Heart Diseases in the United States
The data in this article are
from American
Heart Association (2002 Heart and Stroke Statistical Update, American Heart Association,
Dallas, Texas).
In
1940 there were 132 million Americans. By 1999 the population had more than
doubled to about 273 million. In 1940 the proportion of Americans over age 65
was only 6.8%. By 1999 it had increased to 12.7%. Since 1940 the number of
deaths from cardiovascular diseases has increased, partly because the elderly
population has increased as a percentage of the total U.S. population. The average life expectancy of people born in the
United States is now 76.7 years. Many factors may affect the decline in
cardiovascular disease (CVD) mortality. They include more effective medical
treatment, more emphasis on reducing the major controllable cardiovascular risk
factors (high blood pressure, smoking, high blood cholesterol, physical inactivity,
overweight and obesity, and diabetes), and better treatment for heart attack
and stroke patients. There were 529,659 deaths from coronary heart disease
(CHD) in 1999 and 459,841 in 1998.
Diseases
of the Heart
Acute Rheumatic
Fever/Chronic Rheumatic Heart Diseases
Hypertensive Heart Disease
and Hypertensive Heart and Renal Disease
Coronary Heart Disease
Pulmonary Heart Disease and
Diseases of Pulmonary Circulation
Congestive Heart Failure
Other Forms of Heart
Disease
ABOUT
SUDDEN Death
and Cardiac Arrest
Most known heart diseases can
lead to cardiac arrest and sudden death. The most common underlying cause is
coronary heart disease, which includes heart attack. In 90% of adult victims of
sudden death, two or more major coronary arteries are narrowed by
atherosclerosis. Scarring from a prior heart attack is found in two-thirds of
victims.
When sudden death occurs in
young adults, other heart abnormalities are more likely causes. Under certain
conditions, various heart medications and other drugs as well as illegal drug
abuse can lead to abnormal heart rhythms that cause cardiac arrest and sudden
death. Other causes of cardiac arrest include respiratory arrest,
electrocution, drowning, choking and trauma. Cardiac arrest also can occur
without any known cause.
About 250,000 people a year
die of coronary heart disease without being hospitalized in US. Thats about
half of all deaths from CHD more than 680 Americans each day. If cardiac
arrest victims receive no treatment, brain damage can start to occur in just 4
to 6 minutes after the heart stops pumping blood. If cardiac arrest victims
receive immediate cardiopulmonary resuscitation (CPR), it will keep blood
flowing to the heart and brain until definitive treatment is provided. CPR consists
of mouth-to-mouth rescue breathing and chest compressions. VF cardiac arrest
can be reversed if the victim is treated with an electric shock to the heart
within a few minutes. The electric shock can stop the abnormal rhythm and allow
a normal rhythm to resume. This process, called defibrillation, is done using a
defibrillator. Lay rescuers can be trained to operate portable, computerized,
automated external defibrillators (AEDs).
A
victims chances of survival after VF cardiac arrest are reduced by 7 to 10%
with every minute that passes without treatment. Few resuscitation attempts
succeed after 10 minutes have elapsed. Its estimated that more than 95% of
cardiac arrest victims die before reaching the hospital. Early CPR and rapid
defibrillation combined with early advanced care can produce high long-term
survival rates for witnessed cardiac arrest.
CARDIOVASCULAR
Diseases
Prevalence
61,800,000 Americans have one
or more types of cardiovascular disease (CVD). Of these, 29,700,000 are male
and 32,100,000 are female. 24,750,000 are estimated to be age 65 and older.
High blood pressure
50,000,000.
Coronary heart disease
12,600,000.
Myocardial infarction
7,500,000.
Angina pectoris
6,400,000.
Stroke 4,600,000.
Congenital cardiovascular
defects 1,000,000.
Congestive heart failure
4,790,000.
1 in 5 males and females
has some form of cardiovascular disease.
Mortality
CVD claimed 958,775 lives in
the United States in 1999. This is 40.1% of all deaths or 1 of every 2.5
deaths. CVD was about 60% of total mention mortality, which means that of the
more than 2,000,000 deaths from all causes, CVD was listed as a primary or
contributing cause on about 1,391,000 death certificates.
Since 1900, CVD has been
the No. 1 killer in the United States every year but 1918.
More than 2,600 Americans
die of CVD each day, an average of 1 death every 33 seconds.
CVD claims almost as many
lives each year as the next 7 leading causes of death combined.
Almost 150,000 Americans
killed by CVD each year are under age 65.
1999 CVD mortality: male
deaths 445,871 (46.5% of deaths from CVD); female deaths 512,904 (53.5% of
deaths from CVD) (Note: Includes congenital cardiovascular disease).
In 1999, 33% of deaths from
CVD occurred prematurely (i.e., before age 75, the approximate average life
expectancy in that year).
The 1999 overall death rate
from CVD was 354.1. The rates were 411.5 for white males and 526.0 for black
males; 295.0 for white females and 402.1 for black females.
From 1989 to 1999 death
rates from CVD declined 15.6%. In the same 10-year period actual CVD deaths
increased 2.1%.
Comparisons
Other causes of death in
1999 cancer 549,838; accidents 97,860; Alzheimers disease 44,536; HIV (AIDS)
14,802.
According to the most
recent CDC/NCHS computations, if all forms of major CVD were eliminated, life
expectancy would rise by almost 7 years. If all forms of cancer were
eliminated, the gain would be 3 years. According to the same study, the
probability at birth of eventually dying from major CV diseases is 47%, and the
chance of dying from cancer is 22%. Additional probabilities are 3% for
accidents, 2% for diabetes and 0.7% for HIV.
In the United States in
1999, CVD claimed the lives of 445,871 males and 512,904 females, while cancer
killed 285,832 males and 264,006 females. The CVD death rates were 418.2 for
males and 303.2 for females; cancer death rates were 251.6 for males and 169.9
for females.
Breast cancer claims the
lives of 41,144 females each year; lung cancer claims 62,703. The 1999 death
rates were 27.0 for breast cancer and 40.8 for lung cancer.
Age,
Sex, Race and Ethnicity
The average annual rates of
first major cardiovascular events rise from 7 per 1000 men at ages 35-44 to 68
per 1000 at ages 85-94. For women, comparable rates are achieved 10 years later
in life. The gap closes with advancing age.
Under age 75, there is a
higher proportion of CVD events due to coronary heart disease (CHD) in men than
in women, and a higher proportion due to congestive heart failure (CHF) in
women than in men.
The age-adjusted prevalence
of CVD in adults for non- Hispanic whites is 30.0% for men and 23.8 for women;
for non-Hispanic blacks its 40.5% for men and 39.6 for women; and for Mexican
Americans its 28.8% for men and 26.6 for women.
There are higher CVD risk
factors among black and Mexican-American women than among white women of
comparable socioeconomic status (SES). The large differences by both ethnicity
and SES underscore the critical need to improve screening, early detection and
treatment of CVD-related conditions for black and Mexican-
Among American
Indians/Alaska Natives age 18 and older, 63.7% of men and 61.4% of women have
one or more CVD risk factors (hypertension, current cigarette smoking, high
blood cholesterol, obesity or diabetes). If data on physical activity had been
included in this analysis, the prevalence of risk factors probably would have
been higher.
Surveys show that most
women are far more afraid of breast cancer than of cardiovascular disease (even
though 1 in 30 womens deaths is from breast cancer while 1 in 2.4 is from
CVD).
Aftermath
From 1979 to 1999 the
number of Americans discharged from short-stay hospitals with CVD as the first
listed diagnosis increased 29%.
In 1999 CVD ranked highest
among all disease categories in numbers of hospital discharges. That year CVD
was the first listed diagnosis of 6,344,000 inpatients (3,161,000 males and
3,183,000 females).
In 1999 there were
59,965,000 physician office visits and 5,862,000 outpatient department visits
with a primary diagnosis of CVD.
In 1998, $26.4 billion in
payments were made to Medicare beneficiaries for hospital expenses due to
cardiovascular problems. That was an average of $7,937 per discharge.
In 1997, 25.8% of elderly
nursing home residents age 65 and older had a primary diagnosis of
cardiovascular disease at admission. This was the highest disease category for
these residents. (1997
National Nursing Home Survey, USDHHS, April 25, 2000)
In 1999 the annual rate of
emergency department visits for cardiovascular conditions was 16.2 per 1,000
persons, up from 15.4 in 1992.
