Author + information
- Valentin Fuster, MD, PhD∗ ()
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
- ↵∗Address correspondence to:
Dr. Valentin Fuster, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, New York 10029.
Disappointment can be crippling, but only if the individual allows himself or herself to be emotionally conquered by the defeat. This can be particularly devastating in the young. As an alternate path, I recommend finding refuge in the power of resilience. Psychiatric theorists define resilience as the “ability to bounce back from adversity and successfully adapt to the demands of stressful situations” (1). Studies have shown that highly resilient participants appraised stressful tasks as less threatening, compared with participants with little resilience, and highly resilient individuals appraise difficult situations as a challenge, rather than as a threat (2). I recognize that this attitudinal shift is challenging, as it has taken me a lifetime of disappointments to recognize the importance and power of resilience. I will seek to demonstrate its true power through 3 examples.
Resilience and Purpose
If we are able to find a purpose, or a reason for which something should be done, and set ourselves to complete this task, we will be able to achieve great accomplishments, but only through the power of resilience. One of my lifelong passions is to contribute, even if very little, to the improvement of global health circumstances. However, over the past 20 years, many of us have been disappointed that there have been approximately 30 published global health recommendations on chronic noncommunicative diseases, including cardiovascular disease, with little in terms of follow-up to see whether the recommendations were enacted. Bolstered by a desire of “purpose” to not experience the same disappointment with our 2010 recommendations from the National Institutes of Health (NIH) and the Institute of Medicine (IOM) (3), my colleagues and I planned to monitor their impact. In June of this year, we published a special issue of Scientific American that presents the 12 original NIH/IOM recommendations with a 4-year follow-up of 12 successful programs, each following 1 of the recommendations (4). Significant barriers presented themselves in this arduous process, but we sought to overcome these obstacles to help improve cardiovascular health in 12 communities around the world. In other words, the authors, all internationally recognized, embraced the power of “resilience of purpose” to monitor and report on concrete examples of programs that have been effective in reflecting global progress since 2010.
Resilience and the Heart
Some of the hardest challenges for physicians to overcome are the destructive habits leading to heart disease in adult patients, which have been ingrained over a lifetime, making it particularly important that we begin education with children. Lack of physical exercise and unbalanced diets cause obesity in children, eventually contributing to adult obesity, increased blood pressure, diabetes, hyperlipidemia, and, eventually, heart disease in adults. So, children need to acquire heart-healthy habits at an early age to prevent the establishment of cardiovascular disease later in life.
In 2010, we implemented an outreach program with Sesame Street, the largest informal educator of children in the world, with viewers in 120 countries. The initiative began with the “Project Healthy Habits for Life” that began in Bogotá, Colombia, over 4 years, focusing on preschool children 3 to 6 years of age. The goal was to promote awareness at this early age about the importance of health as a priority, with the hypothesis that such an educational influence on children could help to shape their subsequent behavior as adults. The program in Colombia was divided into 4 areas: educational content development, television production, community involvement, and research. The school curriculum emphasized nutrition, heart health, and the importance of physical exercise to build healthy habits that last a lifetime.
This endeavor has met with countless obstacles, including the painstaking task of selecting 1,000 children in Bogotá and dividing them into 2 groups of 500: 1 would receive the intervention of 70 h of education for health promotion in 6 months, and the other was the control group. Facing countless financial problems, the project moved forward through the resilience of a few individuals who believed in its enormous importance. Despite the obstacles, the results at 3 years of follow-up have demonstrated that the educational interventions initiated in this program produced better nutrition, increased physical activity, and decreased the growing trends of obesity. Today, in 2014, there are more than 20,000 children who follow the program in several regions of Colombia and approximately 40,000 in Spain. Again, these results show the truly significant power of resilience, in this case for the prevention of heart disease when these children reach adulthood.
Resilience and the Mind
Although the hardest needle to move may be with the adult patient in whom symptoms have yet to present, the greatest need for resilience may be required in the scientific discovery process itself. This need became prevalent a few years ago with respect to our understanding of cognitive disabilities in later stages of human life, in attempts to define 2 dysfunctions: degenerative cerebral brain disease and Alzheimer’s disease. Degenerative brain diseases—slow, silent alterations of the cerebrovascular system—are gradually being recognized, in part due to the prolongation of human life in contemporary society; they lead to a progressive alteration of cognitive process, such as loss of short-term memory, language disorders, and the association with pathological lesions of the cerebral white substance (lacunar lesions). Alzheimer’s disease, which is long and progressive, is an acquired disorder of cognitive and behavioral impairment that markedly interferes with social and occupational functioning, with plaques developing in the hippocampus.
In May 2010, we learned that the persistence of 1 or more of the modifiable cardiovascular risk factors, which affect the large arteries leading to a heart attack or stroke, could also clog small cerebral arteries, contributing to degenerative brain disease and acceleration of Alzheimer’s disease. In the last 4 years, in patients with both conditions, especially those affected by several cardiovascular risk factors, a number of studies were able to confirm the presence of frequent blockages of small arteries and lacunar brain injury or microinfarcts, while demonstrating parallel decreases in cognitive ability of these patients. The findings were obtained thanks to new techniques of magnetic resonance imaging, as well as sophisticated cognitive assessment testing. This topic is of the utmost importance, because the aging population may still be able to benefit from modifiable risk factors. The idea of not remembering our loved ones or what we did a few minutes ago should produce fear equal to or even greater than that of having a heart attack or developing another cardiovascular event. Therefore, we, as physicians, must inform patients of these associations to try to convince them that their adherence to lifestyle changes and medication prescriptions all are aimed at reducing modifiable cardiovascular risk factors, including neurodegenerative diseases.
Again, armed with resilience in the face of great difficulties, including operational and financing hindrances, on July 1, 2014, we finally embarked on an ambitious project focused on adult individuals with varied modifiable cardiovascular risk factors. The objective is to partially prevent the development of cerebral degenerative disease and acceleration of Alzheimer’s disease. This project is carried out through an agreement between New York and Madrid. In New York, high-tech imaging is being used to interpret the proportion of patients with occlusion of the cerebral microcirculation as a key mechanism of disease in 1,000 patients; in Madrid, we are using 2 new educational and behavior modification models in an adult population 45 to 55 years of age, with the eventual hope of partly preventing such diseases.
The aspects of the human condition that we hope to improve as cardiologists—our purpose, the heart, and the mind—are the very aspects that we as individuals must use to overcome the challenges of modern medicine. I would suggest to you that if you are willing to empower yourself with resilience, especially when you are young, you will meet far more successes than defeats.
- American College of Cardiology Foundation
- Institute of Medicine
- Fuster V.,
- Narula J.,
- Vedantahan R.,
- Kelly B.B.