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Report: Positive trends in CHD, stroke deaths reversing

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Stephen Sidney

Evidence suggests that declines in death rates from CHD and stroke observed since 2000 have lessened since 2011, according to a report published by the National Forum for Heart Disease & Stroke Prevention.

“While the United States has enjoyed major declines in death rates from heart disease and stroke since 2000, there is troubling evidence of a major deceleration in these declines since 2011,” Stephen Sidney, MD, MPH, FAHA, director of research clinics in the division of research at Kaiser Permanente Northern California, wrote in the report. “Issues of special concern include the rising prominence of heart failure, the continuing disadvantage of African-Americans/blacks and the persistently high numbers of cardiovascular deaths, even when death rates are declining.”

The annual number of U.S. deaths from CVD reached 836,000 in 2015, up 53,000 from 2011, Sidney wrote, noting that in 2015, the death rate from CHD increased for the first time in 22 years, and the death rate from stroke rose for the second time in 2 years.

“We’d seen steady progress for over 20 years, with death rates from heart disease and stroke falling. When that progress stopped, we became deeply concerned,” John Clymer, executive director of the National Forum for Heart Disease & Stroke Prevention and an editor of the report, told Cardiology Today. “We asked Dr. Stephen Sidney, one of the world’s leading cardiovascular epidemiologists, to study these trends and examine ways to reverse the troubling numbers. The result is this important report.”

John Clymer

Sidney wrote that the reversal of the positive trends “may be due to growing rates of obesity and diabetes, offsetting gains in other contributing factors,” noting that other culprits could include “continued aging of the population as well as a newer phenomenon: increasing occurrence of heart failure, some aspects of which remain difficult to treat effectively.”

According to the report, the U.S. death rate from ischemic heart disease dropped by nearly 50% from 2000 to 2015, but the rate of decline slowed from 5% between 2009 and 2011 to 2.7% between 2011 and 2015.

The number of U.S. deaths from HF increased from approximately 56,000 in 2009 to more than 75,000 in 2015, and the number of deaths from other forms of heart disease aside from HF or ischemic heart disease has increased by 37% since 2000, Sidney wrote.

Although the death rate from stroke dropped 38% between 2000 and 2015, the trend in recent years has not been positive, according to the report. Stroke deaths declined by 23% between 2000 and 2009, were flat between 2009 and 2013 and increased by approximately 9% between 2013 and 2015; there were about 140,000 U.S. stroke deaths in 2015.

The trends were similar for men and women, Sidney wrote.

The trends were also similar for all races and ethnicities, but the age-adjusted death rate for all CVD was 30% higher for African-American/black individuals compared with the overall population, according to the report.

Factors contributing to the long-term decline in CVD death include reduction in smoking, more focus on controlling cholesterol and BP, more use of aspirin and statins and publicity generated by awareness campaigns such as the Million Hearts initiative, Sidney wrote.

Despite those factors, one-third of U.S. adults are estimated to be obese and more than 30 million have diabetes, the report stated.

“We’re hoping that when people see this, combined with the CDC’s finding that at least 200,000 deaths from heart disease and stroke each year are preventable, that those two things will serve as a rallying cry to medicine, to health care, to public health and to the whole population that we need to raise the priority on heart disease and stroke prevention,” Clymer told Cardiology Today. “There’s a huge opportunity before us to reduce both the human and economic burdens from heart disease and stroke. We need to seize it.”

Preliminary data suggest that the CHD death rate decreased by 2% from 2015 to 2016 and the stroke rate decreased over that year as well, but “even if the slowing or reversal of these favorable trends in rates is only temporary, the message is clear: Trends in the wrong direction must be reversed, and favorable trends accelerated, if the massive burden of cardiovascular disease in the United States is to be overcome,” Sidney wrote. – by Erik Swain

Reference:

Sidney S. Wrong direction: Troubling trends in the rate of U.S. cardiovascular disease deaths. Available at: www.nationalforum.org.

For more information:

John Clymer can be reached at john.clymer@nationalforum.org.

Disclosure: Clymer and Sidney report no relevant financial disclosures.