The American Heart Association is making a big push for education to improve the cardiovascular health of Americans by 20 percent in 10 years and reduce deaths from cardiovascular disease and stroke by 20 percent.

“;It's a different approach,”; says Dr. Ralph Shohet, director of cardiovascular research at the University of Hawaii and president of the Oahu affiliate of the AHA.

Medical efforts over the past 30 years have targeted progressively larger portions of the population to try to reduce cardiovascular risk factors, he said.

Statens (drugs to lower cholesterol), ace inhibitors and beta blockers initially were used to treat people who had heart attacks and coronary disease, Shohet said. This benefited some patients at risk for having another heart attack but had little effect on the population, he said.

In the past 10 years or so, he said, doctors have been treating people not only with established coronary disease, but those with elevated cholesterol and blood pressure and those who smoke.

“;Even if they don't already have an established heart disease, angina, a heart attack or heart failure, we hope we can prevent development of these problems by treating risk factors—called primary prevention.”;

That has been successful, Shohet said, reducing heart attacks and deaths from heart disease by about half.

“;Now what the AHA is talking about is primordial prevention—trying to get the whole society to reduce even the development of risk factors,”; Shohet said. “;It's ambitious but not as hard as it might seem.”;

One idea is to lower salt intake by getting companies not to add it to processed foods, he said.

“;If you can get people never to start smoking, it's a little easier than getting them to stop smoking,”; he continued, “;and it could have a tremendous effect on the frequency of development of arteriosclerosis and therefore development of heart disease, heart attacks and heart failure.”;

In Hawaii, he said, “;We have a lot of really healthy people, but we also have a lot of problems and populations particularly susceptible to some of these underlying health issues and to development of obesity and high blood pressure.”;

Cardiovascular disease, including heart attacks, strokes and peripheral vascular disease, is the leading cause of death in Hawaii and every developed country, Shohet pointed out.

“;I think it's not as scary as cancer, but it kills and hurts a lot more people,”; he said.