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Saving a million lives, one heart at a time

February 9, 2012
by Ron Manderscheid, PhD, Exec Dir, NACBHDD
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One million persons with behavioral health conditions will die from heart attack or stroke in the next five years

Today, the number of Americans with heart disease is simply staggering—more than 80 million people. Over the next five years, more than 3 million of these Americans will die from heart-related ailments, including heart attack and stroke. This is a tragic number equal to about one percent of the entire US population. Even more tragic for us is the fact that one-third of these deaths—about 1 million persons—will be people who have a mental or substance use condition.

To address this number one killer of Americans, the US Department of Health and Human Services has developed the Million Hearts Campaign. This campaign aims to prevent 1 million heart attacks and strokes over the next five years by implementing ABCS:  A — Appropriate Aspirin Therapy; B — Blood Pressure Control; C — Cholesterol Management; and S — Smoking Cessation; You can learn much more about the Campaign and its activities at

We have known for some time that persons with behavioral health conditions are at particular risk of heart disease. Specifically, depression increases blood cortisol, which increases the risk of heart attack; smoking, a potent risk factor, is very prevalent among those with behavioral health conditions; use of psychotropic medications frequently leads to the metabolic syndrome and obesity, which increases risk; and excessive use of alcohol can exacerbate high blood pressure and trigger a stroke or heart attack.

We also have known another tragic fact: Persons with severe behavioral health conditions are likely to die 25 years or more prematurely. In addition to the risk factors noted above, most of these persons lack access to any primary care. Realization of this very serious problem has led to major behavioral health initiatives at the national, state, and county levels to develop integrated care that brings together mental health, substance use, and primary care. It also has resulted in many efforts to develop wellness interventions, particularly by consumers and their peers. These wellness efforts have been codified by SAMHSA, first in the 10 by 10 Campaign and more recently in the SAMHSA Wellness Initiative. You can learn much more about this Initiative at

What we have not known before is that fully one third of all deaths due to heart disease or stroke are suffered by persons with behavioral health conditions—1 million deaths over five years. We can and must take further action to address this monumental tragedy!

Several courses of action seem very necessary:



Ron Manderscheid

Exec. Dir., NACBHDD and NARMH

Ron Manderscheid


Ron Manderscheid, Ph.D., serves as the Executive Director of the National Association of County...

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