Preventing Heart Disease and Stroke
Addressing the Nation’s Leading Killers
At A Glance
2004
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Charting the Course
“Despite impressive advances in science and medicine,
our nation continues to be plagued by unacceptably high rates of death and
disability from heart disease and stroke, our nation’s first and third
leading causes of death, and minority populations bear a disproportionate
burden of these diseases. Our challenge is to ensure that all of our
citizens benefit from the knowledge that we have gained.”
Rose Marie Robertson, MD
Heart Specialist and Chief Science Officer
American Heart Association
Heart Disease and Stroke: The Nation’s Leading Killers
Deaths, Disability, and Cost
Heart disease and stroke—the principal components of cardiovascular
disease—are the first and third leading causes of death for both men and
women in the United States, accounting for nearly 40% of all deaths. Over
930,000 Americans die of cardiovascular disease each year, which amounts to
one death every 34 seconds. Although these largely preventable conditions
are more common among people ages 65 years and older, the number of sudden
deaths from heart disease among people ages 15–34 has increased.
Deaths are only part of the picture. Over 64 million Americans (almost
one-fourth of the population) live with cardiovascular disease. Coronary
heart disease is a leading cause of premature, permanent disability in the
U.S. workforce. Stroke alone accounts for disability among more than 1
million Americans. Over 6 million hospitalizations each year are due to
cardiovascular disease.
The economic impact of cardiovascular disease on the U.S. health care
system continues to grow as the population ages. The cost of heart disease
and stroke in the United States is projected to be $368 billion in 2004,
including health care expenditures and lost productivity from death and
disability.
Risk Factors Must Be Addressed
Two of the major independent risk factors for cardiovascular disease are
high blood pressure and high blood cholesterol.
- About 90% of middle-aged Americans will develop high blood pressure in
their lifetime, and over 70% of people with high blood pressure do not
have it under control. A 12–13 point reduction in blood pressure can
reduce heart attacks by 21%, strokes by 37%, and all deaths from
cardiovascular disease by 25%.
- Over 80% of those who have high blood cholesterol do not have it under
control. A 10% decrease in total blood cholesterol levels may reduce the
incidence of coronary heart disease by as much as 30%.
A key strategy for addressing these risk factors is to educate the public
and health care practitioners about the importance of prevention. Current
guidelines recommend that all adults have their blood pressure checked
regularly and their blood cholesterol levels checked every 5 years. Systems
changes are also needed to help practitioners adhere to guidelines for
treating patients with or at risk for heart disease and stroke, such as
prescribing beta-blockers and aspirin. Preventive actions can help people at
any level of blood pressure or cholesterol to reduce their risk.
People also need to be educated about the signs and symptoms of heart
attacks and stroke and the importance of calling 911 quickly. Forty-seven
percent of heart attack victims and about the same percentage of stroke
victims die before emergency medical personnel arrive.
Other important risk factors for heart disease and stroke—such as
diabetes, tobacco use, physical inactivity, poor nutrition, and overweight
and obesity—need to be addressed through lifestyle changes and appropriate
use of medications.
Percentage of Americans with Uncontrolled High Blood
Pressure, by Race and Ethnicity
Source: United States Department of Health and Human
Services. Healthy People 2010 Progress Review: Heart Disease and Stroke.
Section E. Washington: April 2003
CDC’s National Leadership
In 1998, Congress funded CDC to launch a nationwide effort to help states
develop the capacity, commitment, and resources necessary for a
comprehensive program to prevent death and disability from heart disease and
stroke and to improve the cardiovascular health of all Americans. In fiscal
year 2004 Congress appropriated $45.7 million for this program. CDC
currently funds 32 states and the District of Columbia (11 for basic
implementation and 22 for capacity building). Program priorities are to
- Control high blood pressure.
- Control high blood cholesterol.
- Increase awareness of the signs and symptoms of heart disease and
stroke and the importance of calling 911 when these signs and symptoms
occur.
- Improve emergency response.
- Improve quality of care.
- Eliminate disparities.
CDC provides national leadership through its many activities and
programs, which include developing a broad public health action plan to
prevent heart disease and stroke, collecting vital data to track these
conditions, and providing support for state-based programs.
Paul Coverdell National Acute Stroke Registry
CDC’s Paul Coverdell National Acute Stroke Registry measures and improves
hospital delivery of emergency care for stroke victims. From 2001 to 2003,
CDC funded eight university-based sites to develop prototype registries and
test methods. CDC will begin to fund registries in state health departments
in 2004.
