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National Center for Chronic Disease Prevention and Health Promotion
Chronic Disease Prevention
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National Center for Chronic Disease Prevention and Health Promotion Chronic Disease Prevention Home | Contact Us |
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CENTERS FOR
DISEASE CONTROL AND PREVENTION Heart Disease Burden America’s leading cause of death, cardiovascular disease, disables millions of Americans, costs the nation billions each year—and is on the rise.
Americans are more likely to die of heart disease or stroke than any other cause. Cardiovascular diseases (CVD) are not only the leading cause of death in the United States, they are also disabling, costly, and growing. Ten million Americans are disabled by CVD, which includes heart disease and stroke, as well as other disorders of the circulatory system. Heart disease is the leading cause of premature, permanent disability in the U.S. workforce. Two-thirds of heart attack patients fail to recover fully. Stroke can dramatically diminish the ability of survivors to function independently— with severe effects on both survivors and their families. Twenty percent of stroke survivors require institutional care, and many survivors cannot perform daily tasks. Younger people may often return to work after a heart attack (88% of those under 65), but most stroke victims do not. CVD may limit a person’s ability to work and perform activities of daily living. Patients and their families feel this burden in their daily lives. People with CVD must cope with the cost of treatment, the side effects of medications, the need for increased medical care and access to quality care, and the possibility of disability and dependency. People who have had a heart attack or stroke tend to report fewer healthy days than people who haven’t had such an event, according to Kurt J. Greenlund, PhD, a CDC epidemiologist specializing in cardiovascular health. The financial costs of CVD are enormous. In 2004, these conditions will cost the nation an estimated $368.4 billion in direct and indirect costs.* As the numbers of people who need medication and lifestyle changes increase, so do the related costs. Heart disease is the leading diagnosis for Medicare, for example, costing the program $26 billion annually. CVD is a growing problem. CDC researchers recently reported that the prevalence of individual CVD risk factors, including high blood pressure, high blood cholesterol, smoking, diabetes, and obesity, is increasing.** Reducing the burden of CVD depends on reducing the prevalence of these risk factors, especially among young people. Death rates are higher among people aged 65 and older—a population that is rapidly increasing. CVD also contributes to health disparities for some racial and ethnic groups and other disadvantaged populations. African Americans, Hispanics, and American Indians have higher rates of CVD risk factors and mortality than whites. These same groups tend to lack access to health care and health insurance coverage. As the impact of CVD continues to increase, CDC researchers say that both the public and health care practitioners need to be educated about the importance of prevention. “We know how to prevent CVD,” said George A. Mensah, MD, FACP, FACC, FESC, Acting Director of NCCDPHP and former Chief of the CDC’s Cardiovascular Health Branch. “We have the tools. Health professionals’ awareness of the CVD epidemic is high. But we need to increase our investment in prevention efforts, reach the public with needed information, and improve treatment of CVD by improving adherence to guidelines.” Risk Factors Risk factors for CVD are also growing. It is projected that 90% of today’s middle-aged Americans will develop high blood pressure. Meantime, 70% of those with high blood pressure and 80% of those with high blood cholesterol levels do not have their condition controlled. Signs of heart disease are appearing even among children. According to a recent study, one in eight children has three or more risk factors for metabolic syndrome, a cluster of symptoms that serves as an early warning signal for heart disease and diabetes. More than half of the children studied had at least one risk factor, including high blood pressure, inefficient processing of glucose, elevated insulin levels, low levels of “good” HDL cholesterol, and elevated triglycerides. Recent studies have convinced researchers that even having the risk factors for CVD is dangerous. “If we are going to take care of this epidemic, we need a broad, comprehensive attack on cholesterol and other risk factors—smoking, hypertension, and obesity,” said Sidney C. Smith, Jr., MD, Professor of Medicine and Director of the Center for Cardiovascular Science in Medicine at the University of North Carolina. “High cholesterol and hypertension (high blood pressure) are especially dangerous risk factors that should be better monitored and followed up more thoroughly,” said Dr. Greenlund. Dr. Mensah agreed, saying, “We need to get physicians to refocus on these risk factors and treat patients to target blood pressure and cholesterol levels according to the guidelines.” The findings of a recent study published in the April 8 issue of The New England Journal of Medicine support this assertion. Researchers reported that the Pravastatin or Atorvastatin Evaluation and Infection Therapy (PROVE IT) study found that reducing cholesterol and blood pressure in people with heart disease decreased their risk of dying of heart disease, having a nonfatal heart attack, and needing heart bypass surgery or angioplasty. “The study suggests that even people without heart disease can benefit from having cholesterol and blood pressure levels lower than those recommended by the national guidelines then in place—results that prompted changes to the guidelines,” according to Dr. Smith. The new guidelines say people at high risk should aim for an LDL (“bad” cholesterol) level of 70 mg/dL. The previous recommendation was 100 mg/dL.