CORONARY
Heart
Disease and Angina Pectoris
Coronary
Heart Disease
Coronary heart disease (CHD)
caused 529,659 deaths in the United States in 1999 about 1 of every 5 deaths.
CHD total mention mortality 680,000 of the more than 2,000,000 deaths from
all causes.
CHD is the single largest
killer of American males and females.
About every 29 seconds an
American will suffer a coronary event, and about every minute someone will die
from one.
This year an estimated
1,100,000 Americans will have a new or recurrent coronary attack (defined as
myocardial infarction or fatal CHD). About 650,000 of these will be first
attacks and 450,000 will be recurrent attacks.* Over 45% of the people who
experience a coronary attack in a given year will die from it.
About 250,000 people a year
die of CHD without being hospitalized. Most of these are sudden deaths caused
by cardiac arrest, usually resulting from ventricular fibrillation.
Yearly totals of sudden
cardiac death in people ages 15 to 34 rose from 2,719 in 1989 to 3,000 in 1996.
Alarmingly, though the numbers are very small, the death rate increased by 30%
in young women. Death rates were also higher among young African Americans than
among Caucasians.
12,600,000 people alive
today have a history of heart attack, angina pectoris (chest pain) or both.
This is about 6,200,000 males and 6,400,000 females.
Its estimated that
7,500,000 Americans age 20 and older have a history of myocardial infarction
(about 4,600,000 men and 2,900,000 women).
From 1989 to 1999, the
death rate from CHD declined 24.0%, but the actual number of deaths declined
only 6.8%.
Age,
Sex, Race and Ethnicity
85% of people who die of
CHD are age 65 or older.
The average age of a person
having a first heart attack is 65.8 for men and 70.4 for women.
About 80% of CHD mortality
in people under age 65 occurs during the first attack.
Based on data from the
NHLBIs Framingham Heart Study in its 44-year follow-up of participants and the
20-year follow-up of their offspring...
CHD is the predominant
cardiovascular event, comprising more than one-half of all such events in men
and women under age 75.
The lifetime risk of
developing CHD after age 40 is 49% for men and 32% for women.
The incidence of CHD in
women lags behind men by 10 years for total CHD and by 20 years for more
serious clinical events such as MI and sudden death.
CHD rates in women after
menopause are 2-3 times those of women the same age before menopause.
50% of men and 63% of women
who died suddenly of CHD had no previous symptoms of this disease.
1999 CHD mortality: male
deaths 267,268 (50.5% of deaths from CHD); female deaths 262,391 (49.5% of
deaths from CHD).
In 1999 the overall CHD
death rate was 195.6. The death rates were 249.4 for white males and 272.6 for
black males, and 152.5 for white females and 192.5 for black females.
1999 preliminary death
rates for CHD were 138.4 for Hispanics, 123.9 for American Indians/Alaska
Natives and 115.7 for Asian/Pacific Islanders (CDC/NCHS).
Among Americans age 20 and
older, the age-adjusted prevalence of CHD for non-Hispanic whites is 6.9% for
men and 5.4 for women; for non-Hispanic blacks its 7.1% for men and 9.0 for
women; and for Mexican Americans its 7.2% for men and 6.8 for women.
Among Americans age 20 and
older, the age-adjusted prevalence of MI for non-Hispanic whites is 5.2% for
men and 2.0 for women; for non-Hispanic blacks its
4.3% for men and 3.3 for
women; and for Mexican Americans its 4.1% for men and 1.9 for women.
The annual rates per 1,000
population of new and recurrent heart attacks in non-black men are 26.3 for
ages 65-74, 39.7 for ages 75-84, and 53.6 for age 85 and older. For non-black
women in the same age groups the rates are 7.8, 21.0 and 24.2, respectively.
For black men the rates are 16.3, 54.9 and 40.8, and for black women the rates
are 13.3, 18.3 and 14.1, respectively.
Among American Indians ages
65-74, the annual rates (per 1,000) of incident heart attacks are 6.8 for men
and 2.2 for women. (Strong Heart Study [1991-98], NHLBI)
The average annual CHD
incidence rate (per 1,000) in middle-aged Japanese-American men living in
Hawaii was 4.6 for ages 45-49, 6.0 for ages 50-54, 7.2 for ages 55-59, 8.8 for
ages 60-64, and 10.5 for ages 65-68.
During the 19-year
follow-up of this study (1966-84), the age-adjusted annual CHD mortality rate
(per 1,000) decreased from 4.7 to 2.9, with an estimated annual decline of
2.7%. This trend is similar to that reported for U.S. white males of comparable
ages in the same period.
Aftermath
25% of men and 38% of women
will die within 1 year after having an initial recognized MI.
In part because women have
heart attacks at older ages than men do, theyre more likely to die from them
within a few weeks.
People whove had a heart
attack have a sudden death rate thats 4-6 times that of the general
population.
CHD is a prominent cause of
death in adults at the peak of their productive lives.
Depending on their sex and
clinical outcome, people who survive the acute stage of a heart attack have a
chance of illness and death thats 1.5-15 times higher than that of the general
population. The risk of another heart attack, sudden death, angina pectoris,
heart failure and stroke for both men and women is substantial.
Within 6 years after a
recognized heart attack
18% of men and 35% of women
will have another heart attack.
7% of men and 6% of women
will experience sudden death.
About 22% of men and 46% of
women will be disabled with heart failure.
Almost half of men and
women under age 65 who have a heart attack (MI) die within 8 years.
About two-thirds of heart
attack patients dont make a complete recovery, but 88% of those under age 65
are able to return to their usual work. The outlook for people who have an
unrecognized attack is about the same or worse.
1,317,000 males and 945,000
females diagnosed with CHD were discharged from hospitals in 1999. From 1979 to
1999, these discharges increased 29.9% for men and 30.5% for women.
CHD is the leading cause of
premature, permanent disability in the U.S. labor force, accounting for 19% of
disability allowances by the Social Security Administration.
In 1998, $10.6 billion was
paid to Medicare beneficiaries for CHD ($10,428 per discharge for acute MI;
$11,399 per discharge for coronary atherosclerosis and $3,617 per discharge for
other CHD).
Angina
Pectoris
About 6,400,000 Americans
have angina pectoris (chest pain or discomfort due to insufficient blood flow
to the heart muscle) about 2,400,000 males and 4,000,000 females. Asmall
number of deaths due to coronary heart disease are coded as being from angina
pectoris. These are included as a portion of total deaths from CHD.
About 400,000 new cases of
stable angina (predictable chest pain on exertion or under mental or emotional
stress) and about 150,000 new cases of unstable angina (unexpected chest pain
while at rest) occur each year.
27% of men and 14% of women
will develop angina within 6 years after a recognized heart attack.
Only 20% of coronary
attacks are preceded by long-standing angina. The percentage is lower if the
infarction is silent or unrecognized.
The age-adjusted prevalence
of angina is greater in women than in men. Angina rates in women age 20 and
older are 3.9% for non-Hispanic white women, 6.2% for non-Hispanic black women
and 5.5% for Mexican-American women. Rates for men in these three groups are
2.6, 3.1 and 4.1%, respectively.
The annual rates per 1,000
population of new and recurrent episodes of angina for non-black men are 44.3
for ages 65-74, 56.4 for ages 75-84, and 42.6 for age 85 and older. For
non-black women in the same age groups the rates are 18.8, 30.8 and 19.8,
respectively. For black men the rates are 26.1, 52.2 and 43.5, and for black
women the rates are 29.4, 37.7 and 15.2, respectively.
About 35,000 males and
47,000 females diagnosed with angina pectoris were discharged from hospitals in
1999.
STROKE
Stroke killed 167,366 people
in 1999 and accounted for about 1 of every 14.3 deaths in the United States.
About 47% of these deaths occurred out of hospital. Total mention mortality
about 278,000.
When considered separately
from other cardiovascular diseases, stroke ranks as the third leading cause of
death, behind diseases of the heart and cancer.
On average, someone in the
United States suffers a stroke every 53 seconds; every 3.1 minutes someone dies
of one.
Each year, about 600,000
people suffer a new or recurrent stroke. About 500,000 of these are first
attacks, and 100,000 are recurrent attacks.
