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AHA: One in three US deaths caused by CVD
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In 2013, one in three deaths in the United States were attributable to CVD, according to the American Heart Association’s 2016 Heart Disease and Stroke Statistics Update.
Worldwide, heart disease was the No. 1 killer and stroke the No. 2 killer, according to the report, written by Dariush Mozaffarian, MD, DrPH, FAHA, from Tufts University, and colleagues.
In 2013, CVD killed approximately 801,000 Americans, heart disease killed more than 370,000 and stroke killed nearly 129,000, whereas worldwide, 31% of deaths were from CVD and 11.8% were from stroke, the report stated.
Darisuh Mozafarian, MD, DrPH
Behavioral metrics
The authors wrote that some behavioral patterns that affect CVD are improving, but others are not, including:
- Less than 1% of U.S. children follow an ideal healthy diet pattern, but more than 80% meet requirements in smoking, BP and fasting glucose metrics.
- Approximately 1.5% of U.S. adults follow an ideal healthy diet pattern, but more than 78% have never smoked or have quit for more than 1 year.
- Over time, fewer children are attaining ideal BMI, but more are attaining ideal smoking and total cholesterol metrics.
- Over time, more adults are attaining ideal smoking metrics, but fewer are attaining ideal BMI and glucose metrics.
- The metrics for which there is the most potential for improvement are health behaviors such as diet quality, physical activity and body weight.
Tobacco use
The authors wrote that tobacco use is the second-leading cause of total deaths and disability in the United States, and one-third of deaths from CHD can be attributed to smoking. However:
- Current cigarette use in U.S. adults declined from 24.1% in 1998 to 16.9% in 2014.
- Current cigarette use in U.S. high school students declined from 36.4% in 1997 to 5.6% in 2013.
Physical inactivity
The authors found that many Americans do not meet guidelines for physical activity, including:
- In 2013, 15.2% of adolescents reported being inactive the prior week, a figure higher in girls than in boys and in blacks and Hispanics than in non-Hispanic whites.
- Approximately half of U.S. adults in 2014 met current guidelines of at least 150 minutes of moderate physical activity or 75 minutes of vigorous physical activity per week, with women meeting them less frequently than men and blacks and Hispanics meeting them less frequently than non-Hispanic whites. They noted that the actual numbers are likely worse than the self-reported numbers.
Nutrition
Suboptimal diet quality is the leading risk factor for death and disability in the U.S., Mozaffarian and colleagues wrote, noting:
- Approximately 58,000 annual U.S. CVD deaths as of 2010 (6.3%; 13.1% of those before age 70 years) could be attributed to sodium intake of more than 2 g/day. The global figure is 1.65 million (9.5% of CVD deaths).
- Consumption of whole grains increased between 2003 and 2012, whereas consumption of sweetened beverages decreased.
- U.S. youth aged 5 to 19 years had poor scores on a dietary metric for CV health 69.2% of the time in 2003 vs. 54.6% in 2012; for adults, the percentages were 50.3% in 2003 and 41% in 2012.
Obesity
The authors wrote that excess body weight is among the leading causes of death and disability domestically and worldwide, noting:
- The prevalence of obesity in U.S. youth was unchanged from 2003 to 2012 and decreased in those aged 2 to 5 years, but the prevalence of severe obesity rose, especially in adolescent boys, and the trend in obesity prevalence was associated with lower socioeconomic status.
- Annual per capita health care expenses related to obesity were $1,160 for men and $1,525 for women.
Health factors
“The prevalence and control of [CV] health factors remains a major issue for many Americans,” Mozaffarian and colleagues wrote, citing as examples:
- More than 100 million U.S. adults aged at least 20 years have total cholesterol of at least 200 mg/dL, whereas more than 31 million have total cholesterol of at least 240 mg/dL.
- Adults aged at least 40 years using a cholesterol-lowering medication in the past 30 days rose from 20% in 2003 to 28% in 2012.
- Approximately 80 million U.S. adults (32.6%) have hypertension, a rate particularly high in black men (44.9%) and black women (46.1%).
- The death rate attributable to high BP rose 8.2% between 2003 and 2012, and the actual number of deaths rose 34.7%.
- One in 10 U.S. adults have diabetes, with 90% to 95% being type 2 diabetes.
Death rates
Although rates of death that can be attributed to CVD have declined, the burden is still high, according to the authors, who also wrote that:
- The 2013 CVD-attributable death rate was 222.9 per 100,000 Americans, which was higher in men than in women and highest in non-Hispanic black men.
- CVD-attributable death rates declined 28.8% and CVD deaths per year declined 11.7% from 2003 to 2013, but 800,937 of the 2,596,993 U.S. deaths in 2013 (30.8%) could be attributed to CVD.
- Of the 750,000 Americans who had MI in 2013, approximately 116,000 died.
- The relative rate of stroke death fell 33.7% from 2003 to 2013, and the actual number of stroke deaths fell 18.2% during those years, but approximately 795,000 Americans per year experience a new or recurrent ischemic or hemorrhagic stroke.
- Approximately 359,000 Americans per year experience out-of-hospital cardiac arrest and 209,000 experience in-hospital cardiac arrest. For out-of-hospital cardiac arrest, survival to hospital discharge is 10.6%, but the figure climbs to 31.4% for bystander-witnessed cardiac arrests.
- CHD was the cause of 370,213 U.S. deaths (approximately one in seven) in 2013, and an American dies of a coronary event once every 1 minute, 24 seconds.
- HF was mentioned on one of nine U.S. death certificates in 2013, a prevalence unchanged since 1995.
- Valvular heart disease was responsible for 50,222 U.S. deaths in 2013, approximately two-thirds of which were aortic valve disorders.
- Peripheral artery disease was listed as the underlying cause for 13,639 of U.S. deaths in 2013 and was mentioned on 61,097 death certificates.
Mark A. Creager, MD, FAHA, FACC
Importance of prevention
“We need to maintain our vigor and resolve in promoting good [CV] health through lifestyle and recognition and treatment of risk factors such as high [BP], diabetes, high cholesterol and smoking,” Mark A. Creager, MD, FAHA, FACC, president of the AHA and director of the Heart and Vascular Center at Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, said in a press release. “We’ve made progress in the fight against [CVD], but the battle is not won.” – by Erik Swain
Disclosure: Mozaffarian reports receiving speaking honoraria from Bunge and Hass Avocado and consulting or serving on an advisory board for Amarin, AstraZeneca, Boston Heart Diagnostics, Elysium Health, GOED, Life Sciences Research Organization and Unilever North America. See the full report for a list of the relevant financial disclosures of the other authors and reviewers. Creager reports no relevant financial disclosures.
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