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AHA: Nearly half of all US adults have CVD
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At least 48%, or 121.5 million, of all adults in the United States had some form of CVD from 2013 to 2016, according to the American Heart Association’s new Heart and Stroke Statistics.
The number of U.S. adults with CVD is an increase from previous years, which the authors of the report attribute to a change in the definition of hypertension after release of the 2017 AHA/American College of Cardiology guidelines.
“As one of the most common and dangerous risk factors for heart disease and stroke, this overwhelming presence of high blood pressure can’t be dismissed from the equation in our fight against cardiovascular disease,” AHA president Ivor J. Benjamin, MD, FAHA, director of the Cardiovascular Center at the Medical College of Wisconsin in Milwaukee, said in a press release. “Research has shown that eliminating high blood pressure could have a larger impact on CVD deaths than the elimination of all other risk factors among women and all except smoking among men.”
CVD deaths
CVD was the underlying cause of death for approximately one of every three deaths, or 840,678 deaths in the U.S. in 2016. CVD was the cause of more deaths annually compared with chronic lower respiratory disease and all forms of cancer combined, Emelia J. Benjamin, MD, ScM, FAHA, assistant provost for faculty development at Boston University School of Medicine and chair of the writing committee, and colleagues wrote.
CHD was the leading cause of CVD-related deaths in the U.S. in 2016 (43.2%), followed by stroke (16.9%), increased BP (9.8%), HF (9.3%), diseases of the arteries (3%) and other CVDs (17.7%).
The leading global cause of death — CVD — accounted for more than 17.6 million deaths annually in 2016, which is expected to increase to more than 23.6 million by 2030, according to the report.
Heart disease, including hypertension, CHD and stroke, continues to be the No. 1 cause of death in the U.S., accounting for approximately 13% of deaths in 2016.
Data from 2005 to 2014 found that the estimated annual incidence of new MI was 605,000 and 200,000 for recurrent MIs. In addition, the average age at the first MI was 65.6 years for men and 72 years for women.
Approximately every 40 seconds, an adult in the U.S. will have an MI or stroke, according to the report. Stroke was the cause for approximately one of every 19 deaths in 2016. Among all causes of death, stroke ranked No. 5 when considered separately from other CVDs and killed approximately 142,000 people a year.
Health behaviors, factors
The AHA also gauged CV health in the U.S. using the AHA’s “Life’s Simple 7,” which are seven key health behaviors and factors that increase the risks for stroke and heart disease. These factors include:
- Smoking: This was one of the top three leading risk factors for disease and led to an estimated 7.2 million deaths in 2015. Smoking also ranked fourth in the cause for disability-adjusted life-years in 2016. Tobacco smoking is one of the largest preventable causes of death both nationally and globally.
- Physical inactivity: More than one-quarter of adults (26.9%) did not participate in leisure-time physical activity. In 2016, 21.9% of adults would have met the 2008 Physical Activity Guidelines for muscle-strengthening and aerobic guidelines. Only 27.1% of ninth- to 12th-graders had 60 minutes of exercise every day.
- Nutrition: From 2003-2004 to 2011-2012, poor diets in children decreased from 69.2% to 54.6%. This also decreased in adults from 50.3% to 41%. These improvements were largely related to decreased sugar-sweetened beverage consumption and increased whole grain consumption in adults and children.
- Overweight/obesity: The prevalence of obesity in adults increased from 1999-2000 (30.5%) to 2013-2014 (37.7%). Between 2011 and 2014, 32.1% of children had overweight or obesity.
- Cholesterol: A total cholesterol of 200 mg/dL or higher was seen in 38.2% of adults in the U.S. from 2013 to 2016. In addition, 11.7% of adults had a total cholesterol higher than 240 mg/dL.
- Diabetes: This condition was diagnosed in 9.8% of adults from 2013 to 2016, and 3.7% had undiagnosed diabetes. Prediabetes was seen in 37.6% of adults in the U.S. Approximately 80,058 deaths in the U.S. were caused by diabetes in 2016.
- High BP: Between 2013 and 2016, 46% of adults had hypertension, and 82,735 deaths were primarily caused by increased BP.
“Beginning in 2020, we’ll chart our progress with a metric called healthy life expectancy,” Mariell Jessup, MD, FAHA, chief science and medical officer of the AHA, said in a related commentary. “Also known as health-adjusted life expectancy, it captures the number of years a person can expect to live in good health based on current patterns of mortality and morbidity. The lay public may find [healthy life expectancy] a more meaningful and relatable metric than statistics about death rates and risk factors.”
See the full report for more statistics. – by Darlene Dobkowski
Disclosures: Emelia J. Benjamin reports no relevant financial disclosures. Ivor J. Benjamin is president of the AHA. Jessup is an employee of the AHA. Please see the report for all other authors’ relevant financial disclosures
Perspective
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Dariush Mozaffarian, MD, DrPH
These new findings highlight the crushing health and economic burdens of CVD and related obesity and type 2 diabetes. The economic consequences of CVD alone are seven times larger than the annual budgets of the NIH, CDC and FDA combined. These burdens are expected to double in the next 15 years.
Among different preventable causes, food and nutrition loom large. Robust strategies are urgently needed to rigorously incorporate nutrition into health care — a holistic “Food is Medicine” approach. This should include systematic changes in medical education and training by including more questions on nutrition, lifestyle and behavior change in the United States Medical Licensing Examination and specialty certifications; incorporation of nutrition and food security screening tools into electronic health record standards; changes to procurement standards for hospital cafeterias and patient food services; and use of mobile technologies to test innovative platforms for healthier eating that combine shared proximal goal setting, self-monitoring, peer support, regular feedback, gamification and financial incentives.
Goals and strategies of currently disconnected large federal programs, like SNAP and Medicare/Medicaid, which frequently cover the same individuals, should be integrated and harmonized. As providers move toward accountable care, risk-sharing payment models should invest in nutrition for meaningful cost-savings and improved patient outcomes. All these programs should include special focus on vulnerable and sensitive groups and address social determinants of health.
Today, 1 in 4 federal dollars and 1 in 5 dollars in the entire economy is spent on health care, largely on preventable diet-related diseases. This is entirely unsustainable. We are on a cliff, but falling over the edge so slowly and steadily that many don’t seem to notice. Food is Medicine offers a real chance at improving health, lowering disparities and reducing costs.
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