risk factors, and close to 1,000 women made lifestyle changes to decrease their risk of heart disease. Analysis of the data indicated that the program was effective in decreasing risk parameters and ten year cardiovascular risk for women with abnormal values at screening.  Subsequently, SagePlus in Minnesota was one of 21 states funded for the grant period 2008 to 2013. New grant requirements offered annual rescreening to women and interventions tailored to their willingness to make changes in lifestyle habits. The new grant requirements also streamlined services and enhanced integration with the breast and cervical screening program.

Between 2008 and 2013, 12,534 women were screened through SagePlus with over 7,000 women completing a follow-up appointment to address abnormal cardiovascular values; 38% with hypertension, 56% with hyperlipidemia and 14% with elevated glucose/A1C.  155 women were found to have pre-diabetes.  SagePlus interventions in this grant period included referring women with pre-diabetes to the YWCA  I CAN PREVENT DIABETES program and covering the cost of the 16 class program, offering women with a BMI of 27 to 40 vouchers to attend Weight Watchers ( up to 20 vouchers), and referring smokers to the QUIT Line.  SagePlus also continued to offer women 2 programs; STEPS -increasing physical activity, and SMART CHOICES – increasing number of fruits and vegetables.  Both programs asked women to submit tracking cards to measure success, with small rewards for reaching established goals, 1 million steps or 1,000 servings of fruits/vegetables.

Although the WISEWOMAN program is no longer available in Minnesota, analysis of the SagePlus program data demonstrated that by offering Minnesota women knowledge, opportunity, support and tailored interventions their cardiovascular risk was reduced through participation in SagePlus.  For more information about program results, please contact Gay Lynn Richards at 651-201-5632 or gaylynn.richards@state.mn.us.


Northeastern Minnesota to benefit from the Million Hearts Learning Collaborative

Minnesota granted one of nine awards to focus on high blood pressure identification, control, and improvement

Aitkin, Itasca and St. Louis Counties all boast spectacular natural beauty and diverse communities, from small mining towns and farm communities to busy cities. They are also, however, home to some of the highest hypertension rates – high blood pressure – in the state.

Survey data from 2010 show that Northeastern Minnesota experiences hypertension rates of 26.6%, higher than the 2009 state average of 20.9%. In addition, parts of Northeast Minnesota face up to a 50% higher heart disease mortality rate when compared to the Twin Cities metro area.
These were vital considerations for selecting Northeastern Minnesota as part of the Minnesota Department of Health’s (MDH) application for support and funding from the Association of State and Territorial Health Officials (ASTHO) as part of the U.S. Department of Health and Human Services' Million Hearts® Initiative.

“This initiative complements work already underway through the Community Transformation Grant (CTG) in Northeastern Minnesota,” said Dr. Jane Korn, Medical Director of the Health Promotion and Chronic Disease Division. “Focusing first on this region will help MDH create an effective hypertension practice before taking what we’ve learned and spreading it statewide.”

Through this award, MDH leads a collaborative effort with the Healthy Northland Partnership, St. Louis County and four clinics in Northeastern Minnesota to improve blood pressure control in their patient populations. From identifying patients with hypertension, through treatment, education and management, this project will develop an organized system for patient follow-up and review that effectively measures patient outcomes.

“Minnesota’s strong local public health system plays a vital role in connecting these clinics with their respective communities,” said Dr. Korn. “Leveraging these connections can positively impact population health by keeping hypertension under control.”

Hypertension is characterized by having blood pressure of 140/90 mmHg or above.1 Hypertension increases an individual's risk of heart disease and stroke, which are two of the leading causes of death in the United States.1 Based on the Behavioral Risk Factor Surveillance System data, an estimated 1.1 million Minnesota adults report having hypertension. The good news is that once detected, blood pressure is highly controllable.
Million Hearts® is a national initiative to prevent 1 million heart attacks and strokes by 2017. Million Hearts® brings together communities, health systems, nonprofit organizations, federal agencies, and private-sector partners from across the country to fight heart disease and stroke.
The Community Transformation Grant (CTG) in Minnesota is helping control health care spending and create a healthier future. CTG aims to prevent chronic diseases – such as cancer, heart disease and diabetes – by reducing exposure to tobacco, increasing physical activity and healthy eating, and improving clinical community linkages.

1 CDC. "High Blood Pressure Facts." Available at http://www.cdc.gov/bloodpressure/facts.htm. Accessed 10/30/2013.


Updated Minnesota Diabetes and Cardiovascular Disease Fact Sheets Available!

Save the date!  Join the American Heart Association for Their 2014 Heart on the Hill on April 2!

The American Heart Association’s (AHA) Heart on the Hill event takes place at the Kelly Inn and State Capital in St. Paul, MN, from 8 a.m. to 4 p.m.  There is no cost to attend but advance registration is required.  AHA’s policy agenda includes promoting physical activity to reduce heart disease with funding for Safe Routes to School and bike/pedestrian investments and improving access to lifesaving Automatic External Defibrillators by developing a statewide registry of all public access AEDs for location and maintenance.

Register online at www.yourethecure.org/Minnesota or call 952-278-7928 by March 1, 2014.  For more information, please contact Jean LaLonde at 952-278-7928 or  Jean.LaLonde@heart.org or go to www.yourethecure.org/Minnesota


Updated Wednesday, April 23, 2014 at 02:15PM