The most common variety of
complete stroke is atherothrombotic brain infarction, which accounts for 61% of
all strokes. The next most common is cerebral embolus (24%).
Of incident definite or
probable strokes reported in the NHLBIs ARIC study, 83% were ischemic, 10%
were intracerebral hemorrhage, and 7% were subarachnoid hemorrhage. Among the
178 definite thrombotic brain infarctions, 38% were classified as lacunar
strokes (in small blood vessels) and twice as many were in blacks as in whites (Stroke.
1999;30:736-743).
7.6% of ischemic strokes
and 37.5% of hemorrhagic strokes result in death within 30 days (Stroke
1999;30:736-743).
About 4,600,000 stroke
survivors (2,300,000 males and 2,300,000 females) are alive today.
From 1989 to 1999, the
stroke death rate fell 13.0%, but the actual number of stroke deaths rose 8.6%.
Age,
Sex, Race and Ethnicity
According to the NHLBIs
Framingham Heart Study
28% of people who suffer a
stroke in a given year are under age 65.
For people over age 55, the
incidence of stroke more than doubles in each successive decade.
The chance of having a
stroke before age 70 is 1 in 20 for both sexes.
Stroke is more common in
men than in women. In most age groups, more men than women will have a stroke
in a given year. At older ages, the incidence is higher in women than in men.
More than half of total stroke deaths occur in women.
1999 stroke mortality: males
64,485 deaths (38.5% of deaths from stroke); females 102,881 deaths (61.5%
of deaths from stroke).
The 1999 overall death rate
for stroke was 61.8. Death rates were 60.0 for white males and 87.4 for black
males, 58.7 for white females and 78.1 for black females.
1999 preliminary death
rates for stroke were 40.0 for Hispanics, 39.7 for American Indians/Alaska
Natives and 52.4 for Asian/Pacific Islanders.
Based on the NHLBIs ARIC
study, the age-adjusted stroke incidence rates (per 1,000 person-years) are
1.78 for white men, 4.44 for black men, 1.24 for white women and 3.10 for black
women. Blacks have a 38% greater risk of incident (first) strokes than whites (Stroke
1999;30:736-743).
Among Americans age 20 and
older, the age-adjusted prevalence of stroke for non-Hispanic whites is 2.2%
for men and 1.5 for women; for non-Hispanic blacks its 2.5% for men and 3.2
for women; and for Mexican Americans its 2.3% for men and 1.3 for women.
The prevalence of TIAs in
men is 2.7% for ages 65 - 69 and 3.6% for ages 75-79. (A TIA or transient
ischemic attack is a mini-stroke that lasts less than 24
hours.) For women, TIA
prevalence is 1.6% for ages 65-69 and 4.1% for ages 75-79.
The annual rates per 1,000
population of new and recurrent strokes for non-black men are 14.4 for ages
65-74, 24.6 for ages 75-84, and 27.9 for age 85 and older. For non-black women
in the same age groups the rates are 6.2, 22.7 and 30.6, respectively. For
black men the rates are 11.9, 17.5 and 40.8, and for black women the rates are
16.1, 22.4 and 0.0, respectively.
Compared with Caucasians,
young African Americans have 2-3 times the risk of ischemic stroke, and African
- American men and women are more likely to die of
stroke (Stroke. 1988;19:1-9).
The annual rates (per
1,000) of new and recurrent strokes in American Indians ages 65-74 are 15.2 for
men and 7.9 for women.
The average annual
incidence rates (per 1,000) of stroke in Japanese-American men increased with
advancing age from 45-49 to 65-68 at the initial examination: 2.1 to 8.2 for
total stroke, 1.5 to 6.6 for thromboembolic stroke; and 0.4 to 1.0 for
intracerebral hemorrhage.
The age-adjusted annual
incidence rate (per 1,000) has declined markedly for total stroke from 5.1 to
2.4; for thromboembolic stroke, from 3.5 to 1.9; and for hemorrhagic stroke,
from 1.1 to 0.6.
Among non-Hispanic blacks,
the relative risk is 4 times higher at ages 35-54, 3 times higher at ages 55-64
and almost 2 times higher at ages 65-74. The risk is only 1.2 times higher at
ages 75-84 and slightly lower at age 85 and older.
Among American
Indians/Alaska Natives, the relative risk is almost 2 times higher at ages
35-44, 1.3 times higher at ages 45-54 and 1.5 times higher at ages 55-64. The
risk is slightly less at ages 65-84 and less than half at age 85 and older.
Among Asian/Pacific
Islanders, the relative risk is 1.3 times higher at ages 35-54 and 1.4 times
higher at ages 55-64. The risk is about the same at ages 65-84 and slightly
lower at age 85 and older.
Among Hispanics, the
relative risk is about 1.3 times higher at ages 35-64 and slightly lower at
ages 65-74. The risk is about half that of non-Hispanic whites at age 75 and
older.
Aftermath
Stroke is a leading cause
of serious, long-term disability in the United States.
In 1999 there were more
than 1,100,000 American adults who reported difficulty with functional
limitations, activities of daily living, etc. resulting from stroke.
According to the NHLBIs
Framingham Heart Study
The length of time to recover
from a stroke depends on its severity. 50 to 70% of stroke survivors regain
functional independence, but 15 to 30% are permanently disabled. Institutional
care is required by 20% at three months after onset.
22% of men and 25% of women
who have an initial stroke die within a year. This percentage is higher among
people age 65 and older.
8% of men and 11% of women
will have a stroke within 6 years after a myocardial infarction.
51% of men and 53% of women
under age 65 who have a stroke die within 8 years.
14% of persons who survive
a first stroke or TIA will experience a recurrence within 1 year.
434,000 males and 527,000
females were discharged from hospitals in 1999 after having a stroke. From 1979
to 1999 these discharges increased 28.8%.
In 1998, $3.6 billion
($5,912 per discharge) was paid to Medicare beneficiaries discharged from
short-stay hospitals for stroke.
Blood
Pressure
High blood pressure (HBP or
hypertension) was listed on death certificates as the primary cause of death of
42,997 Americans in 1999. HBP was listed as a primary or contributing cause of
death in about 227,000 of the more than 2,000,000 U.S. deaths that year.
About 50,000,000 Americans
age 6 and older have HBP, defined as systolic pressure of 140 mm Hg or higher or
diastolic pressure of 90 mm Hg or higher, or taking antihypertensive medicine.
1 in 5 Americans (and 1 in
4 adults) has HBP.
The cause of 90-95% of the
cases of HBP isnt known; however, HBP is easily detected and usually
controllable.
People with lower
educational and income levels tend to have higher levels of blood pressure.
From 1989 to 1999 the
age-adjusted death rate from HBP increased 21%, but the actual number of deaths
rose 46%.
Of those with HBP, 31.6%
are unaware they have it; 27.4% are on medication and have it controlled; 26.2%
are on medication but dont have their HBP under control; and 14.8% arent on
medication.
Age,
Sex, Race and Ethnicity
Ahigher percentage of men
than women have HBP until age 55. From ages 55-74 the percentage of women is
somewhat higher; after that a higher percentage of women have HBP than men do.
1999 HBP mortality: males
17,194 deaths (40.0% of deaths from HBP); females 25,803 deaths (60.0% of
deaths from HBP).
The 1999 overall death rate
from HBP was 15.9. Death rates were 12.8 for white males, 46.8 for black males,
12.8 for white females and 40.3 for black females.
HBP is 2-3 times more
common in women taking oral contraceptives, especially in obese and older
women, than in women not taking them.
About one-half of people
who have a first heart attack and two-thirds who have a first stroke have blood
pressures higher than 160/95 mm Hg.
The prevalence of HBP among
blacks and whites in the southeastern United States is greater and death rates
from stroke are higher than among those in other regions.
As many as 30% of all
deaths in hypertensive black men and 20% of all deaths in hypertensive black
women may be attributable to HBP.
The prevalence of
hypertension in blacks in the United States is among the highest in the world.
Compared with whites, blacks develop HBP earlier in life and their average
blood pressures are much higher. As a result, compared with whites, blacks have
a 1.3 times greater rate of nonfatal stroke, a 1.8 times greater rate of fatal
stroke, a 1.5
times greater rate of heart
disease death and a 4.2 times greater rate of end-stage kidney disease.
