Heart Disease and Stroke

Goal

Improve cardiovascular health and quality of life through prevention, detection, and treatment of risk factors for heart attack and stroke; early identification and treatment of heart attacks and strokes; and prevention of repeat cardiovascular events.*

Overview

Heart disease is the leading cause of death in the United States.1 Stroke is the third leading cause of death in the United States. Together, heart disease and stroke are among the most widespread and costly health problems facing the Nation today, accounting for more than $500 billion in health care expenditures and related expenses in 2010 alone.2 Fortunately, they are also among the most preventable.

The leading modifiable (controllable) risk factors for heart disease and stroke are:

• High blood pressure
• High cholesterol
• Cigarette smoking
• Diabetes
• Poor diet and physical inactivity
• Overweight and obesity

Over time, these risk factors cause changes in the heart and blood vessels that can lead to heart attacks, heart failure, and strokes. It is critical to address risk factors early in life to prevent the potentially devastating complications of chronic cardiovascular disease.

Controlling risk factors for heart disease and stroke remains a challenge. High blood pressure and cholesterol are still major contributors to the national epidemic of cardiovascular disease. High blood pressure affects approximately 1 in 3 adults in the United States,3 and more than half of Americans with high blood pressure do not have it under control.3 High sodium intake is a known risk factor for high blood pressure and heart disease,4 yet about 90 percent of American adults exceed their recommendation for sodium intake.5

The risk of Americans developing and dying from cardiovascular disease would be substantially reduced if major improvements were made across the U.S. population in diet and physical activity, control of high blood pressure and cholesterol, smoking cessation, and appropriate aspirin use.6

Why Are Heart Disease and Stroke Important?

Currently more than 1 in 3 adults (81.1 million) live with 1 or more types of cardiovascular disease.2 In addition to being the first and third leading causes of death, heart disease and stroke result in serious illness and disability, decreased quality of life, and hundreds of billions of dollars in economic loss every year.

The burden of cardiovascular disease is disproportionately distributed across the population. There are significant disparities in the following based on gender, age, race/ethnicity, geographic area, and socioeconomic status:7

• Prevalence of risk factors
• Access to treatment
• Appropriate and timely treatment
• Treatment outcomes
• Mortality

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Understanding Heart Disease and Stroke

Disease does not occur in isolation, and cardiovascular disease is no exception. Cardiovascular health is significantly influenced by the physical, social, and political environment, including:

• Maternal and child health
• Access to educational opportunities
• Availability of healthy foods, physical education, and extracurricular activities in schools
• Opportunities for physical activity, including access to safe and walkable communities
• Access to healthy foods
• Quality of working conditions and worksite health
• Availability of community support and resources
• Access to affordable, quality health care

Emerging Issues in Heart Disease and Stroke

No national system exists to collect data on how often cardiovascular events occur or recur, or how often they result in death. Similarly, there is inadequate tracking of quality indicators across the continuum of care, from risk factor prevention through treatment of acute events to posthospitalization and rehabilitation. New measures and tools are needed to monitor improvement in cardiovascular health over the next decade.

Other emerging issues in cardiovascular health include:

• Defining and measuring overall cardiovascular health.
• Assessing and communicating lifetime risk for cardiovascular disease.
• Addressing depression as a risk factor for and associated condition of heart disease and stroke.
• Examining cognitive impairment due to vascular disease.
• Dealing with substantial gaps in the cardiovascular surveillance system.

References

1Xu J, Kochanek KD, Murphy SL, et al. Deaths: Final data for 2007. Natl Vital Stat Rep. 2010;58(19).

2Lloyd-Jones D, Adams RJ, Brown TM, et al. Heart disease and stroke statistics—2010 update: A report from the American Heart Association statistics committee and stroke statistics subcommittee. Circulation. 2010;121:e1-e170.

3Ostchega Y, Yoon SS, Hughes J, et al. Hypertension awareness, treatment, and control—continued disparities in adults: United States, 2005–2006. [NCHS Data Brief] Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Health and Nutrition Examination Surveys; 2008. Available from: http://www.cdc.gov/nchs/data/databriefs/db03.pdf

4Institute of Medicine. Dietary reference intakes for water, potassium, sodium, chloride, and sulfate, 1st ed. Washington, DC: National Academies Press; 2004.

5Centers for Disease Control and Prevention. Sodium intake among adults—United States, 2005–2006. MMWR. 2010;59:746-9.

6Agency for Healthcare Research and Quality (AHRQ), U.S. Preventive Services Task Force. Aspirin for the prevention of cardiovascular disease [Internet]. AHRQ; 2009. Available from: http://www.ahrq.gov/clinic/USpstf/uspsasmi.htm

7Agency for Healthcare Research and Quality (AHRQ). 2008 National Healthcare Quality & Disparities Reports [Internet]. AHRQ; 2009. Available from: http://www.ahrq.gov/qual/qrdr08.htm

Footnote

*Cardiovascular events are defined for this purpose as heart attacks, hospitalizations for heart failure, and strokes.

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