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Heart and stroke death rates steadily decline; risks still too high

January 23, 2008

In an appropriate prelude to American Heart Month, which is just ahead in February, new mortality data from the Centers for Disease Control and Prevention (CDC) shows that, since 1999, coronary heart disease and stroke age-adjusted death rates are down by 25.8 percent and 24.4 percent, respectively. This means that the American Heart Association's 2010 strategic goal for reducing deaths from coronary heart disease has been achieved, and for stroke nearly achieved - ahead of time. However, potential problems loom for the future, as all of the major risk factors for these leading causes of death are still too high and several are actually on the rise. If this trend continues, death rates could begin to rise again in years ahead.

In 1999, the American Heart Association set a strategic goal of reducing the death rates from coronary heart disease and stroke, and reducing the risk factors for these diseases by 25 percent by 2010. The new CDC data notes early success in meeting the coronary heart disease death rate goal, and shows that success is near for the 25 percent reduction in stroke. However, American Heart Association president Dan Jones, M.D., said the victory could be short-lived if the risk factors that lead to heart disease and stroke are not also reduced.

"This progress in the reduction of death rates is a landmark achievement, and has come about as a result of tremendous efforts from many partners in research, healthcare, government, business and communities," Jones said. "As encouraging as it is, heart disease and stroke remain the No. 1 and No. 3 causes of death in the United States. We still have remaining goals that we haven't yet met - reductions in the risk factors that lead to heart disease and stroke, as well as eliminating the striking disparities in care for women and minority populations. We must continue to address those concerns at the same time we continue to support the advances that we know are saving lives today."

The reduction in the death rates for coronary heart disease and stroke equates to approximately 160,000 lives saved in 2005 (the most recent year for which data is available) compared to the 1999 baseline data. If the current mortality trends hold (which will not be the case if the current trends in risk factors are not improved and current quality of care improvements do not continue), the American Heart Association analysts projects that there may be a 36 percent decline in the age-adjusted coronary heart disease death rate and a 34 percent decline in the age-adjusted stroke death rate when the 2008 data are released in a few years (in comparison with the 1999 data). The population size in 2008 will also be larger, so it is projected that the estimated lives saved in 2008 will be approximately 240,000.

Multiple factors appear to have led to the reduction in deaths. Ongoing scientific research has led to improvements in medications and in technology. The development of evidence-based practice guidelines has helped healthcare providers know what is effective both for the treatment and prevention of heart attacks and strokes. Some of the advances are complex and others are quite simple, though important.

"We know that getting patients to the hospital quickly for the appropriate treatment is crucial to saving lives. We know that timely angioplasty to open blocked coronary arteries, or thrombolysis when primary angioplasty is not available or appropriate, is making a difference. The development of more hospitals into primary stroke centers and providing more rapid and better care for stroke victims have all made positive impacts," Jones said. "Improving the quality of care through the dissemination of evidence-based clinical guidelines can help patients benefit from the research that we and others have supported, helping them live longer and reducing their risk of a second heart attack or stroke. The American Heart Association's Get With The Guidelines hospital-based quality improvement program initiative, which now includes more than a million patient records, is just one way we continue to translate scientific knowledge into day-to-day practice."

Among those practice measures making a difference is better control of blood pressure and cholesterol levels, both with lifestyle change and with medications. In addition, a variety of strategies to reduce smoking in this country have made a difference, including tobacco excise taxes, clean indoor air legislation and smoking cessation efforts. But not everyone is receiving the proven medicines and treatments that save lives.

Coronary heart disease age-adjusted death rates for women have dropped 26.9 percent since 1999. But, age-adjusted stroke death rates among women are down by only 23.7 percent, lower than the overall age-adjusted stroke death rate reduction and the age-adjusted stoke death rate reduction for men, which is 25.8 percent. The age-adjusted death rate for blacks is down 23.8 percent for coronary heart disease (compared to 25.6 percent for whites) and 20.3 percent for stroke (compared to 25 percent for whites.) These disparities in the outcomes for women and minority populations are echoed in the statistics for those living in certain parts of the country, such as the Stroke Belt in the South, and for those with lower income levels.

"These disparities are unacceptable," Jones said. "We are actively seeking ways to better address these issues so that we can ensure that every person has the appropriate care they need to live a healthier, longer life."

He said this will require reaching the American Heart Association goals for reducing the major modifiable risk factors for heart disease and stroke. Those include hypertension, high blood cholesterol, obesity, diabetes, physical inactivity and tobacco use. Because of progress in research, each of these risk factors can be controlled to goal levels for nearly everyone with either lifestyle changes alone or lifestyle combined with medications.

However, the data show that while there is progress on some of these risk factors, others are not being reduced nearly enough. The number of people with uncontrolled hypertension has fallen by 16 percent since the American Heart Association set its 25 percent 2010 strategic goals. The number of people with elevated blood cholesterol is down 19.2 percent and tobacco use is down 15.4 percent. Perhaps most alarming, the rate of physical inactivity has only declined by 2.5 percent and the prevalence rates for obesity and type II diabetes are actually increasing, and are appearing at earlier ages than ever before.

"We're working on this, but much more needs to be done," Jones pointed out. "If we don't make a concerted effort to reduce these risks, we will lose the momentum we celebrate today. We will see our children developing heart disease earlier, experiencing early deaths or needing major medical care sooner. The financial and, more importantly, the emotional toll is too great."

"We are pleased with the progress this new data shows, but we know we can do much more," Jones said. "We need to continue to push for more research and new medical advances, along with improved adherence to our practice guidelines. Most importantly, we must make it a priority to institute lifestyle and behavior changes, and the patient-healthcare provider partnership that can control risk factors and reduce the risk of developing cardiovascular disease in the first place."

American Heart Association