Compared with white women,
black women have an 85% higher rate of ambulatory medical care visits for
hypertension.
Among U.S. adults age 20
and older, the age-adjusted prevalence of HBP for non-Hispanic whites is 25.2%
for men and 20.5 for women; for non-Hispanic blacks its 36.7% for men and 36.6
for women; and for Mexican Americans its 24.2% for men and 22.4 for women.
The age-adjusted (1980
standard) prevalence of HBP for Asian/Pacific Islanders is 9.7% for men and
8.4% for women.
Among American Indians ages
45-74, 26.8% of men and 27.5% of women have HBP. (Defined as definite
hypertension: systolic blood pressure of 160 mm Hg or greater or diastolic
blood pressure of 95 mm Hg or greater on one occasion or reported to be
currently taking antihypertensive medication.)
73% of Japanese-American
men ages 71-93 have HBP.
Among Americans age 18 and
older, the median percentages who have been told by a professional that they
have high blood pressure are:
For whites, 23.0%.
For blacks, 30.9%.
For Hispanics, 18.6%.
For Asian/Pacific
Islanders, 16.3%.
For American Indians/Alaska
Natives, 20.7%.
Discharges
172,000 males and 267,000
females diagnosed with HBP were discharged from hospitals in 1999.
End-Stage
Renal Disease (ESRD)
ESRD (also called end-stage
kidney disease) is a condition closely related to high blood pressure. ESRD
morbidity rates vary dramatically among different age, race, ethnicity and sex
population groups. Morbidity rates tend to increase with age, then fall off for
the oldest age group. The largest 5-year age group for incidence is patients
ages 70-74; for prevalence, its ages 65-69. The excess CVD risk in people with
chronic renal disease is caused, in part, by a higher prevalence of CVD risk
factors in this group than in the general population. The main factors include
older age, high blood pressure, high blood cholesterol and lipids, diabetes and
physical inactivity.
In 1999, the estimated
incidence of new ESRD patients was 89,252.
344,094 patients were being
treated for ESRD by the end of 1999.
66,964 patients died from
ESRD in 1999.
More than 13,590 kidney
transplants were performed in 1999.
Diabetes continues to be
the most common reported cause of ESRD.
The incidence of reported
ESRD therapy has almost doubled in the past 10 years.
Age,
Sex, Race and Ethnicity
The average incidence rates
for pediatric ESRD are more than twice as high among children 15-19 years as
for children 10-14 years. The rates are more than 3 times higher than those for
children ages 0-4 and 5-9.
Children with pediatric
ESRD have high transplantation rates. More than 44% of children starting
therapy received a transplant during the first year of therapy, compared with
10% of patients 20-64 years of age at ESRD incidence.
Treatment of ESRD is more
common in men than in women.
Blacks and Native Americans
have much higher rates of ESRD than whites and Asians. Blacks represent 32% of
treated ESRD patients.
Arrhythmias
(Disorders of Heart Rhythm)
Mortality 39,262. Total
mention mortality about 500,000 of the more than 2,000,000 U.S. deaths.
Hospital discharges 761,000. In 1998, $2.1 billion ($6,047 per discharge) was
paid to Medicare beneficiaries for cardiac arrhythmias.
Atrial fibrillation and
flutter.
Mortality 8,338. Total
mention mortality more than 61,500. Prevalence 2,000,000. Hospital
discharges 384,000. A higher percentage of men than women have atrial
fibrillation, but the actual numbers of men and women with it are about equal.
About 70% of people with atrial fibrillation are between 65 and 85 years old (Archives of Internal
Medicine, 1995;155:469-473). About 15% of
strokes occur in people with atrial fibrillation.
Tachycardia (ICD/9 427.0,1,2) (ICD/10
I47.0,1,2,9). Mortality 683. Total
mention mortality more than 6,800. Prevalence in 1996 2,300,000. Hospital
discharges 92,000. Paroxysmal supraventricular tachycardia. Mortality 27.
Hospital discharges 28,000.
Ventricular fibrillation.
Mortality 1,626. Total
mention mortality 21,300.
Hospital discharges 9,000.
Although ventricular fibrillation is listed as the cause of relatively few
deaths, the overwhelming number of sudden cardiac deaths from coronary disease
(which are estimated at about 250,000 per year) are thought to be from
ventricular fibrillation.
Artery
Diseases
Mortality 40,788. Total
mention mortality 124,100. Hospital discharges 287,000.
Atherosclerosis is a process that leads to a
group of diseases characterized by a thickening of artery walls. Mortality
14,979. Hospital discharges
120,000. Atherosclerosis is
also a leading cause of many deaths from heart attack and stroke. As such, it
accounts for nearly three-fourths of all deaths from CVD.
Aortic aneurysm. Mortality
15,807. Total mention mortality 22,400. Hospital discharges 63,000.
Other diseases of arteries.
Mortality 10,002. Hospital discharges 104,000. Kawasaki disease.
Mortality 2. Up to 2,500
cases of Kawasaki disease are diagnosed yearly. Hospital discharges 15,000,
primary plus secondary diagnoses.
About 80% of patients with
Kawasaki disease are under age 5; most are under age 2. Children older than 8
years are rarely affected.
Kawasaki disease occurs
more often among boys (63%) and among those of Asian ancestry.
Bacterial
Endocarditis
1998 total mention mortality
2,212. Hospital discharges 17,000, primary plus secondary diagnoses.
Cardiomyopathy
Mortality 27,260. Total
mention mortality 53,700. Hospital discharges 35,000.
87% of cases are congestive
or dilated cardiomyopathy. 50% of patients with dilated cardiomyopathy are
alive 5 years after their initial diagnosis; 25% are alive 10 years after the
diagnosis.
Recent studies show that
36% of young athletes who die suddenly have probable or definite hypertrophic
cardiomyopathy.
Mortality from
cardiomyopathy is highest in older persons, men and blacks.
Congenital
Cardiovascular Defects
Mortality 4,436. Total
mention mortality about 6,700. Hospital discharges 54,000.
About 40,000 babies are
born each year with cardiovascular defects. (Metropolitan Atlanta Congenital Defects Program.
At least 35 distinct types
of defects are recognized, ranging from simple defects to complex
malformations. Common defects diagnosed in infancy include ventricular septal
defect (14-17%), tetralogy of Fallot (9-12%), transposition of the great
arteries (10-11%), atrioventricular septal defect (4-10%) and coarctation of
the aorta (8-11%). Most defects can be corrected or improved with surgery or
catheter-based therapy.
About 1,000,000 Americans
with congenital cardiovascular defects are alive today.
Mortality associated with
congenital defects has been declining. From 1979-97, death rates from all
defects declined 39%. More than half of deaths occur in infants less than 1
year old. Mortality varies considerably according to type of defect (Circulation.
2001;103:2376-2381).
More deaths occur due to
cardiac defects than to any other birth defect (Genetic Epidemiology. 1997;14:493-505).
The 1999 overall death rate
for congenital cardiovascular defects was 1.6. Death rates were 1.7 for white
males, 2.3 for black males, 1.5 for white females and 1.8 for black females.
Crude infant death rates (under 1 year) were 46.4 for white babies and 61.0 for
black babies. Some types of defects occur more commonly in females or males.
From 1989 to 1999, death
rates for congenital cardiovascular defects declined 31.5%, while the actual
number of deaths declined 22.7%.
Congestive
Heart Failure
Mortality 50,824; males
18,987 (37.4% of total deaths from CHF); females 31,837 (62.6% of total
deaths from CHF). Total mention mortality 287,200. Hospital discharges
430,000 males and 532,000 females. From 1979 to 1999, these discharges
increased 155.2%.
About 4,790,000 Americans
(2,360,000 males and 2,440,000 females) have CHF and are alive today.
The age-adjusted prevalence
of CHF among non-Hispanic whites age 20 and older is 2.3% for men and 1.5% for
women. For non-Hispanic blacks, the percentages are 3.5 for men and 3.1 for
women.
About 550,000 new cases of
CHF occur each year.
The incidence of CHF
approaches 10 per 1,000 population after age 65.
75% of CHF cases have
antecedent hypertension.
About 22% of male and 46%
of female heart attack (MI) victims will be disabled with heart failure within
6 years.
