CV Deaths Decline, But No Cause for Celebration

Lisa Nainggolan
December 19, 2007 (Greenville, TX)– The latest statistics compiled by the American Heart Association (AHA) show that deaths from cardiovascular disease in the US continue to decline, but there has been no drop in nonfatal cardiovascular events, which often turn out to be extremely disabling. In addition, risk factors such as obesity and diabetes are most definitely on the rise, and this will have major clinical implications, say Dr Wayne Rosamond (University of North Carolina, Chapel Hill) and colleagues in a report published online December 17, 2007 in Circulation [1].
A coauthor of the year-end report, Dr Donald Lloyd-Jones (Northwestern University, Chicago, IL), told heartwire: "It's nice to see those mortality data coming down, but that's not the whole story by any stretch. There are some very concerning trends, both in nonfatal events and the disability that results from them and in risk-factor levels that are pretty clear indicators that we are not going to be celebrating long, and in fact we should not be celebrating at all."
Physicians, among others, he says, are going to have to address these issues. "What we are seeing here is the tip of the iceberg. There are real reasons to be concerned. We need to do a much better job at a public-health level of educating the public about their real risks from cardiovascular disease. And we doctors need to do a much better job of having patients know their numbers in terms of their risk factors and having concrete plans for addressing those risk factors for everyone."
CHD single leading cause of death
The 123-page report shows that in 2004--the most recent year for which statistics are available--the age-adjusted CVD death rate per 100 000 persons in the US was 288.0, compared with 307.7 in 2003.
CVD is the number-one cause of death, listed as the underlying cause in 869 724 deaths, compared with 911 163 deaths in 2003. Cancer was the second leading cause, and stroke, when considered separately from CVD, the third. And coronary heart disease alone--even when considered separately from other cardiovascular diseases--was still by far the nation's single leading cause of death (451 326 deaths in 2004).
But while CVD deaths are on the decline, the prevalence of many risk factors is increasing, says the report. Among adults, 66% are now overweight, while 31.4% are obese. Among children and adolescents aged 12 to 19, 17% are overweight (up from 6.1% in 1971–1974), as are 17.5% of six- to 11-year-olds (up from 4.0%). And even in the 2-to-5 age range, 14% of children are overweight.
One-and-a-half million new cases of diabetes were diagnosed in people over the age of 20 in one year, the report adds, and it is projected that diabetes prevalence will more than double from 2005 to 2050.
In addition, the incidence of reported end-stage renal disease has more than doubled in the past 10 years, and the prevalence of chronic kidney disease has increased to 16.8%, from 14.5% in 1988-1994.
Obesity and diabetes: Alarm bells should ring
"Obesity and diabetes are very definitely on the rise," Lloyd-Jones told heartwire. "So any improvements in cardiovascular disease mortality we have seen over past decades are likely to be reversed very soon.
"We are well into this obesity and diabetes epidemic, and we are going to start to pay the price very soon. We need to have the alarm bells fully ringing, and we need to address these issues, which is going to require intensive lifestyle changes as well as more medications, undoubtedly."
As evidence of this, Lloyd-Jones refers to a "beautiful" piece of research published last month in the Journal of the American College of Cardiology [2], which he says they were unable to include in this year-end report. As reported by heartwire, this paper found that mortality rates from coronary heart disease in the US appear to be leveling in young adults and may even be rising.
A major factor in this epidemic is poor diet, with the report showing that fewer than one in three adults in the US eats fruit two more times a day and just under 30% eat vegetables three or more times a day. And smoking--which raises the risk of CHD by two to three times--is still very prevalent, with 46 million Americans still smoking.
The burden of nonfatal events
Also of major concern is the fact that nonfatal events are not declining, adds Lloyd Jones. "These are very important events. These are people who have a heart attack, a major coronary event, or a stroke and are often disabled by that event. They certainly require a lot of medication, a lot of healthcare expenditure, and many require care from family members.
"There are a lot of repercussions of nonfatal events, and these are not really going down. The disability that comes from CVD is a major burden for individuals," he stresses.
On a more positive note, however, the report shows that improvements have been made in the quality of care that cardiovascular disease patients receive in the US. From 2002 through 2004, among almost 160 000 patients treated for heart failure at 285 hospitals, there were improvements in beta-blocker prescriptions, left ventricular assessments, counseling at discharge, and advice on smoking cessation.
Quality of care also improved via the AHA's Get With the Guidelines Program. For coronary artery disease, some key performance measures showed good progress, including whether patients received aspirin, cholesterol-lowering drugs, and other medications and advice on stopping smoking when they were discharged from the hospital. Composite quality-of-care scores for stroke were also improved.
Author disclosures are listed at the end of the report.
Rosamond W, Flegal K, Furie K, et al. Heart disease and stroke statistics--2008 Update. A report from the American Heart Association Statistics Committee and Stroke statistics subcommittee. Circulation 2007; DOI: 10.1161/CIRCULATIONAHA.107.187998. Available at: http://circ.ahajournals.org. Abstract
Ford ES, Capewell S. Coronary heart disease mortality among young adults in the US from 1980 through 2002. Concealed leveling of mortality rates. J Am Coll Cardiol 2007; 50:2128-2132. Abstract