“The new recommendations take into consideration the results of PROVE IT, which demonstrate benefits from a more aggressive lowering of cholesterol,” Dr. Smith said. Evidence from other studies will be needed to better inform additional changes to the guidelines.
Dr. Mensah agreed. “Definitely, more people will be prescribed statins as a result of the study,” he said. “The lower you can get cholesterol levels, the better off patients are. But most people could reach lower levels by exercising more and adopting a diet rich in fruits and vegetables and low in saturated fats.” Populations at High Risk Although many people think CVD affects only older adults, about 20% of people who die of heart disease are under the age of 65. Women also need to know that CVD is not just a man’s problem. In fact, CVD is a bigger threat to women because they often do not understand their risks or know the warning signs. Over 40% of all female deaths in the United States are due to CVD, according to the American Heart Association. Once women are over age 45, a higher percentage of them than men have high blood cholesterol. At older ages, women who have heart attacks are twice as likely as men to die within a few weeks. Women typically have heart attacks later in life than men do: the average age of a person having a first heart attack is 65.8 years for men and 70.4 years for women. Stroke is an even greater risk for women. Each year, about 40,000 more women than men die of stroke. Although men have higher CVD rates, women have higher numbers of the diseases because more women are in the oldest age groups, making them especially prone to heart attack and stroke. Comorbidities also contribute to a person’s risk for CVD. About one-quarter of people with diabetes die of stroke. Having diabetes doubles the risk for stroke because of the circulatory problems associated with the disease. To make matters worse, diabetes may mask some heart attack symptoms. When doctors instruct patients on how to manage their diabetes, they should also emphasize the importance of preventing CVD risk factors. Other major factors that influence a person’s CVD risk are mental illness and depression, which also can predict the chances of recurrent heart attack. “Depression may also be an outcome of having a stroke,” Dr. Greenlund said. Depressed patients are unlikely to be able to manage self-care routines that can help prevent future heart attacks or stroke. The biological mechanisms of depression also worsen the risk for heart attack. “Abnormal hormone levels and changes in blood biochemistry seen in the setting of depression or psychosocial stress may lead to cardiac arrest,” Dr. Mensah explained. Things That Must Change In addition to preventing and reducing CVD factors, the public and the health care community must adhere more closely to national guidelines. Dr. Greenlund describes control of blood pressure in the United States as “suboptimal.” Only 30% of white patients, 22% of African American patients, and 15% of Hispanic patients have their blood pressure under control. “Patients may find it difficult to make the needed lifestyle changes. Other challenges include not getting the proper medications and staying on the medications once they are prescribed. Patients and practitioners need to be persistent because the drugs may sometimes be hard to adapt to,” Dr. Greenlund said, “and finding the right combination of medicines may be difficult for some patients.” Act in Time Unfortunately, few people recognize the signs and symptoms of heart attack and stroke, even those at higher risk. Timely access to emergency cardiac care and survival depends in part on early recognition of symptoms and immediate action. For example, if given within 3 hours of the start of symptoms, a clot-busting drug can reduce long-term disability for the most common type of stroke. Also, CDC estimates that 400,000–460,000 people die of heart disease in an emergency room or before reaching a hospital every year, accounting for 60% of all cardiac deaths. Educational campaigns to increase awareness among the general population and targeted messages for persons at high risk and their families may help to improve these statistics. For example, a new campaign by the American Heart Association and the National Heart, Lung, and Blood Institute, called “Act in Time,” seeks to increase people’s awareness of heart attack and the importance of calling 9-1-1 immediately at the onset of symptoms. *American Heart Association. Heart disease and stroke statistics—2004 update. Dallas, Tex: American Heart Association, 2003. **CDC. Declining prevalence of no known major risk factors for heart disease and stroke among adults—United States, 1991–2001. MMWR 2004;53(1):4–7.
*** Links to non-Federal
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constitute an endorsement of any organization by CDC or the Federal
Government, and none should be inferred. The CDC is not responsible for
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Privacy
Policy | Accessibility This page last reviewed August 30, 2004 United
States Department of Health and Human Services |
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