80% of men and 70% of women
under age 65 who have CHF will die within 8 years.
After CHF is diagnosed,
survival is poorer in men than in women, but fewer than 15% of women survive
more than 8-12 years. Their 1-year mortality rate is higher with 1 in 5 dying.
In people diagnosed with
CHF, sudden cardiac death occurs at 6-9 times the rate of the general
population.
From 1979 to 1999, CHF
deaths increased 145%.
The 1999 overall death rate
for CHF was 18.8. Death rates were 19.4 for white males, 21.9 for black males,
18.2 for white females and 19.4 for black females.
Hospital discharges for CHF
rose from 377,000 in 1979 to 962,000 in 1999.
The annual rates per 1,000
population of new and recurrent CHF events for non-black men are 21.5 for ages
65-74, 43.3 for ages 75-84, and 73.1 for age 85 and older. For non-black women
in the same age groups the rates are 11.2, 26.3 and 64.9, respectively. For
black men the rates are 21.1, 52.0 and 66.7, and for black women the rates are
18.9, 33.5 and 48.4, respectively.
In 1998, $3.6 billion
($5,471 per discharge) was paid to Medicare beneficiaries for CHF.
Rheumatic
Fever/Rheumatic Heart Disease
Mortality 3,676; males
1,042 deaths (28.4% of total deaths from RF/RHD); females 2,634 deaths (71.6%
of total deaths from RF/RHD). Total mention mortality about 9,000. Hospital
discharges 45,000.
In 1950 about 15,000
Americans (adjusted for changes in ICDA codes) died of these diseases compared
with about 4,000 today.
From 1989 to 1999 the death
rate from RF/RHD fell 34.6%, while actual deaths declined 26.4%.
The 1999 overall death rate
for RF/RHD was 1.4. Death rates were 0.9 for white males and 0.8 for black
males, 1.7 for white females and 1.2 for black females.
Many of the 96,000 annual
operations on heart valves are related to rheumatic heart disease.
The incidence of rheumatic
fever remains higher in African Americans, Puerto Ricans, Mexican Americans and
American Indians.
In developing countries,
rheumatic fever is the most frequent cause of heart disease in the
5-13-year-old group, causing 25-40% of all cardiovascular diseases and
33-50% of all hospital
admissions.
Valvular
Heart Disease
Mortality 19,612. Total
mention mortality 39,500. Hospital discharges 97,000.
Aortic valve disorders.
Mortality 12,212. Total
mention mortality about 11,609. Hospital discharges 52,000.
Mitral valve disorders.
Mortality 2,895. Total
mention mortality about 6,100. Hospital discharges 43,000.
The NHLBIs Framingham
Heart Study reports that prevalence is about 1-2% and no more common in women
than in men. This was a study of people ages 26-84.
Pulmonary valve disorders.
Mortality 10.
Tricuspid valve disorders.
Mortality 5.
Tobacco
Smoke
For the years 1990-94, an
average of 430,700 Americans died each year of smoking-related illnesses. The
largest portion of these deaths was cardiovascular-related.
About 1 in 5 deaths from
cardiovascular diseases is attributable to smoking. About 37,000-40,000
nonsmokers die from CVD each year as a result of exposure to environmental
tobacco smoke.
Smoking costs Americans an
estimated $130 billion annually in medical care. This includes the effects of
smoking during pregnancy, lost workdays, lost output from early death and
retirement, and fires caused by smoking.
Studies show that among
people age 18 and older in the United States, smoking has declined by about 44%
since 1965. Recent data indicate that this downward trend may have leveled off.
Global mortality from
tobacco use is projected to rise from 3 million deaths in 1990 to 10 million in
2030.
According to the WHO, 1
year after quitting, the risk of coronary heart disease decreases by 50%, and
within 15 years, the relative risk of dying from CHD for an exsmoker approaches
that of a long-time (lifetime) nonsmoker.
A recent study indicates
that passive smoking substantially reduces coronary flow velocity reserve in
healthy young adults (JAMA. 2001;286:436-441).
Age,
Sex, Race and Ethnicity
During 1988-96, among
people 12-17 years old, the incidence of initiation of first use increased by
30%, and first daily use increased by 50%. More than 6,000 people under age 18
try a cigarette each day, and each day more than 3,000 persons under age 18
become daily smokers. If trends continue, about 5 million of these people will
eventually die from a disease attributed to smoking.
According to 1999 data from
the National Youth Tobacco Survey, 29.3% of middle school students and 63.5% of
high school students reported ever smoking cigarettes; 15.4% and 41.6% reported
ever smoking cigars; and 7.1% and 18.2% reported ever using smokeless tobacco,
respectively.
In 1996 about 15 million
children and adolescents under age 18 were exposed to environmental tobacco
smoke in the home.
About 80% of people who use
tobacco begin before age 18, with the most common ages of initiation being 14
to 15 (MMWR,
Vol. 48, No. 31, Aug. 1999, CDC/NCHS).
White youths ages 18-24,
from families with lower educational attainment, report substantially higher
smoking rates than black and Mexican-American youths from families with similar
educational attainment. 77% of young white men and 61% of young white women are
current smokers compared with 35% of minority youth (JAMA. 1999;281:1006-1013).
From 1980 to 1997, the
percentage of high school seniors who smoked in the past month increased almost
20%. For males it was 39.2%, and for females it was 5.4%. For whites it was
37.1%, while for blacks there was a 41% decrease.
Current age-adjusted prevalence for Americans age 18 and older shows 25,030,000
men (25.7%) and 22,640,000 women (21.5%) are smokers, putting them at increased
risk of heart attack and stroke.
1999 National Health
Interview Survey (NHIS) data from
CDC/NCHS for persons age 18
and older show...
Among non-Hispanic whites,
25.5% of men and 23.1% of women smoke.
Among non-Hispanic blacks,
28.7% of men and 20.8% of women smoke.
Among Hispanics, 24.1% of
men and 12.3% of women smoke.
Among Asian/Pacific
Islanders, 24.3% of men and 7.1% of women smoke.
Among American
Indians/Alaska Natives, 40.9% of men and 40.8% of women smoke.
Among American Indians ages
45-74, 40.5% of men and 29.3% of women are current smokers.
Studies show that smoking
prevalence is higher among those with 9-11 years of education (35.4%) compared
with those with more than 16 years of education (11.6%) and is highest among
persons living below the poverty level (33.3%).
47.7% of working adults age
17 and older who dont use tobacco report exposure to environmental tobacco
smoke at home or at work (JAMA. 1995;273:402-407).
37.4% of nonsmoking adults
are exposed to environmental tobacco smoke at home or at work. The ethnic
breakdown is 37.4% of non-Hispanic whites, 36.9% of non-Hispanic blacks and
35.1% of Mexican Americans (JAMA. 1996;275:1233-1240).
The risk of death from CHD
increases by up to 30% among those exposed to environmental tobacco smoke at
home or work.
The proportion of adults
who report that their workplace has an official smoke-free policy ranges from
61.3% to 82.1%. As the respondents level of education increases, they are more
likely to report working under a smoke-free policy.
High
Blood Cholesterol and Other Lipids
An estimated 102,340,000
American adults have total blood cholesterol levels of 200 milligrams per
deciliter (mg/dL) and higher. Of these, about 41,260,000 have levels of 240
mg/dL or above. In adults, total cholesterol levels of 240 mg/dL or higher
are considered high risk. Levels from
200 to 239 mg/dL are considered borderlinehigh risk. For information on dietary
cholesterol, total fat, saturated fat and other factors that affect blood
cholesterol levels, see the Nutrition section on pages 29-30.
Among children and
adolescents ages 4-19 years:
Females have significantly
higher average total cholesterol and low-density lipoprotein (LDL) cholesterol
(bad cholesterol) than do males.
Non-Hispanic black children
and adolescents have significantly higher mean total cholesterol, LDL
cholesterol and high-density lipoprotein (HDL) cholesterol (good cholesterol)
levels when compared with non-Hispanic white and Mexican-American children and
adolescents.
Among children and
adolescents ages 4-19, the mean total blood cholesterol level is 165 mg/dL. For
boys its 163 mg/dL and for girls its 167 mg/dL. The racial/ethnic breakdown
is:
For non-Hispanic whites, 162
mg/dL for boys and 166 mg/dL for girls.