Charting the Course
Public Health Action Plan
In 2003, CDC released A Public Health Action Plan to Prevent Heart
Disease and Stroke. This plan charts a course for the nation—led by CDC,
collaborating public health agencies, and other partners—to prevent heart
disease and stroke over the next two decades and beyond. The Action Plan
was developed with input from a broad range of partners. A national forum in
April 2004 will seek commitments for implementing the plan from
organizations throughout the country.
Fully implementing the Action Plan will increase our nation’s
investment in preventing disease rather than waiting to treat its
consequences. The plan will also help to transform public health agencies
and their partners into effective agents of change.
Atlases Highlighting Local Data
As the third in a series of CDC atlases related to cardiovascular diseases,
the Atlas of Stroke Morality: Racial, Ethnic and Geographic Disparities
in the United States provides, for the first time, an extensive series
of national and state maps of county-level data on stroke death rates among
the five largest racial and ethnic groups. Future planned atlases include
the On-Line Heart Disease Atlas for 1996–2000, Atlas of
Out-Of-Hospital Cardiac Deaths, and Atlas of Heart Disease and Stroke
Among American Indians and Alaska Natives.
States Funded by CDC for Heart Disease
and Stroke Prevention Programs, Fiscal Year 2003
[A text
description of this chart is also available.]
State Programs and Key Partnerships
State Heart Disease and Stroke Prevention Programs
With support from CDC, states are conducting a range of activities to
reduce the burden of heart disease and stroke, including the following:
- As part of the National Health Disparities Collaborative, partnering
with the Health Resources and Services Administration (HRSA) and health
care centers to help centers better manage high blood pressure among
underserved populations.
- Promoting changes in the health care system to help providers
implement prevention guidelines.
- Helping work sites establish policies and environments that support
cardiovascular health.
- Collaborating with educational partners to promote school policies and
environments that support cardiovascular health.
- Developing campaigns that educate people about the signs and symptoms
of heart attack and stroke and the importance of calling 911 for immediate
medical care.
Collaborations Are Key to Success
CDC works with partners both inside and beyond the health sector to
address the Healthy People 2010 objectives for preventing heart
disease and stroke. Partners include other federal agencies (e.g., Centers
for Medicare and Medicaid Services, HRSA, Indian Health Service, National
Institutes of Health), national health organizations (e.g., American Heart
Association/American Stroke Association, National Stroke Association), and
professional groups (e.g., American College of Cardiology, Association of
Black Cardiologists).
State Programs in Action |
The Montana Cardiovascular Health Program is using the
Guidelines Applied in Practice (GAP) model to help Montana
hospitals implement acute care guidelines and secondary prevention
practices as ongoing routine. This pilot program has stimulated
health care facilities statewide to evaluate their practices and
make changes to improve care. |
The Missouri Cardiovascular Health Program is partnering with
the Missouri Diabetes Control Program and Federally Qualified
Health Centers to administer and evaluate a comprehensive approach
to improving standards of care for patients with cardiovascular
disease, hypertension, and diabetes. Part of this approach will
include a registry of clinical patient data to help health care
providers more effectively follow-up and monitor patients. |
The Kentucky Cardiovascular Health Program and its partners
are collaborating to improve the quality of care for patients with
coronary artery disease by using the American Heart Association’s
Get with the Guidelines for Coronary Artery Disease. These
guidelines help health care professionals follow proven treatments
and procedures for hospitalized patients with coronary artery
disease to reduce their risk for recurrent heart attacks. |
The South Carolina Cardiovascular Health Program has partnered
with universities and private organizations to address the
hypertension crisis in South Carolina, where one of every four
adults has high blood pressure. The state program is providing
support to increase the hypertension expertise of primary care
providers statewide, especially those with large numbers of
Medicaid patients and those who practice in rural areas. |
|
Future Challenges and Directions
CDC will continue to provide national leadership to prevent death and
disability from heart disease and stroke and to eliminate disparities in
health and health care. In this leadership role, CDC will work with partners
to fully implement A Public Health Action Plan to Prevent Heart Disease
and Stroke. Priorities will be to build the public health foundation for
translating science into practice, to address disparities in quality years
of healthy life by ensuring the availability of basic essential services,
and to fund the 18 unfunded states to help prevent heart disease and stroke
among all Americans.
For more information or additional copies of this document, please
contact the
Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
Mail Stop K–47
4770 Buford Highway, NE
Atlanta, GA 30341-3717
Telephone (770) 488-2424
Fax (770) 488-8151
ccdinfo@cdc.gov
http://www.cdc.gov/cvh |