AHA stats show decrease in death rates, rise in comorbidities

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Cardiovascular disease (CVD) death rates are declining, but CVD is still the No. 1 cause of death in the United States, and risk factor control remains a challenge for many, according to the American Heart Association (AHA) release of the “Heart Disease and Stroke Statistics—2008 Update,” published online on Dec. 17 at Circulation.

CVD include heart disease, stroke, high blood pressure, heart failure and several other conditions including arrhythmias, atrial fibrillation, cardiomyopathy and peripheral arterial disease.

CVD has been the leading cause of death in the United States every year since 1900, except during the 1918 flu epidemic. In 2004, the most recent year for which final statistics were available for this report, the age-adjusted CVD death rate per 100,000 persons was 288, compared to 307.7 in 2003. CVD (the overall leading cause of death) was listed as the underlying cause of death in 869,724 deaths, compared to 911,163 deaths in 2003.

Cancer was the second-leading cause of death, responsible for 553,888 lives lost. Stroke, when considered separately from other CVDs, was the nation's third-leading killer (150,074 deaths). Coronary heart disease (CHD), even when considered separately from other CVDs, was still by far the nation's single leading cause of death (451,326).

Donald Lloyd-Jones, MD, chair of AHA’s statistics committee, which, along with the association's stroke statistics subcomittee, is responsible for the update, said the “statistics make it clear that CVD remains, by far, our greatest public health challenge.”

While CVD deaths appear to be decreasing, the prevalence of related risk factors is holding steady or increasing. Obesity, in both adults and children, has been rising for several decades. Sixty-six percent of adults are overweight while 31.4 percent are obese. Seventeen percent of children and adolescents ages 12 to 19 are overweight, along with 17.5 percent of children aged six to 11, and 14 percent of children aged two to five.

Smoking, which raises the risk of CHD death two to three times, remains highly prevalent. More than 46 million U.S. adults are daily smokers, and about 4,000 people aged 12 to 17 begin smoking every day.

The 2008 update also includes enhanced content for diabetes, a major cardiovascular risk factor, and end-stage renal disease and chronic kidney disease, which are associated with diabetes and high blood pressure.

The AHA said it does not generate the data, but synthesizes it from various sources and provides it online without charge for government policymakers, physicians, researchers, educators and the public.