For non-Hispanic blacks,
168 mg/dL for boys and 171 mg/dL for girls.
For Mexican Americans, 163
mg/dL for boys and 165 mg/dL for girls.
About 10% of adolescents
ages 12-19 have total cholesterol levels exceeding 200 mg/dL.
The prevalence of
cholesterol screening during the preceding 5 years increased from 67.3% in 1991
to 70.8% in 1999.
A 10-percent decrease in
total cholesterol levels may result in an estimated 30% reduction in the
incidence of CHD.
Among Americans age 18 and
older, the median percentages who have been told by a professional that they
have high blood cholesterol are:
For whites, 29.7%.
For blacks, 26.0%.
For Hispanics, 25.6%.
For Asian/Pacific
Islanders, 27.3%.
For American Indians/Alaska
Natives in Alaska, 26.0%; in Oklahoma, 28.6%; in Washington, 26.5%.
Studies show that a higher
percentage of women than men have total blood cholesterol of 200 mg/dL or
higher, beginning at age 50.
53,830,000 adult women and
48,180,000 adult men had total blood cholesterol levels of 200 mg/dL or higher
in 1999.
Age-adjusted prevalence
among non-Hispanic whites ages 20-74:
52% of men and 49% of women
have total blood cholesterol levels over 200 mg/dL.
18% of men and 20% of women
have total blood cholesterol levels of 240 mg/dL or higher.
Age-adjusted prevalence
among non-Hispanic blacks ages 20-74:
45% of men and 46% of women
have total blood cholesterol levels over 200 mg/dL.
15% of men and 18% of women
have total blood cholesterol levels of 240 mg/dL or higher.
Age-adjusted prevalence
among Mexican Americans ages 20-74:
53% of men and 48% of women
have total blood cholesterol levels over 200 mg/dL.
18% of men and 17% of women
have total blood cholesterol levels of 240 mg/dL or higher.
Among elderly
Japanese-American men, 42% have total cholesterol levels of 200 mg/dL or higher
or are taking cholesterol-lowering medication.
Trends in Mean Total Blood
Cholesterol Among Adolescents Ages 12-17 by Sex, Race and Survey
For American Indians ages
45-74, 37.7% of men and 37.6% of women have total blood cholesterol levels of
200 mg/dL or higher. 8.6% of men and 12.7% of women have levels of 240 mg/dL or
higher.
LDL
(Bad) Cholesterol
Mean LDL cholesterol levels
among children and adolescents ages 12-19 are:
Among non-Hispanic whites,
91 mg/dL for boys and 100 mg/dL for girls.
Among non-Hispanic blacks,
99 mg/dL for boys and 102 mg/dL for girls.
Among Mexican Americans, 93
mg/dL for boys and 92 mg/dL for girls.
The age-adjusted prevalence
among Americans age 20 and older with LDL cholesterol levels of 130 mg/dL or
higher, which is associated with a higher risk of coronary heart disease, is:
For non-Hispanic whites,
49.6% of men and 43.7% of women. (20.4% of men and 17.0% of women have an LDL
cholesterol level of 160 mg/dL or higher.)
For non-Hispanic blacks,
46.3% of men and 41.6% of women (19.3% of men and 18.8% of women have an LDL
cholesterol level of 160 mg/dL or higher.).
For Mexican Americans,
43.6% of men and 41.6% of women. (16.9% of men and 14.0% of women have an LDL
cholesterol level of 160 mg/dL or higher.)
HDL
(Good) Cholesterol
Mean HDL cholesterol levels
among children and adolescents ages 4-19 are:
Among non-Hispanic whites,
48 mg/dL for boys and 50 mg/dL for girls.
Among non-Hispanic blacks,
55 mg/dL for boys and 56 mg/dL for girls.
Among Mexican Americans, 51
mg/dL for boys and 52 mg/dL for girls.
The age-adjusted prevalence
among Americans age 20 and older with HDL cholesterol of less than 40 mg/dL,
which is associated with a higher risk of coronary heart disease, is:
For non-Hispanic whites,
40.5% of men and 14.5% of women.
For non-Hispanic blacks,
24.3% of men and 13.0% of women.
For Mexican Americans,
40.1% of men and 18.4% of women.
The risk of
myocardial infarction (heart attack) in both men and women is highest at lower
HDL cholesterol (HDL-C) levels and higher total cholesterol levels, overall.
However, those with lower levels of HDL-C (37 mg/dL or lower in men and 47 mg/dL
or lower in women) are at a high risk regardless of their total cholesterol
level. Conversely, those with high levels of total cholesterol have lower risks
of myocardial infarction when accompanied by higher levels of HDL-C (53 mg/dL
or greater in men and 67 mg/dL or greater in women). This suggests the
importance of screening for both total and HDL cholesterol levels in adults.
Physical
Inactivity
The following data are based
on leisure-time physical activity.
In 1998 about 29% of
Americans age 18 or older reported no leisure-time physical activity. 27%
achieved recommended levels of physical activity. 44% reported some activity
but not enough to achieve recommended levels.
Men, young people and
whites had a higher prevalence of recommended levels of activity compared with
women, older people and people from minority races or ethnic groups.
People who were
college-educated, in high income brackets or living in the West had a higher
prevalence of recommended activity.
The relative risk of CHD
associated with physical inactivity ranges from 1.5 to 2.4, an increase in risk
comparable to that observed for high blood cholesterol, high blood pressure or
cigarette smoking. (JAMA. 1995;273:402-407)
Less-active, less-fit
persons have a 30-50% greater risk of developing high blood pressure. (Cardiovascular benefits and
assessment of physical activity and physical fitness in adults. Med Sci Sports
Exerc 1992;24(suppl 6):S201-S220)
Age,
Sex, Race and Ethnicity
Daily enrollment in
physical education classes among high school students has declined from 42% in
1991 to 29.1% in 1999.
56.1% of high school
students were enrolled in physical education classes in 1999, but only 29.1%
attended classes daily.
Physical inactivity is more
prevalent among women than men, among blacks and Hispanics than whites, among
older than younger adults and among the less affluent
than the more affluent.
Among American Indians ages
45-74, 16.8% of men and 19.6% of women report no physical activity during the
past year.
Among adults age 18 and
older, the following proportions of people are sedentary (have no leisure-time
physical activity):
For non-Hispanic whites,
33.3% of men and 38.9% of women.
For non-Hispanic blacks,
46.0% of men and 57.1% of women.
For Hispanics, 49.9% of men
and 57.1% of women.
For non-Hispanic
Asian/Pacific Islanders, 36.2% of men and 49.2% of women.
Arecent study
of over 72,000 female nurses indicates that moderate-intensity physical
activity such as walking is associated with a substantial reduction in risk of
total and
ischemic stroke when compared
with physical activity done at an average or casual pace (JAMA. 2000;283:2961-2967).
The prevalence of physical
inactivity during leisure time among Mexican Americans is higher than in
the general population.
The prevalence of physical
inactivity among those whose main language is English is 15% of men and 28% of
women. This is similar to that of the general population (17% of men and 27% of
women).
Those whose main language
is Spanish have the highest prevalence of physical inactivity (38% of men and
58% of women).
Overweight
and Obesity
Using a body mass index (BMI)
of 25.0 or higher as overweight and a BMI of 30.0 or higher as obese,
108,330,000 Americans age 20 and older are considered overweight (56,350,000
men and 51,980,000 women). Of these, 44,250,000 are considered obese
(18,680,000 men and 25,570,000 women). In addition, an estimated 5,030,000
children ages 6-17 are considered overweight (based on the 95th percentile of
BMI values in the 2000 CDC growth chart for the U.S.).
Using the 95th percentile
of BMI values, the prevalence of overweight among American children ages 6-11
is:
For non-Hispanic whites,
10.3% of boys and 9.2% of girls.
For non-Hispanic blacks, 11.9%
of boys and 16.4% of girls.
For Mexican Americans,
17.4% of boys and 14.3% of girls.
Using the 95th percentile
of BMI values, the prevalence of overweight among American adolescents ages
12-17 is:
For non-Hispanic whites,
11.1% of boys and 8.5% of girls.
For non-Hispanic blacks,
10.7% of boys and 15.7% of girls.
For Mexican Americans,
14.6% of boys and 13.7% of girls.
Each year an estimated
300,000 U.S. adults die of causes related to obesity (JAMA 1999;282:1530-1538).
Among Americans age 18 and
older, the following people are overweight (defined as a BMI of 25 kg/m2 or higher):
For non-Hispanic whites,
62.4% of men and 43.0% of women.
For non-Hispanic blacks,
64.1% of men and 64.5% of women.
For Hispanics, 64.7% of men
and 56.8% of women.
For non-Hispanic
Asian/Pacific Islanders, 35.2% of men and 25.2% of women.
Among Americans age 18 and
older, the median percentages of obesity are (defined as a BMI greater than 30
kg/m2):
For whites, 15.6%.
For blacks, 26.4%.
For Hispanics, 18.2%.
For Asian/Pacific
Islanders, 4.8%.
For American Indians/Alaska
Natives, 30.1%.
Prevalence of Moderate or
Vigorous Physical Activity in Americans Age 20 and Older by Sex, Race/Ethnicity
and BMI*
Among Americans ages 20-74
(with a BMI of 25.0 or higher to indicate overweight and a BMI of 30.0 or
higher to indicate obesity), the age-adjusted prevalences are:
For non-Hispanic whites,
61.5% of men and 46.8% of women are overweight. 20.8% of men and 23.2% of women
are obese.
For
non-Hispanic blacks, 58.4% of men and 68.3% of women are overweight. 21.3% of
men and 38.2% of women are obese.
For Mexican Americans,
69.3% of both men and women are overweight. 24.8% of men and 36.1% of women are
obese.
Among American Indians ages
45-74, 25.9% of men and 31.3% of women are overweight (defined as a BMI of
27.8-31.0 for men and 27.3-32.2 for women). 35.5% of men and 41.2% of women are
obese (defined as a BMI of 31.1 or higher for men and 32.3 or higher for
women).
The prevalence of obesity
(BMI of 30 kg/m2
or higher) was 19.8% in 2000. Mississippi
had the highest prevalence of obesity (24.3%) and Colorado had the lowest
(13.8%) (JAMA
2001;286:1195-1200).
An expert group convened by
the World Health Organization in June 1997 found that overweight and obesity
represent a rapidly growing threat to the health of populations in an
increasing number of countries worldwide. WHO recognized obesity as a disease
that is prevalent in both developing and developed countries and that affects
children and dults alike.
Mean BMI for Women* Ages
25-64 by Education and Race/Ethnicity, Diabetes Mellitus
In 1999 diabetes killed
68,399 Americans. Males 31,150 deaths (45.5% of total deaths from diabetes);
females 37,249 deaths (54.5% of total deaths from diabetes). Total mention
mortality 202,000.
10,600,000 Americans have
physician-diagnosed diabetes (about 4,900,000 males and 5,700,000 females) (Diabetes Care
1998;21:518-524).
The prevalence of diabetes
rose from 4.9% in 1990 to 6.5% in 1998, an increase of 33.3%. Increases were
observed in both sexes, all ages, all ethnic groups, all education levels, and
nearly all states (Diabetes
Care 2000;23:1278-1283).
The prevalence of diabetes
was 7.3% in 2000. Mississippi had the highest prevalence of diabetes (8.8%) and
Alaska had the lowest (4.4%) (JAMA 2001;286:1195-1200).
798,000 new cases of
non-insulin dependent diabetes are diagnosed every year according to estimates
of the National Institute of Diabetes, Digestive, and Kidney Diseases.
545,000 Americans diagnosed
with diabetes mellitus were discharged from hospitals in 1999. Of these, about
262,000 were males and 283,000 were females.
The 1999 overall death rate
from diabetes was 25.2. Death rates were 25.8 for white males, 48.6 for black
males, 20.5 for white females and 50.4 for black females.
Two-thirds of people with
diabetes mellitus die of some form of heart or blood vessel disease.
The age-adjusted prevalence
of physician-diagnosed diabetes in adults age 20 and older is:
For non-Hispanic whites,
5.4% of men and 4.7% of women.
For non-Hispanic blacks,
7.6% of men and 9.5% of women.
For Mexican Americans, 8.1%
of men and 11.4% of women.
Among Americans age 18 and
older, the median percentages who have be told by a professional that they have
diabetes are:
For whites, 4.4%.
For blacks, 7.6%.
For Hispanics, 5.5%.
For Asian/Pacific
Islanders, 4.6%.
For American Indians/Alaska
Natives, 7.6%.
Among American Indians ages
45-74, 43.5% of men and 52.4% of women have diabetes mellitus. Also, 14.2% of
men and 17.4% of women have impaired glucose tolerance.
17% of Japanese-American
men ages 71-93 have diabetes. In addition, 19% have unrecognized diabetes, and
32% have impaired glucose tolerance.
The risk of diabetes for
Mexican Americans and non-Hispanic blacks is almost twice that for non-Hispanic
whites (Diabetes
Care 1998;21:518-524).
Compared with white women,
black women have 138% higher rates of ambulatory medical care visits for
diabetes.
An estimated 5,600,000
Americans have undiagnosed diabetes about 3,000,000 men and 2,600,000 women.
The following age-adjusted
prevalence of undiagnosed diabetes in Americans age 20 and older uses
American Diabetes Association criteria of fasting plasma glucose of
126
mg/dL or more:
For non-Hispanic whites,
3.0% of men and 2.1% of women.
For non-Hispanic blacks,
2.8% of men and 4.7% of women.
For Mexican Americans, 5.8%
of men and 3.9% of women.
An estimated 13,800,000
Americans have impaired fasting glucose about 8,400,000 men and 5,500,000
women.
The following age-adjusted
prevalence of impaired fasting glucose among Americans age 20 and older uses
American Diabetes Association criteria of fasting plasma
glucose of 110 to less than
126 mg/dL:
For non-Hispanic whites,
9.4% of men and 4.8% of women.
For non-Hispanic blacks,
8.0% of men and 6.8% of women.
For Mexican
Americans, 12.1% of men and 6.7% of women.
The prevalence of diabetes
in adults globally was estimated to be 4.0% in 1995 and was predicted to rise
to 5.4% by the year 2025. The number of adults with
diabetes in the world is
estimated to rise from 135 million in 1995 to 300 million in 2025 (Diabetes Care
1998;21:1414-1431).
Its projected that the
number of people with diabetes will increase 42%, from 51 million to 72
million, in developed countries and 170%, from 84
million to 228 million, in
developing countries.
The majority of people with
diabetes in developing countries is projected to be younger, ages 45-64, while
those in developed countries will be age 65.
Diabetes will be
increasingly concentrated in urban areas, with the greater burden of disease
among women.
NUTRITION
Good
nutrition is important for preventing heart disease and stroke. Healthy food
habits help maintain normal blood pressure, desirable blood cholesterol levels
and a healthy body weight. They also may aid blood clotting, oxidation,
maintaining a normal heart rhythm and other effects. A poor diet, on the other
hand, contributes to high blood pressure, high blood cholesterol and excess
body weight. Overweight and obesity in turn contribute to diabetes, cholesterol
disorders and high blood pressure.
The
American Heart Association recommends a diet low in saturated fat, trans fat,
cholesterol and sodium. It should be high in vegetables, fruits, whole grains,
legumes, fat-free or low-fat dairy products, and dietary fiber. The following
data support these recommendations.
Between 1965 and 1991 among
U.S. adults age 18 and older, total daily calories declined from 2,049 to
1,807, but then rebounded to 2,000 calories in 1996. This contributed to the
marked increase in obesity levels in the past decade (Prev Med 2001;32:245-254).
Between 1965 and 1996 among
adults, total fat as a proportion of daily calorie intake fell steadily from 39.1
to 33.1%. Saturated fat fell from 14.4 to 11.0%.
However, total calorie intake
increased between 1991 and 1996. Over the same period daily total fat
consumption rose from 70.9 grams (g) to 74.8 g (Prev Med 2001;32:245-254).
Total fat intake (saturated,
trans, monounsaturated, polyunsaturated) should be less than 30% of
total daily calories.
Saturated fat and trans fat
should not exceed 10% of total daily calories for healthy people.
Saturated fat should be
less than 7% of total daily calories for people with coronary heart disease,
diabetes or high LDL cholesterol.
The average daily intake of
total fat in the United States is 81.4 grams (96.5 g for males and 67.3 g for
females).
For non-Hispanic whites the
average is 82.7 grams (99.0 g for males and 67.4 g for females).
For non-Hispanic blacks the
average is 82.0 grams (94.6 g for males and 71.2 g for females).
For Mexican Americans the
average is 77.6 grams (88.0 g for males and 66.5 g for females).
The average daily intake of
saturated fat in the U.S. is 27.9 grams (33.1 g for males and 23.0 g for
females).
For non-Hispanic whites the
average is 28.4 grams (34.1 g for males and 23.1 g for females).
For non-Hispanic blacks the
average is 27.5 grams (31.7 g for males and 23.8 g for females).
For Mexican Americans the
average is 26.7 grams (30.1 g for males and 23.1 g for females).
The proportion of fat
calories from beef, pork, dairy products and eggs fell from 50% in 1965 to 33%
in 1994-96. The proportion of fat calories from poultry increased from 4% to
7%. Calories from fruits and vegetables rose from 8% to 13% (Prev Med 2001;32:245-254).
In 1994-96, pizza, Mexican
food, Chinese food, hamburgers, French fries and cheeseburgers accounted for
10.8% of total fat intake. These six foods accounted for only 1.9% of fat
intake in 1965 (Prev
Med 2001;32:245-254).
The major sources of
saturated fat in the diet are red meat, butter, whole milk and eggs. Intake of
these foods has fallen markedly since 1965. The decline in whole milk consumption
from 21.3 gallons in 1972-76 to 8.2 gallons in 1997 accounts for most of the
reduction in saturated fat (Prev Med 2001;32:245-254).
The recommended daily
intake of dietary cholesterol for adults is less than 300 mg. The average daily
intake of dietary cholesterol in the U.S. is 269.6 milligrams (mg). For males
its 323.5 mg and for females its 218.9 mg.
For non-Hispanic whites the
average is 259.3 milligrams (312.6 mg for males and 209.1 mg for females).
For non-Hispanic blacks the
average is 297.9 milligrams (358.8 mg for males and 245.6 mg for females).
For Mexican Americans the
average is 316.2 milligrams (365.9 mg for males and 263.8 mg for females).
The recommended daily
intake of dietary fiber is 25 grams or more. Americans consume a daily average
of 15.6 grams of dietary fiber (17.8 g for males and 13.6 g
for females).
For non-Hispanic whites the
average is 15.8 grams (18.1 g for males and 13.7 g for females).
For non-Hispanic blacks the
average is 13.4 grams (15.0 g for males and 12.0 g for females).
For Mexican Americans the
average is 18.5 grams (21.0 g for males and 15.9 g for females).
Only 22.7% of adults
consumed fruits and vegetables at least 5 times a day in 1996. This was an
increase from 19.0% in 1990.
The highest proportion of
adults who consumed fruits and vegetables at least 5 times a day were those 65
years and older, whites, college graduates, those actively engaged in
leisure-time physical activity, and nonsmokers (Prev Med 2001;32:245-254).
The percentage of men who
consumed fruits and vegetables at least 5 times a day increased from 16.5% in
1990 to 19.1% in 1996. The percentage of women increased from 21.3% in 1990 to
26.2% in 1996 (Am
J Public Health 2000;90:777-781).
From 1990 to 1996, the
percentage of obese adults who consumed at least 5 servings of fruits and
vegetables a day dropped from 16.8% to 15.4%. (Prev Med
2001;32:245-254)
Recent studies support the
intake of up to 9 servings of fruits and vegetables per day. (Appel, et al., NEJM 1997;336:1117-1124)
QUALITY
of Care
The National Committee for
Quality Assurance has chosen 5 quality-of-care performance measures related to
preventing and treating cardiovascular diseases (The State of Managed Care Quality, 2000,
NCQA):
Advising smokers to quit
Use of beta blockers after
a heart attack
Cholesterol screening in
patients with coronary heart disease
Cholesterol control in
patients with coronary heart disease
Control of high blood
pressure
Performance data for these
indicators apply to patients who receive their medical care from providers in
managed care plans in the United States. Evidence supports the contention that
the quality of care may be better in managed care settings than in other
settings. Improvements in the quality of care measured by these performance
indicators would be associated with substantial reductions in morbidity and
mortality related to cardiovascular diseases.
Advising
smokers to quit
In 1999, 65.3% of smokers
were advised to quit, an increase from 61.0% of smokers in 1996.
The 90th percentile
benchmark was 73% of smokers. If all practices performed at this level, an
estimated 2.7 million additional smokers would be advised to quit and 82,000
additional smokers would actually quit smoking. This would lead to substantial
reductions in smokingrelated morbidity, mortality (683 fewer deaths per year)
and healthcare costs.
Use
of beta blockers after a heart attack
In 1999, 85.0% of heart
attack survivors were receiving a beta blocker at the time of discharge from
the hospital, an increase from 62.2% in 1996. If all practices performed at the
90th percentile level (96%), an additional 4,000 deaths could be avoided each
year.
Cholesterol
screening in patients with coronary heart disease
In 1999, 68.9% of patients
hospitalized for heart attack, bypass surgery or angioplasty were screened for
LDL cholesterol between 60 and 365 days following discharge. This proportion
represented an increase from 59.1% in 1998, the first year this performance
indicator was used. The 90th percentile benchmark was 83%.
Cholesterol
control in patients with coronary heart disease
In 1999, 45.3% of patients
hospitalized for heart attack, bypass surgery or angioplasty were treated with
an LDL cholesterol goal of less than 130 mg/dL. The 90th percentile benchmark
was 64.4%.
Note that this treatment
goal is less aggressive than the goal endorsed by the American Heart
Association and the National Cholesterol Education Program (less than 100
mg/dL). Hence, its likely that control to the AHA and NCEP goal is worse than
suggested here.
Control
of high blood pressure
In 1999 only 39.0% of
adults with high blood pressure were controlled to levels less than 140/90 mm
Hg. The 90th percentile performance goal was 47.9%.
MEDICAL
Procedures,
Facilities and Costs
From 1979 to 1999, the number
of cardiovascular operations and procedures increased 413%.
Cardiac
Catheterization
From 1979 to 1999, the
number of cardiac catheterizations increased 355%.
In the United States, an
estimated 1,359,000 inpatient cardiac catheterizations were performed in 1999.
472,000 ambulatory
(outpatient) surgical procedures for cardiac catheterization were performed in
1996. 298,000 of them were done on males and 175,000 on females.
Coronary
Artery Bypass Surgery
In the United States in 1999,
the NCHS estimates that 571,000 of these procedures were performed on 355,000
patients. These numbers represent both code and vessel data. Thus its
impossible to determine the average number of vessels per patient.
Heart
Transplants
In 2000, 2,198 heart
transplants were performed in the United States. Currently there are 260
transplant centers in the United States, 196 of which perform heart
transplants.
Its estimated that each
year thousands of Americans would benefit from a heart transplant.
In the United States 73% of
heart transplant patients are male, 77% are white, 19% are ages 35-49, and 51%
are ages 50-64.
84% of patients survived 1
year, based on heart transplants performed from 1994 to May 2000. The 3-year survival
rate was about 77%, and the 5-year survival rate was 69%.
Percutaneous
Transluminal Coronary Angioplasty (PTCA)
An estimated 601,000 PTCA
procedures were performed in 1999 in the United States. From 1987 to 1999 the
number of procedures increased 285% and the number of patients increased 286%.
In 1999, 66% of
PTCA procedures were performed on men; 48% were performed on people over age
65.
ECONOMIC
COST of
Cardiovascular Diseases
The cost of cardiovascular
diseases and stroke in the United States in 2002 is estimated at $329.2
billion. This figure includes health expenditures (direct costs, which include
the cost of physicians and other professionals, hospital and nursing home
services, the cost of medications, home health care and other medical durables)
and lost productivity resulting from morbidity and mortality (indirect costs).
By comparison, in 2001 the estimated cost of all cancers was $156.7 billion
($56.4 billion in direct costs and $100.3 billion in indirect costs). In 1999
the estimated cost of HIV infections was $28.9 billion ($13.4 billion direct
and $15.5 billion indirect).